HomeMy WebLinkAbout106 Lakeside CirCITY OF SANFORD PERMIT APPLICATION
Permit #:
Job Address: 106 zo%e,
Description of Work:
Historic District: Zoning:
Permit Type: Building Electrical
Electrical: New Service — # of AMPS
Mechanical: Residential Non -Residential
Plumbing/ New Commercial: # of Fixtures
Date: Da'
Value of Work: $ M
Mechanical Plumbin Fire Sprinkler/Alarm Pool
r
Addition/Alteration Change of Service Tempotary Pole
Replacement New (Duct Layout & Energy Cale. Required)
of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets - Plumbing Repair — Residential or Commercial •' .
Occupancy Type: Residential V Commercial Industrial Total Square Footage:
Construction Type: JP4" • # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: // o0 30
Owners Name & Address: T
Phone & Fax: 1Z274 / ?,T — 7-9-7
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
0r2 o (Attach Proof of Ownership & Legal Description)
Phone:
Fax:
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 certify that no work or installation has commenced prior to the
issuance of a permit and that all work will be performed to meet standards of all laws regulating construction in this jurisdiction. 1 understand that a separate
permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, and
AIR CONDITIONERS, etc.
OWNER'S AFFIDAVIT: I certify that all of the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of
this county, and there may be additional permits required from other governmental entities such as water management districts, state agencies, or federal agencies.
Acceptance of permit is verification that I %%ill notify the owner of the property of the requircyr is f Florida ieAw, FS 713.
OS
Signature of Owrter/Agent Date Sign ure o Contra for/Agent Date
Print Owner/Agent's Name Print Contractor/Agent's Name
dyliy
Signature of Notary -State of Florida Date Signatur J. JVStateofFlorida t
a JenkinsJlliu
Commission #DD225370
W. 4 ': i Expires: Jun 22, 2007
Owner/Agent is Personall. Known to Me or Contactor/Agent is _ J. I'ersonaliy O ' 'p,lv, a or Bonded'T1UU
Produced ID _ _ _Produced II) gra N1%, _tlantiCBOnt InSCO•.1
AI'l'I.I(: AIION API'RO% I:I) BY: Bldg:
lnrtial & Date)
i;>ii ice! Condition,:
oiling: Utilities: PI):
Initial & Dare) (htilial C Date) (liHtial & Dater
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