HomeMy WebLinkAbout143 Country Club DrCITY OF SANFORD PERMIT APPLICATION
Permit # : 0,Y - F30
Job Address:
Description of Work:
Historic District: Zoning:
Date:
Cu
Value of Work: S OTO 7E o
Permit Type: Building Electrical Mechanical Plumbing Z Fire Sprinkler/Alarm Pool
Electrical: New Service - # of AMPS
Mechanical: Residential Non -Residential
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets _
Occupancy Type: Residential Commercial
Construction Type: # of Stories:
Parcel #:
Owners Name & Address:
Contractor Name & Address:
Addition/Alteration Change of Service Temporary Pole
Replacement New (Duct Layout & Energy Calc. Required)
of Water & Sewer Lines # of Gas Lines
Plumbing Repair esidential r Commercial
Industrial Total Square Footage:
of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Attach Proof of Ownership & Legal Description)
Phone:
I State License Number:
Phone & Fax: Y07-9604 Contact Person: ; V Bonding
Company: Address:
Mortgage
Leader: _ Address:
Architect/
Eagineer: Address:
Phone:
Fax:
Application
is hereby made to obtain a permit to do the work and installations as indicated. I 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. I understand that a separate pemdt
must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, and AIR
CONDITIONERS, etc. OWNER'
S AFFIDAV ff: 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, then; 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 will notify the owner of the property of the requirements o 'da Lien w 713. Signature
of Owner/Agent Date Signature o on Agent Date 11
Print
Owner/Agent's Name Prinf Contractor/ gent's Name Signature
of Notary -State of Florida Date i atu sp otary-State of FIon a Date DEBBIE
BLANTON MY
COMMISSION # DD 18W1 EXPIRES:
February 25.2007 Owner/
Agent is _ Personally Known to Me or Cc itrainod-Agentis r PAW or Produced
ID ed• d APPLICATION
APPROVED BY: Bldg: Initial &
Date) Special
Conditions: Zoning:
initial &
Date) Utilities:
FD: Initial &
Date) (Initial & Date)