HomeMy WebLinkAbout170 Clear Lake Cir (3)CITY OF SANFORD PERMIT APPLICATION
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Permit # :CAS 1 O Date: z os—
Job Address: % 70 C f e a. /' co. k' e-
Description of Work: re e-l-c 81" Lpq
Historic District: ping: Value of Work: S O 00
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool _
Electrical: New Service - # of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets Plumbing Repair - Residential or Commercial _
Occupancy Type: Residential ' Commercial Industrial
Construction Type:
Parcel #:
Owners Name & Address: I]
Contractor Name & Address:
Phone & Fax:
Bonding Company:
Address:
of Stories: # of Dwelling Units:
Total Square Footage:
Flood Zone: (FEMA form required for other than X)
Attach Proof of Ownership & Legal Description)
Phone: Iad 7^ 4 Z 2—% —V 5 d
State License Number:
Contact Person: Phone:
Mortgage Lender:
Address:
Architect/Engineer: Phone:
Address: 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
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 w 11 notify the owner of the property of the requirements of Florida Lien Law, FS 713.
1-12I _0i ,
Si re of Owner/Agent Date Signature of Contractor/Agent
b rLIJK cNCE A. DE GRAVE
MY COMMISSION # DO 164280
EXPIRES: November 12, 2006
Owner/Ag"&Vrss8'P1 0W 4 k "ftdde or 0 ProducedID •-I a - 3 4 f-
4iAPPLICATIONAPPROVEDBY: Bldg: Zoning: Ini (&
Date) Special
Conditions: Print
Contractor/Agent's Name Date
Signature
of Notary -State of Florida Date Contractor/
Agent is _ Personally Known to Me or Produced
ID Initial &
Date) Utilities:
Initial &
Date) (Initial & Date)
SANFORD HIDDEN LAKE VIU AS HOMEOWNERS ASSOCIATION, INC.
APPROVAL FORM _.... ••
Architectural Control Committee Approval for Improvements to Exterior of Hidden Lake Villas
and Carlton Homes. - -
Please Print):
Instructions: Please complete the following information and mail, or fax,
this form to the address below. Upon approv*l, a signed copy will be
forwarded to you. VIsual inspection by an Architectural Control. Committee
Member, Association Board Member or Managing Agent may be
necessary.
601.;1 N
Telephone NumberAo 7 _2= max. Number Date Z
Description of Improvements:
FOR FENCES AND ADDITIONS: Applicant must submit drawing on Plat of Survey ; jofpropertyshowingitis100frommarpropertylino ' fire
Please provide drawing:
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of App cant Mail to: Sanford Hidden Lake Villas BOA, Inc.
P. O. Box 1892
Sanford, Florida 32772-1892
Fax.. 410-1-Sft -014 9 (o Approved
by representative of ACC or Association
Board or Managing Agent t
0 S• Dat
Signature . C"
co 'j P"0!
IF -
DESCRIPTION
Lof 7 //es.r /,. «/e e.y 2 3 ee/ Zo/6, //,dse,, Lake VAtj /7Aa,
as recorded In Plat Book 2,5 , Page W J,1,5, to , Public Records of Sernlnole County, Florida
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