HomeMy WebLinkAbout2100 Stone Brook DrCITY OF SANFORD PERMIT APPLICATION
Permit #: O 1 5 Date: III rZo Co
Job Address: c 4.n_ (e oblc _ , _ 'ice , (,., t at 2
Description of Work: Qe.- Qcw>V SbWtngkts - 91 ' 0 s T% O, Ff .
Historic District: Zoning: Value of Work: S l gte .
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool _
Electrical: New Service — # of AMPS Addition/Aheration 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 Closes
0. Plumbing Repair — Residential or Commercial _
Occupancy Type: Residential Commercial Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel R: Vii - AID ' 00 ' 511`1 ' O 1500 — ('3w:l Q (Attach Proof of Ownership &•
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Leegal Description)
Owners Name & Address:?(1a 10V46t 01L LT0 %O zm Orr 4 e 2 `5 — p eo r z c
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LP343 P. r w NTO %-Cx Pines: - t 750$ $'
Contractor Name&Address L. k14WCj Ias VC*1o" Z 23 $
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9P!!!n0l F1 •3?C1StateLicenseNumber: CIA cLS'4A"
Phone & Fax: o l • 3M - -7p 21 ~"" 1109 Contact Person: ITNOr e%%i oteAL!l phone: C107- AW —/9 0 W
Bonding Company:
Address:
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 PAYD<G
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.
TICE: 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.
tan f ri r t I will notify the owner of the property of the requirements of Florida Lien Law, FS 713.
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Si ture of Owner/Agent
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Date
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Signature of Contractor/Agent ate
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Q Print Owner/Agent's Name Print ontractor/Agent' Name
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Oa il oiCiSignatureofNotary -State of Flori Date Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or Contractor/Agent is Personally Known to Me or
Produced IDOL- 12a%F0- /q3-(o0- 3y9-D _ Produced ID
APPLICATION APPROVED BY: Bldg: Zoning: Utilities:
Initial & Date) (Initial & Date)
Special Conditions:
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FD:
Initial & Date) (Initial & Date)