HomeMy WebLinkAbout3100 Stone Brook Dr0
CITY OF SANFORD PERMIT APPLICATION
Permit # : Date. t10 to
Job Address: St4le..o Ulr.1 r fit. _ U.
Description of Work: O S F •
Historic District: Zoning: Value of Work: S
Permit Type: Building Electrical
Electrical: New Service — # of AMPS
Mechanical: Residential Non -Residential
Plumbing/ New Commercial: # of Fixtures _
Mechanical Plumbing Fire Sprinkler/Alarm Pool
Addition/Alteration Change of Service Temporary Pole
Replacement New (Duct Layout & Energy Calc. Required)
of Water & Sewer lanes # of Gas Lines
Plumbing/New Residential: # of Water Closets Plumbing Repair — Residential or,Commercial
Occupancy Type: Residential Commercial 1 _ Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel a: QZ-DO - 0 -S14 - O d00 •-Ood (Attach Proof of Ownership & Legal Description) Owners Name &Address:TDtowa lopKe A' bm L 10 C/o oetC:4+4-f PTj-6e*1r Zo!r
ie3b3 A). S? pHwN lint Sim too _
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Contractor Name & Address: R. L • M w0 *% CO s{-ut eOa ZZ•'3 S M tr,t I to Q•
R1. tlOrtt>r+tD O
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3 /Z State License Number: ''ds•7•
Phone & Fax: 0 )• -`Op r'"'"'` /105 Contact Person: J*AV0r4NAJ L441!4 y Phone: q&7 -,RY—l9 0
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. 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: 1 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 PAYMG
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.
Accep .e I permit is 3renfication that 1 will notify the ow er f the roperty of the requirements of Florida Lien Law, FS 713.
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r. C Signature of Agent , Date Signature of Contactor/Agent Date '= cHw5
Pri Owner/Agent'sent's Name = F, g Prin Contractor/Agent's Name m:
f l t101, I7 0 gSignatureofNotary -State of Florida Date tgnature of Notary -State of Florida Date
Owner/A .Owner/Agent is Personal) Known to Me or LC11116,11I.-I g Y Contractor/Agent is Personally Known to Me or,..XProduced ID DI_ — a 0 - l j- L -34R--O _ Produced ID wwow•uuw
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APPLICATION APPROVED BY: BldvAfl Ot h Zoning:
Initial & Date)
Special Conditions:
Initial & Date)
Utilities: FD:
Initial & Date) (Initial & Date)