HomeMy WebLinkAbout7100 Stone Brook DrV CQ — 101 CITY OF SANFORD PERMIT APPLICATION
Permit #: !q 1 as Date: gIo
Job Address: rta y,b
Description of Work: IU- QooV SM't" is - S 3 Sao S i 4
Historic District: Zoning: Value of Work: S7isZ •
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 Cale. 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 Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: 4n2-?.b - 30 —51 q-0800-• o0 (» (Attach Proof of Ownership&
OW-i* V4Kt A106als L.370 Q/. 0e1 v r
Description)
Owners Name & Address: PI o PM -oewr
AZ&e* N - art- ttwu hil sip NOD If-tw a Plane:_ . 7SM32
Contractor Name&Address:_Q.L. %la/wt++Rt Eoa*%a ftael.t0 LZ3S M Ct#•O IL
M A"ARD • FL 3-lbbl- State License Number: C.CC o0.9-1?L(V54
Phone & Fax:07 - 3" - l of 129 6014 19Contact Person: 00301,*ew 'Katy V Phone: %kcI ' e3ect - (9 037 Bonding
Company: Address:
Mortgage
Leader: Address:
Arcbitect/
Engineer: Phone: Address:
Fax: Application
is hereby made to obtain a permit to do the work and installations as indicated. 1 certify that no wont 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 PAYITG 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 ifrcation that 1 will notify the owner of the property of the requirements of Florida Lien Law, FS 713. 17/06
r. ture` /
Agent Date Signature of Contractor/Agent Date Prin Owner/
Agent's Name Print Contractor/Agent's_.Name ignature of
Notary -State of Flori ate Signature of Notary -State of FloriDate tJls QwAer/Agent
is Personally Known to Me or N ;.„ Y`y
ProducedlDTbl.- &XV0-
it1,3-&0-3'f-q-o APPLICATION APPROVED BY:
Bldg: kkNZoning: Initial & Date) Special
Conditions: Contractor/
Agent is -
4 Personally Known to Me or Produced ID Initial &
Date) Utilities:
FD: Initial &
Date) (Initial &
Date)