HomeMy WebLinkAbout103 Skogen Ct,
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v.�:•.:•q.���;�L�.• � CITY OFSANFORD PERMIT•APPLICATION •�w'!',<.;d3ti�.•.�. ,�,
Permit #,:-°i� ^ IL�.J Date'/Azz) 3
Job Address: D 75
to
Description of Work:.
Historic District: Zoning: Value of Work: $
Permit Type: Building Electrical Mechanical PlumbinY Fire Sprinkler/Alarm PoQI .
Electrical: New Service — # of S AdditiogAltera�dnn t/_ Change of Service Tempol*y Pole
Mechanical: Residential e/ Non -Residential Replacement New (Duct Layout & Energy Cali. 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 #:
(Attach Proof of Ownership & Legal Description)
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
Phone:
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: I certify that all of the foregoing information is accurate and that all work will be done in cornpliance 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 WrM 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 1 will notify the owner of the property of the
Signature of Owner/Agent Date
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is_ Personally Known to Nle or
_ Produced ID
3/
APPLICATION APPROVED BY: Bldg: Zoning:
tlniiia & Date)
Spccia! Conditions:
tirw7nts of Florida Lien I.Aw, FS
Signature of Contractor/Agent Date
&eeze—%�:
t Contractor Agent's N er
� /
g1y�niF,�y /(�,
Signaturopf -3ry-FLVMI:NGtA�V Date
tP ; • r1.VM
* * MY COMMISSION # DD 164280
�• �
EXPIRES: November 12, 2006
C'onirac't$Ak N- ,-. ii t t wn to Me or
Produces
(Initial & Date)
(Initial & Date)
(Initial & Dait