162 Brush Creek Dr - BR08-000591 (REPLACE HEAT PUMP) DOCUMENTS (2)CITY OF SANFORD PERMIT APPLICATION
Application # : v 0 J / Submittal Date:
exam
Job Address: % b 2 et-u54 et lr Value of Work: $
Parccl ID: 3-19 — 3C7 ^ S I q noaa b a -n Zoning: Historic District:
n (- 0- t Qu,taP Square Footage: Description of Work: /\ C p lGtC? ' o i dt 171at
Permit Type: Building Electrical Mechanical YX Plumbing Fire Sprinkler/Alarm Pool Sign
Electrical: New Service --# of AMPS Addition/Alteration 11 Change of Service Temporary Pole
Mechanical: Residential Id' Non -Residential Replacement (A' 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 Commercial
Occupancy Type: Residential Commercial Industrial Occupancy Use Group(s):
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FENIA form required )
Property Owner: Ca-w r mice 3 tM A I Contractor:
Address: (D A Qr--I Creek P r Address: Ilk_ si #tl
5,Cr, 31:7-7 t r4 (L 3a713
Phone: E-mail: Phone:3xd $-5`State License Number:ir &COSUU, -
Bonding Company:
Address:
Architect/Engineer:
Address:
Plan Review Contact Person:
Mortgage Lender:
Address:
Phone:
Fax:
Phone: Fax: E-mail:
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: t certiN 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, A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
FIRST INSPECTION. 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 s h as water management districts, state agencies, or federal agencies.
Acceptance of permit is verification that I will notik, the owner of the roe of i ements of Florida Lien Law, FS 713.
Signature of SiinOwner/Agent Date ature/f/AgenttontractorDate
Print Owner/Agent's Name Print Contractor/Agent's Name
Signature of Notary -State of Florida Date Signatu N.tary-State of Florida Date
ANGELACARLSON
MY COMMISSION 0 DD 48M
b= EXPIRES: December 3, 2009
t,",Rr 1n• ded ThN PuDNc U
Owner/Agent is _ Personally Known to Me or Contra
ProducedlD _ ProducedtD
APPROVALS: ZONING:
Special Conditions:
Rev 07.07
U"I'IL: FD: ENG: BLDG:
4'S 3