HomeMy WebLinkAbout200 Park Ave 12-820��iV [^J, i
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Application No: 1 � ?C'�b
CITY OF SANFORD
FEB Z�1Z BUILDING & FIRE PREVENTION
PERMIT APPLICATION
L - -_ - - --
Documented Construction Value: $ _ 1/
Job Address:. ( >(? Pr'-z- (— 6 3 1� -4- (c) C�
Parcel ID:
Description of Work: k V -i
Historic District: Yes ❑ No ❑
Zoning:
Plan Review Contact Person: 00' ��t >i {� I t�J Title:
Phone: � 0_� Y. I Is R(211( � Fax:
E -mail:
Property Owner Information 146-7 3N .
Name �'e E U Ljo--Aoes Phone: `4 o,3 '� Os' t
Street: PL''L'�' �C;�l U �j Resident of property?
City, State Zip: 6 \fke_
Contractor Information
Name
Street: `l �� ' ipry"Irce Lei k(' bf
City, State Zip: !;�(FN �U.( (r A--( 3 J J3 y
Phone: �i O —)
Fax:
State License No.:
Architect/Engineer Information
Name: I, Phone:
Street: Fax:
City, St, Zip: E -mail:
Bonding Company:
Address:
Building Permit ❑
Square Footage:
No. of Dwelling Units:
Electrical ❑
New Service — No. of AMPS:
Mortgage Lender:
Address:
PERMIT INFORMATION
Construction Type: No. of Stories:
Flood Zone:
Plumbing ❑
Mechanical ❑ (Duct layout required for new systems)
- L,Y1 h-e (—/I,) l
New Construction - No. of Fixtures:
Fire Sprinkler /Alarm ❑ No. of heads:
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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 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 such as water management districts, state agencies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the property of the requirements of Florida
Lien Law, FS 713.
The City of Sanford requires payment of a plan review fee. A copy of the executed contract is required in order
to calculate a plan review charge. If the executed contract is not submitted, we reserve the right to calculate the
plan review fee based on past permit activity levels. Should calculated charges exceed the documented
construction value when the executed contract is submitted, credit will be applied to your permit fees when the
permit is released.
ire of Owner /Age Date Signature of Contractor /Agent Date
0 (�; LAW r
wner/ gent's Name Print Con'tIpctor /Agent's Name
0-13
>=e 9PI<IotaglSta BFI rid g.4 Signature of Notary-State of Florida Date
JUSTIN J. JAKEL
Notary Public - State of Florida
My Comm. Expires Dec 1, 2013
•.',;F� F�o?r Commission # DD 943433
Owne Ptrg–ona-IYK56im to Me or
Produced ID v�f"— Type of ID 1=t, Ot -
Ls &v— '7�2 -7- 9-'7 — as J� — v
APPROVALS: ZONING: UTILITIES:
ENGINEERING:
COMMENTS:
Rev 11.08
i3r901114
Contractor /Agent is own to Me or
Produced ID
-•. �� ". eonded�h� O
• r ° °�J�Ol'Fainansotat�.���, .
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, 'Winter Springs
Date: %
I hereby name and appoint:
an agent of:
to be my lawful attorney -in -fact to act for me to apply for, receipt for, sign for and do all things
necessary to this appointment for (check only one option):
����78. 9e�+a�ffi_ke"i333:i:�•;r59�..lL �'syb': '1 !.'�!__ ' ! ..,..4 •4±9l8::BB_"S3�E'�3
❑ The
F(specific
\ permit and ap liclation for work located at:
(Street Address)
Expiration Date for This Limited Power of Attorney:
e. Ro� C" Z 4
State License Number:
STATE OF FLORIDA
COUNTY OF 5.eM r
The foregoing instrument was acknowledged before me this 2 day of
200A , by p y 6 Z o 1,a iier c/!', who is ❑ personally known
to me or i7a-�ho has produced C/ A, /%ry��'s �;�,�h�p as
identification and who did (did not) take an oath. L 51�d - 7R17- a 17- ;? c/-F- ()
Signature
(Notary Seal) (ij'(�/G/
Print or typ ame
"..'Ay P& CHERYL MEIS
: °. Notary Public -State of Florida Notary Public -State of
3• « s • My Comm. Expires Aug 13, 2015 Commission No. t.'_Z5 ///ill?
Commission # EE 111419
Bonded Through National Notary Assn. My Commission Expires:
'•nnna
(Rev. 3/27/07)