HomeMy WebLinkAbout101 N Elliott Ave 03-2799 New additionq
CITY OF SANFOR
Permit # • t — D 9
Job Address: 10 1 W, F_ L L j orr A V i i= f
Description of Work: tit i OLc . N
Historic District: Zoning: Value of Work: $ CX>o
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 Calc. 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 q: (Attach Proof of Ownership & Legal Description)
Owners Name & Address: AA P IT E I,1,1 0 1 0 RQ . S-A10-C-0-g-o •
Phone:
Contractor Name & Address: P "S-- fE 4—<--rp-kc R0
OV t , State License Number:
Phone & Fax: pia 't9 -391.5 Ao - QQ SContact Person: S' T (Zt:*<.- d Phone: Zi 87 _S-09 3 g
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. 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 I.N YOUR PAYIN
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 pe it' er tcatio at 1 w notify
owner ofthe property of the requireme of Florida Lien Law, FS 713.
tv-- `7-CDs
Si' at Owne /Agent Date Sig re ontra or/Agent Date
5v ) vcsTe--P- 80,vio u
Print Owner/Agent's Name Print C ntractor/Agent's Name, n
Signature of Notary -State of Florida
Owner/Agent is -
Produced ID
Personally Known to Me or
APPLICATION APPROVED BY: Bldg:
Initial & Date)
Special Conditions:
Date natur l f [sr$ a -Sicat
F o^
Contractor(Age.n( js
Produced ID
Zoning: Utilities: _
Initial & Date)
ofFlddd Ul tvt.,turnvounDao% MY COMMISSION 11 CC 92.180E
EXPIRES: March 23, I "A.
Bonded Thru Budget Notary cn..;res
FD:
Initial & Date) (Initial & Date)
POWER OF ATTORNEY
Date:
1 hereby name and appoint
of
to be my lawful attorney
in fact to act for me and apply to the C
Building Department fora
permit
for work to be performed at a location described as:
Section Township Range
Subdivision
dI j, e
Address of Job)
1.
Lot Block
Owner of Property and Address)
and to sign my name and do all things necessary to this appointment
Type or Print Name of Cerhfi an ntracto License Number
The foregoing instrument was acknowledged before me this day of 20
by
who is personally known. to mewl b produced -
as identification and who did not take oath.
State of Florida
County of
4rmoPublicCounty, Florida. A
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