HomeMy WebLinkAbout409 W 14 St 04-701 Electricalr
CITY OF SANFORD PERMIT APPLICATION
Permit #: `I Yy
Date: I a I I I O3 Jo6aA
dress: 1401 w . % 1 5 T- SA,,, Word A-L . 3a-7 7 / Description
of Work: 712+ M 71cc4t-iC Historic.
District: Zoning: Value of Work: $ /0007, o
Permit
Type: Building Electrical X 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 #: (
Attach Proof of Ownership & Legal Description) Owners
Name & Address: JotJ %//A,,-A,,,1 , A/JGArc-txJ -F Phone:
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. 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. 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 FloridaLienLaw, FS 713. Signature of
Owner/Agent Date Signature of Contractor/Agent Date t o )
OCA2 - 13 r c Print Owner/
Agent's Name Pr*tractor/Agenj s islaeb Signature of
Notary -State of Florida Date - bAWE GRAVE Date MY COMMISSION
1 DD 16426- EXPIRES: November
12, 2006 9rFOF FAO'. Bonded Thru Budget Notary Services Owner/Agent
is _ Personally Known to Me or Co ctor/Agent is y to M ,. f Produced ID
Pno ory roduced
ID V (y Personally APPLICATION APPROVED
BY:
BI Zoning: In ate) Special
Conditions: Utilities:
FD: Initial &
Date) (Initial &
Date) (Initial & Date)
POWER OF ATTORNEY
Date:
T
I hereby name and appoint
of 'tl Cis to be my lawful attorney
in fact to act for me and apply to the C. L t SIamt to(
Building Department for permit
for work to be performed at a location described as:
Section Township Range Lot Block
Subdivision V09 U..) , ly 4-1,
ST SAI,Qoid FL..3a-71
Address of Job)
Owner of Property and Address)
and to sign my name and do all things necessary to.this appointment.
Type or Print Name of Certified Contractor and Contractor's License Number
Signature of Certified Contractor
The foregoing instrument was acknowledged before me this 3 l day A l5
byCAS who
is personally knownlwho produced as
identification and who did not take oath. State
of Florida gam'"` Joseph P Lynch My
commission 00081018 Expires
August 19.2005 County
of SvtA6L`i_ Seal
6£
ary Public, Orange Cgafity, Florida CAWMriPmfiles\
kpace\PersonnIQIa= Coordinatioa%Woer For=\PowerofAttomey doc Page
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