HomeMy WebLinkAbout450 S Elliott Ave 03-1936 HVAC1-0-23 1 = 3E F'M FR.QM
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CITY OF SANFORD PERmrr APPILICATION
190 (e E7Cr ZOL GPermit : ) Date/
Job Address: 7 SiS + <1>Or/1
o0ye,
Description
of Work-- zt/ ywe In rJG'-, H'
s Co ricDistrict• Zuni oral f W k: ing. ue o Permit Type:
Building _—_ Electrical __. Mechanical2L Plumbing Fire Sprinkler/Alarm Pool Electrical. NewSelvico—#
ofAMP5 AdditioulAlteration Cli ngeofService,,,' TemporaryPole Mechanical. Residentiial , hlon-
Residential Replat meat ___ _ hEew (D= iaypu -& Energy Cak. Required) Plnmbinpl New Cornmerclal: #
of FixWM3 # of Water dr, Sewer Lines # of Gas Ulm- ' PlumbingNtw Residential: # of
Water Clown Plumbing Repair Residential or COmmercial — Deeupaney Type: Ri
sidendal --L Commercial _.. Industrial __ . Total Square Footage: Construction 'type: „_ # of
Stories: # of Divollin; Units; flood Zatae: (IFEMA, forth repaired for other than x) Parcel 9: Owners
Namc & Address:
Contractor Name & Address:
Phone & Fax: _3-
9G Bonding Company: Address:
Mortgago Lender:
Address:
ArchiteclfEngineer: Attach
Proof
Of
Ownor4hip & Legal 17aaoripti* Phone: PVP / -3 `
8— Statoucen,c NunrbCr; Contact
Person: 1 1701
1 r Phone: ,% ..=325d Phone: Address: Fax: —, Application
is
hereby made
to obtain a permit to da the work and installations.as indicated. i certify that no wank or installation has commenced vior 0 the issuance of a permit
and that all work Will be Performed to meet standards of all laws regulating construction in this junsdiction. I understand that a 9sparate permit must be secured
for ELECTRICAL WORK; PLUMBING. SIGNS- WELLS, POOLS, FURNACES, BOILERS, HEATERS. TANKS, and AIR CONDITIONERS, etc, OWNER'
SAFFIDAVIT 1 Certify
that all of the foregoing information is accurate and that all work will be done in compliance with all appliGaLlc Lacs Ccy {l tirtp, con:t uctian atd rgni
lt, WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OFCOMMENCFMF-NT MAY XBSULT (N YOUR VAY INIG TWICE FOR IMPROVEMENTS TO YOUR PROPERTY.
IF YOU INTEND TO OBTAIN FINAhC(NG, CONfit.7I T WITH YOUR LENDER (4, AN ATTORNEY BEFOkF. RECORDING YOUR NOTICE OF
COMMENCEhIENT. NOTICE: In addition;0 ihd rwittiremerim
of this permit, there may bo additional restrictions appl cabte to this promey that may be fband in the public records of this county, and there troy be
additional permits required from other governmental entities svcli a!: Watti'nanagemgni dislriecs, ;Mate agenCivs, or federal agencies. Acceptance Of Petnlil is verification that
I will notifythe owner of the property of the raqui f Florida Lien , FS 713. O SignautrevfOwnerfAaent Date Signatureni &ctOr/Agent
ate.
Print wncflA tCOt'& Name Y:i
ticjr' 'g Na 9ip •.. m Dare - t nd urc o Notary -
State of Fivridu Date a rnc3 s Pp ikh'stura
of Nuf.
srY-
StateofFloridaOwner/Agent is _ Personally Known to
Me or I'MduCed I I) APPLICATION APPROVED
F9'Y; Wdg; tnitiat &
Date) Special Conditions: n' rr
CD- W
0 Con
r a cur/
A ent
it ers aI!v K t7S t n ro Me or ( n a d f'niducczi IU Gk-z 4
g l a° N 0 o C7 O
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Zoning:_
Initial & Datc) (
initial
Sc Oaten (
Initial &
Datc) `.4 s"
Fla. St. Lic. #CA C039739
CM C009251 - #CS C041365
Ga. St. Lic. #CN007951
ER 0008153
I hereby name and
AIR CONDITIONING • BEAT o SHEET METAL o ELECTRICAL
P.O. Drawer 730008 • Ormond Beach, Florida 32173-0008
Daytona 253-7774 • West Volusia 738-3888 • Fax 255-9431 • www.dgmeyer.com
LIMIED POWER OF ATTORNEY
9 zoa3
Date
of D. G. MEYER, INC. to be my lawful attorney in fact to act for me
and apply to i > `wit for a MECHANICAUELECTRICAL
permit for work to be performed at a location described at:
Address of Job)
Owner of Property and Address)
and to sign my name and do all things necessary to this appointment.
k \)bne-5 C me 65 90ar
Type or Print name of Certified Contractor, License #
Signature of CeMfied Contractor
Acknowledged:
Sworn to and subscribed before me this
1 /
h
Day of A.D. 2l Vv3
N Public, State of Florida
t1 Ij,,, Jane S. Turner
c=of'"G: Commission # CC 997355
lj- Expires Fdb. 17, 2005
Bonded Thra
i ii` Atlantic Bonding Co., Ino.