HomeMy WebLinkAbout2553 Marshall Ave - BR05-003835 (ROOF) DOCUMENTS0)6 I�
CITY OF SANFORD PERMIT APPLICATION
Permit # : 644"T3r� Date: L2 S
Job Address: 2,56-3 iVl 19025 i l /f i L /�lJ �s
Description of Work: R6 1-
Historic District: A-) 6 Zoning: Value of Work:
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 V Commercial Industrial Total Square Footage:
Construction Type: Wcr� - # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #:(Attach Proof of Ownership & Legal Description)
Owners Name & Address: I -pp 0- T IZ I -' t et r A S `
/t -1t16 Phone:
Contractor Name & Address: 60 1 �12� ; / �f
P 0 6e)( �S $ S G i-6 kt� M �'t-r2 `� 1%L 327 5'- eijatate Li/cense Number:
Phone & Fax: 3Z 13 77- e 4$ 0 "'/C% 32 Z ,�' rr �l l Contact Person: J?, C K KG V it CS 1 K Phone: 3z 1 3 7 7- D V D
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 pennit, 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 federal agencies -
Acceptance of pennit is verification that 1 will notify the owner of the property of the requirement ol; Flom aer wh F 13. JJJ
•, f'
Signature of Owner/Agent Date Sign C.reofContractor/Agent Date
Print Owner/Agent's Name
Signature of Notary -State of Florida
Owner/Agent is Personally Known to Me or
Produced ID
Date Signatu
APPLICATION APPROVED BY: W Zoning:
(1 ull
l�tc)
Special Conditions:
s Name
Date
DEBBIE BiANTON
.f .t1' CC)la9P' ;BION # DD 188491
Contractor/Ag t is:�:v_ F' ers6iiallyKnoWanOr�>3SQ2007
Produce ID-2'00-3-RC7ARY FL,',otary Discount A-oc. Co.
(Initial & Date)
Utilities:
FD:
(Initial & Date) (Initial & Date)
AFFIDAVIT
REGARDING ROOF DRY -IN AND FLASHING INSPECTIONS
Company: �o �Z 111,17-1.11 4-11u
License #: (f 4 C e:0S 9 �2 416'
Project Information
Owner: Pl r2 /"//1 J c'Zi k i n1 S'
name
m lt?eS L ftyt
address
phone
Permit #:
Subdivision:
Lot #:
I,G" FfiJ ��ti1�9c r t< , affiant, hereby affirm that I am the duly licensed
contractor of record for the above referenced permit, that all the foregoing information is true
and accurate, and that the dry -in, flashings at the above referenced address or lot has been
installed in accordance th the applicable codes and standards.
Contractor: _._rZ C -f t.0 t, -,,i
,I
signature
7`r E'A11� ,S1 1�
printed name
STATE OF FLO
COUNTY OF '
This instrument was acknowledged before me this day of , 20 , by the
above referenced individual, , who acknowledged that he/she is a
duly licensed contractor with , and who acknowledged that
he/she was authorized to execute this document. He/she is either personally known to me or
produced
WITNESS my hand and seal this
as valid identification.
day oL 7EBE Ej BiANT sDD sast
SIR ; l eoruary 25, 2007
iscount Assoc. Co.
Notary Public