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HomeMy WebLinkAbout402 W 19 St (3)CITY OF SANFORD PERMIT APPLICATION rPer..mit�l# : y 73 4Job Address: % ©rZ 0 Date: Description of Work: A, -P1% 5 7 S Historic District: Zoning: Value- W rk: $ 900cJ; Cjd Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool Electrical: New Service — # of AMPS 20 0 Addition/ ltemtion ✓ 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: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X) Parcel # Owners Name & Address: (Attach Proof of Ownership & Legal Description) Phone: Contractor -Name &Address: o q 3-2 %d p2 / State -License Number: �C /� O 6 --Phone & Fax: �� / ` b O ' l�J �� Contact Person: Phone Bonding Company: Address: Mortgage Lender: Address: Architect/Engineer: Address: Phone: 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 pertonned 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. OWNERS 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, 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. %� Signatur f-Contractor/Agent Date Signature of Owner/Agent Date c-) c Print Owner/Agent's Name P 'nY nuact rh gen "Name Signature ofNojary-!$laUF�rlAtd9EGRAVE Date Signature of Notary -State of Florida Date MY COMMISSION # DD 164280 "^ �XPIAES:November 12,2006 m` 3nvdndThr9Bud atNof Service Owner/Agent is Personally Known to Me or Produced ID on Tactor/Agent is Pei10mown �o e or 1 Produced ID �� 'A"� - 0 APPLICATION APPROVED BY: Bldg: (Initial & Date) Special Conditions: Zoning: Utilities: FD: (initial & Date) (Initial & Date) (Initial & Date) LIMITED POWER OF ATTORNEY I hereby name and appoint of If,/ Date '? --c S— to be my lawful attorney in fact to act for me and apply to C i / j it " 5'l9�•% v /(� for an for work to be performed at a residence at a location described as: Section Township Range Lot Block Subdivision Street Address City or County Zip Code Owner of Property Address Telephone And to sign my name and do all things necessary to this appointment. Ronald R. Howe Printed name of Active Certificate Holder R Electric ignature of license holder EC -13002933 State Registration or certificate Number The foregoing instrument was acknowledged before me this I I day of At�ust, 2005 by Ron Howe who is 1personally known to ne who produced as identification and who did not take oath. Notary Public, State of Florida ap�arAnn Martin tj My Commission DD312061 y 120, 2008 Aja F Expires App