HomeMy WebLinkAbout120 Linberry Ln (2)Permit # : V� J 3 o I
Job Address:_] (1
Description of Work:
CITY OF SANFORD PERMIT APPLICATION
Date:
Historic District: Zoning: Value of Work: $�9()0 -
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 V--"—Industrial
�Industrial Total Square Footage: N_65:: -
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #:-�F\V% _U16UU ` 5 (U i (Attach Proof Aof Ownership & Legal Description)
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Owners Name & Address: U 'AM Stirs w,_ L -.L C_ 140n f"\IS:� tti S�
Contractor Name & Address:T1_NtJ lid I, ►�r`�r c L 0 l -11 JACJL-': ;tti FNQC — knJ i�v7A'��
3, / Wy - State Liee\n�e Numher :(�F f_ ' J? 57�t V -7_(/
Phone & Fax: Aul - 6 LA 5 c2 �9 6. Contact Person: 1"Ni�.®'�M( imt, t�[S� Phone�.�C L-2-1 O / 7 �V
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 Florida Lien Law, FS 713.
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Signature of Owner/Agent Date Si ature of Contractor/ gent Date
Print Owner/Agent's Name Print Contractor/Agent's Name 7/� l�
Signature of Notary -State of Florida Date Signature of N ary-State of Florida Dat
Owner/Agent is _ Personally Known to Me or
Produced ID
APPLICATION APPROVED BY: BI Zoning:
(Initial & Date)
Special Conditions:
Contractor/Agent is personally Known to Me or
Produced ID
Utilities: FD:
(Initial & Date) (Initial & Date) (Initial & Date)
Margaret ARzeszut
My Commission DOI67812
moi' Expires January 28, 2007
1-1
PALMERELECTRIC COMPANY
NY
875 Jackson Avenue
Winter Park, Fl. 32789
I hereby name and appoint
of 875 Jackson Avenue, Winter Park, Florida to be my lawful attorneys in fact to act for
me and apply to the
for an ELECTRICAL permit and to sign my name and all things
necessary to this appointment.
7 eaL
3a 7 7
PALMER ELECTRIC COMPANY
Signature of Certified Contractor, EC 0001858
875 Jackson Avenue, Winter Park, Fl. 32789
State of Florida, County of ORANGE
Sworn to and subscribed to before me this day of , 20PJe
.
Q
Margaret. Rzeszut
Personally known: V
�u1 d Margaret A Rzeszut
My Commission D0167812
l )Vms January 26, 2007