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Home My WebLink About121 Laurel Dr (3)y�► CITY OF SANFORD PERMIT APPLICATION Pperrmiitt # : ©5- �3 `k6 Date: 5-17-05 Job Address: [flu Uz- Description of Work: Historic District: Zoning: Value of Work: $ 5400. op Permit Type: Building Electrical _� Mechanical Plumbing Fire Sprinkler/Alarm Pool Electrical: New Service - # of AMPS Addition/Alteration— Z_ 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 Industrial Total Square Footage: Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X) Parcel #: Owners Name & Name & Address: Phone ' Fax: y, Bonding Company: Address: Mortgage Lender: Address: Architect/Engineer: C I -A (C '6 173v Contact Person: (Attach Proof of Ownership & Legal Description) Phone: License Number: 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 rcgxrlating 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. m Acceptance of permit is verification that I will notify the owner of the property of the requirements Flo r a Lien aw, F 713. o N N n O Signature of Owner/Agent Date Signature of Contractor/Agent el ate IL Print Owner/Agent's Name Print Contractor/Agents Name E H w o w ;a 0. 2 w Signature of Notary -State of Florida Date Signature of Notary -State U Florida Date • rw'to d Owner/Agent is _ Personally Known to Me or Contractor/Agent is Personally Known to Me or Produced ID Produced I APPLICATION APPROVED BY: Bldg: Zoning: Utilities: _ FD: (Initial & Date) (Initial & Date) (Initial & Date) (Initial & Date) Special Conditions: h`. � J T LIMITED POWER OF ATTORNEY I hereby authorize ��640& GtL5e eer of G Date to sign his/her name on my behalf in order to apply for a S yV HiQ - permit for the work to be performed at: o� PUS ' Lot Subdivision Address �6lvrzY �LGC / �21G c0m P'+Av y to o010 -13g Type or print name of companv and License # of Contractor Signature of Licensed Contractor STATE OF FLORIDA ORANGE COUNTY 77te fore}going instrument was acknowledged before ►ne this 7 day of a�� -y C r name of person acknowl 5 I ,. , (Signature of Notary Public- tate of Florida) �lh6 Diane M Parker My Commission DD04s050 kora Expires August 10, 2005 (Print, Type or Stamp Commissioned Name) Personally known OR produced identification Type of identificati n produced CITY OF SANFORD PERMIT APPLICATION Permit # : Date: Job Address: Description of Work: fLcu- C� Historic District: we 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 L,-'-Non-Residential Replacement �ew (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 Industrial Total Square Footage: Construction Type: # of Stories: # of Dwelling Units: �_ Flood Zone: (FEMA form required for other than X) Parcel #: Owners Name & Address: Contractor Name & Phone & Fax: Bonding Company: Address: Mortgage Lender: _ Address: Architect/Engineer: Address: (Attach Proof of Ownership & Legal Description) Phone: �11 - St to icense N ber: Contact Person: Phone: !%47J -S90~ Phone: Fax: Application is hereby made to obtain a pemvt 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 Florida Lien Law, FS 713. 7 Signature of Owner/Agent Date Signature of Contractor/Agent Date Print Owner/Agent's Name Pri ontractor/Agent's Name / Signature of Notary -State of Florida Date Owner/Agent is _ Personally Known to Me or Produced ID APPLICATION APPROVED BY: Bldg. (Initial & Date) Special Conditions: Zoning: (Initial & Date) 'V1 < CQ- f,1"4',:SION # DD 188491 LiiPIHUG : February 25, 2007 or Produced ID Utilities: FD: (Initial & Date) (Initial & Date) p �,. / � Ds��t� ,4 • rs"� ' p �,. / � Ds��t�