HomeMy WebLinkAbout1710 W 3 St/v 01 CITY OF SANFORD PERMIT APPLICATION
Permit #: (9 SS'. 6�d DQ/ 6?® % _ Date:
Job Address: _% /0 W 3 4 GI? -f
Description of Work: Se 4 V � t— t ���✓ u �`.�S
Historic District:
Zoning:
Value of Work: S
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS 2 6W 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 Oras 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 #: -24J-, (Attach Proof of Ownership & Legal Description)
Owners Name & Address: �i1 a h �l �C is �itaC
Phone: " 'Z2-2 — ,3 g6b
Contractor Name & Address: Pak -/,3 L f t r 74.� '` L
R. f% - .0,'{/ v2 b% State License Number:
Phone &Fax: Contact Person:t!C Phone: 3.2/-6ef-iS 2
47
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 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 p t iserification I will noti
the owner of the property of the requi em sof Florida Lien La F 713.
S —� 5
des
J :"� 5
Signature o /Agent
Date'
S ature of C ntractor/Agent
Date
;Pri caner/A isN me
�\�\-��//%% /
\J'A U,�
� Con to gent's Name
J' �� G��,i
Signature of -State oftlorida
Date
Signature of Notary -State of Florida
Date
Owner/Agent is _ Personally
Produced ID
APPLICATION APPROVED BY: Bldg:
Special Conditions:
Me or
(Initial & Date)
Zoning:
*tod
R�Tai�it to M or
ION # DD 18849 ruary 25, 2007Discount Ass' oc. Co.
Utilities:
(Initial & Date) (Initial & Date) (Initial & Date)
POWER OF ATAP93-RNE, y 7 ., j.,;,>:
Date:
r
I Hereby mine and appoint �A r
of
to be my lawful attorney
in fact to act for me and apply to the.
Building Department for a
n ca 1 _- Mi -1-
for work to be perforrned at a location described as:
Section 1,01vnsli, Range g Lot
Subctivision
f eL
(Address of fob)
(Owner of Property and Address)
G=/
and to sign my name and do all things necessary to this appointment_
Block
DAVIS ELECTRIC EC -0001403
Type or Print Name of Certified Coag and Contractor's License Number
Of Certified
The foregoing inst` i eat was acknowledged before me this 5 - day of 20 c�
by Harold Davis—.r. ;
who is personally known to me/
:gid'
as identification and who did not take oath.
State of Florida
County of DUVAL
No ��blic, Orange County, Florida
Joyce L. Ashton
C:1wINNT1PmGlesll�to�lt'cnoaallFtans C00rdm-60a%iasW Foems\Power of Adomty.doe
Pie 1 orr
171'Z8�`99
permit
tPRY PSB
JOYCE L ASHTON y
* * MY COMMISSION I DD 083197
EXPIRES: March 3, 2006
fFOFFIeO! Bonded?hru Budget Notary Senias
Seal