HomeMy WebLinkAbout1907 S Mellonville Ave•
l ` CTTY OF SANFORD. PERMIT APPLICATION
Permit
Q —7/ , Date:
Job Address: t L I S kL-LL0� i L A U VF SA RJ)
Description of Work: k U N WOUt, � AS S MY CM' Ulig n ib4t r6p— � f
QHistoric District: Zoning: Value of Work: $ (J , a
Permit Type: Building Electrical
Mechanical Plumbing Li Its prinkler/Alarm Pool
Eledyical: New Service — # of AMPS
Addition/Alteration
Change of Service Temporary Pole
N!"anical: Residential Non -Residential
.
Replacement
New (Duct Layout &Energy Calc. Required)
�.
Plumbing/ New Commercial: # of Fixtures
# of Water & Sewer Lines # of Gas Lines
Plumbing/New R�idential: # of Water Closets
Plumbing Repair — Residential or Commercial
Occupancy Typer;Residential --)(— Commercial
Industrial
Total Square Footage:
Construction Type: # of Stories:
# of Dwelling Units:
Flood Zone: (FEMA form required for other than I►)
Parcel #: 51-15-31— SO- -D
CV -6130
(Attach Proof of Ownership & Legal Description)
Owners Name & Address:
Contractor Name & Address:
Phone & Fax: )JV
Bonding Company:
Address:
Mortgage Lender: -
Address:
Architect/Engineer:
Address:
Phone:
a State Liceense Number:
Contact Person:., SUZ lp%W19 Phone: 396
8
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 regulati_ne 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 he done in c6inpliance 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 apI
this county, and there may be additional permits required from other governmental entities such
Acceptance of permit is verification that I will notify the owner of the property of the
Signature of Owner/Agent Date
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is _ Personally Known to Me or
T Produced ID
APPLICATION APPROVED BY: Bldg: Zoning:
(lni ' 1 &Date)
Special Conditions:
bl'e to this property -that may be found iii`th'e-public records of
;nater management districts, state agencies, or fed I agencies.
of Florid Lien Law, FS 713. ^�
//,� i /
ontractor/Agent Date
Prin Contractq ge Name
Signature of
Jptaxy4State�
KH
ojataxy4Stateof Date
MY COMMISSION # DD 1642K'
% o EXPIRES November 19 2001.
Co tractor Agent.as ` Per ovally Knj to5.
e��� �f
Produced ID S� y
l
Utilitie . FD:
(Initial & Date) (Initial & Date) (Initial & Date)
POWER OF ATTORNEY
Date: 7/21/05
)LL`�J�' o hereby authorize SC {�aM
to pull the gas plumbing permit for ��b�l S, i [� (InVi Ile Aue-" �
address
Signature
o,►�Y?�e�; Martha Jackson Hartman
?' ° ' Commission #DD244694
a oQ Expires: Oct 10, 2007
Bonded Thru
�O�OF ��0`•
Atlantic Bonding Co:; Inc.
,IK&)Ck
tha Jackson Hartmazi, Notary
Personally k to me or drivers license #
St -a -o -o lorida, County of � n (,(�c a on _day of
�u 2005
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