HomeMy WebLinkAbout2039 S Mellonville Ave (2)Permit #. 5 3T/
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Job Address:s
Description of Work:
Historic District:
Zoning:
CITY OF SANFORD PERMIT APPLICATION %
Date:
Value of Work: $ (-0-7 S • 00
Permit Type: BuildingElectrical Mechanical Plumbing Fire Spriril er/Alarm Pool
Electrical: New Service - # of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Cale. 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:
A
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than N)
Parcel #:31-1q - 31 - 5(3 (3 S o ` wO (Attach Proof of Ownership & Legal Desc�tription)
Owners Name & Address ( n V I 1 V1 1 An tIlAn C — - �Q � _ _ I11 n o I I rwi v/ ' I ti, t tP
Name & Address:
Phone & Fax:A&
Bonding Company:
Address:
Mortgage Lender-
Address-
Architect/Engineer
ender:Address:
Architect/Engineer
Address:
Phone: — IDUW 011
c1: a
State License Nuumber_ LF C. C� I (0
-,211 3 -7 5 �' Contact Person:,.S(,i.1 S«dS- er7 O(n Phone:3 SCIIYIE
v
Phone:
Fax:
Application is hereby made to obutin 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 iaork 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 LN 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 rcqucements of this permit, there maybe 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 regmre cnts/o�ffFlonda l.i aw,j7l]l
Signature of Owncr;:leent Date Sri aturc of Contractor/Agent Date
Print Owner/Agent's Name
Si«nature of Notary --State of Florida Date
Owner/A ,ent is _ Personally Known to Me or
Produced ID
APPLICATION APPROVED BY: Bl �: zoning: Utilities:
]ni 09, ate (initial &Date)
Special Conditions:
$a�
DEBBIE BLANTON
MY C01,1MISSION 0# DD 188491
FD:
(Initial & Date) (Initial & Date)
POWER OF ATTORNEY
Date:
I, Q d K i lv1fC , do hereby authorize1711 Soruf.s-Irofn
to pull the gas plumbing permit for aa'�9- S, AW )on l le
address
Signature
6 � ,-- P/-; �"' a
Wynn Haat Keck
_�. Co mmission#DD292007
Expires: Mar 26, 2008
Bonded Aflantic Bonding Co., Inc.
By Don d Kitner who�"s personally known tomdrivers license
State of Florida, County of
o Iu,<'-� c' on I day of Auat,�s_ 2005.