HomeMy WebLinkAbout221 W 19 St (2)Permit
Job Address:
Description ofWork: /S
Historic District:
CITY OF SANFORD PERMIT APPLICATION
Date:
I 94-h ST c—
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Zoning: Value of Work: $ L2/ , DO
Permit Type: Building Electrical Mechanical Plumbing X 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 Cate. 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 farm required for other than X)
2 �y yy�
Parcel #:3 0 ''1) ! (� ' 0,
OG - l OO - h VQ (Attach Proof of Ownership & Legal Description)
Owners Name &'Address: -,'s J LcKens -,)c�) vi .) q( -h�/
� ld % Phone: 7/ O -7
Contractor Namel & Address: F"lo!'! u / C )' t'7e^ . O ! �O e f•'
• 0 - cState License Number: CPC Q S-7 CO
Phone & Fax: Vo -75 3 `a1 73 7 Is 2 1. 3 3 Cr&ntact Person: , 5an d �KO m Phone:
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Bonding Company:
Y
Address:
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Mortgage Lender:
Address:
ArchitecUEngineer. Phone:
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Address: Fax:
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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 constriction 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 PAYLNG
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITI f YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
NOTICE: In addit � n 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.
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Acceptance of permit is verification that I will notify the owner of the property of the requiremen of Florida Lien , w, FS 713.
-7/05
Signature of Ow'ncr,'Agent Date Siam e o a or/Agent
Date
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Print Ou-ner/Agent's Nacme
Pr t oor/ nt's _' me /
Signaturn�
e of Nota -State of Florida Date Signature of Notary -State of Florida Date
DEBBIE BLANTON
MY Ct�M
Owner/A,cn[ is _Personally Known to Me or Contractor/EID
ersonall} �i1N9�A,11?Prl88491
_ Prolduced ID ProduEXPI 3E5: February 25, 2007
AFiY FL Neta_4
y Di ,count Assoc Co.
APPLICATION APPROVED BY: Bldgd Zoning: Utilities: FD:
ni k 1 te) (Initial & Date) (Initial & Date) (Initial & Date)
Special Conditions;
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POWER OF ATTORNEY
Date:
1
do hereby authorize '� `} J(- C 1-4-r-om
to pull the gas plumbing permit for aD.I 5 -
address
Signature
Notary
Z2 ally known to mfr drivers license #
State of Florida, County of `\J0[ a on —74"`- day of
a LkvmL , 2005
WynnHart Reck
cnm
miiss an#DD292007
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xpires• Mar 26, 2008
�cBonded Thio
���'' I00 Adando Bonding Co., Inc.