HomeMy WebLinkAbout1006 French Aver4
Permit N:
Job Address: 106C der e -- G _
Description of Work:
Historic District: —1
Permit Type: Building Electrical
Electrical: New Service - # of AMPS
Mechanical: Residential Non -Residential
Plumbing/ New Commercial: # of Fixtures
RECEJv E0
CITY OF SANFORD PERMIT APPLICATIONL -7AU2 12006
Date: v G
�J t
Total Square Footage__4 Tfo ST
a yalue of Work: S �O6
Mechanical Plumbing Fire Sprinkler/Alarm Pool
- Addition/Alteration Change of Service Temporary Pole _
Replacement New (Duct Layout & Energy Calc. Required)
# of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets Plumbing Repair - Residential or Commercial _
Occupancy Type: Residential Commercial Industrial
Construction Type: W • F• # of Stories: 1 # of Dwelling Units: ( Flood Zone: (FEMA form required)
Owners Name & Address:
Contractor Name & Address:
U0. —
Phone:
State License Number: C--13 �- (G-) y /-1. 3
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Phone & Fax:40 r� T ^ 4 Z r4 p - D Z SQ Contact Person: /QM f -t y (%r e e el Phone: Sei ^^
Bonding Company:
Address: / G
Mortgage Lender:
2
Address:
Architect/Eagineer: 17APhone:
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. 1 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 govemmental entities such as water management districts, state agencies, or federal agencies.
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Acceptance of t is v 'ft Ln
hat I will notify the owner of the property of the requireme lorida Lien Law,
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Si ��u//re ofO Ser/Agent
�' Date re ofContracto ent / ate
!J[ - Zeal �GIOM �i S � .tet
er/Agen� t s Name Print Contractor/Agent's Name
44
3 0l0
ature of Notary -State of Florida I V Date Signature Ulo Date
Deborah A Bray "_(.0
UMON
My Commission 00340700 # DD I eWl
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p ExPi Jtdy ary 25, 2007
Owner/Agent is Z ersonally Known to Me or Contract aftW
Produced ID ��jj Pro(.D
APPROVALS: ZO G zoc,L: FD: ENG: BLDG:
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Special Conditions:
Rev 03/2006
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POWER OF ATTORNEY
I, / e -A e r ,S 4,4ACe r do hereby grant -7—h o ^-, ' S r i- eel 7
authorization to; arty r, sign for, pick up and drop off permits for the
el -t)( o j- sr ,7 . r municipality address
State Zip
Home Owner e' Ic H Siy
State of Florida
County of (e o"n f -'70 �-
Tforegoing instrument was acknowledged before me this day of
2006, by Pen Aar S4j'6Ca who is personally known to me.
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Public
TERET L LARSON `
. Y CI
OMM$SIOA # DD 229583
g EXPIRES: July 7, 2007
(Name of Notary, typed or printed)
Commission number
Commission expires
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