HomeMy WebLinkAbout1403 Locust Ave (2)O^ CITY OF SANFORD PERMIT APPLICATION p
Permit # :� ( Date:
Job Address: [ IyU I—o o a-5 r ) -. 5 ^ .y r -;?
Description of Work: C4iC 14(f G A48-6cr , 3 / CO ° -el
Historic District: Zoning: Value of Work: 00
Peimit Type: Building Electrical �124 Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/Alteration —7'�< 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 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 form required for other than X)
Parcel #: (Attach Proof of Ownership & Legal Description)
Owners Name & Address: O� �� [-(N SQ
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U%C r Phone:
utractor Name & Address: 'eLe t "/► ►I C �//�� ' - Qom o 1 1 a2�� L 9 ?30"O Slate License Number: E l V
Phone dtFax: 1/07— 136.— 3 6 Contact Person: Phone: y07— lS3 q '7 U3;?
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer: Phone:
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 1
AIR CONDITIONERS, etc. w
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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 g
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construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING o
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. 6Nt c
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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 a
this cdunty, and there may he additional permits required from other governmental entities such as water management districts, state agencies, or federal agencies. c 9 x
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Acceptance of permit is verification that I will notify the owner of the property of the requirements of Flw, F 71
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Signature of Owner/Agent Date Signature ontractor/Agent Date �� � �►
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Print Owner/Agent's Name Printont ctor/Agent's Name
g/off
Signature of Notary -State of Florida Date Sig lure of Notary -State of Florida Date
Owner/Agent is _ Personally Known to Me or
Produced ID
APPLICATION APPROVED ny: Bldg:
(Initial & Datc)
Special Conditions:
Zoning:
Contractor/Agent is _y_ Personally Known to Me or
_ Produced ID
(Initial & Date)
Utilities:
FD:
(Initial & Date) (Initial & Date)
LIMITED POWER OF ATTORNEY
I hereby authorize
Date
of SSG Ulg< 51-4aA<:!� �L�L l ULAy
to sign his/her name on •my behalf in order to apply for a permit
for the work to be performed at:
Lot Subdivision
Address_L Ouv'T- /�y
�lEiy[ZY C -Z p2 /c Cvrn A -IN y '6R 00/0.736
Type or print name of comnanv and License # of Contractor
Signature of Licensed' Con ractor
STATE OF FLORIDA
ORANGE COUNTY
The foregoing instrument was acknowledged before me this � tt
by C [ -s �. _� day of _J [� n�C�
�ti name of person acknowledging).
ob0�
(Signature of Notary Public -State of Florida)
Ej7y7�::Nojary Oublic Shote of Florida
ne M Parker
Commssron DD451612
(Print, Type or Stamp ommissione lame)
Personally knownOR produced identification
Type of identification produced