HomeMy WebLinkAbout1715 W 15 St1
Permit #: O&, 3 19
Job Address:
Description of Work:
Historic District:
CITY OF SANFORD PERMIT APPLICATION
Date:
?--r- 0 �
( ?'–Z-27 7
Zoning: Value of Work: S ft;? iT & Cl r
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alamo Pool
Electrical: New Service – # of AMPS Addition/Alteration
Change of Service Temporary Pole
Mechani esidential Non -Residential placement
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 ✓ Comgtercial Industrial
Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units:
Flood Zone: (FEMA form required for other than X)
Parcel #: 3S '/ 47–.30
(Attach Proof of Ownership & Legal Description)
Owners Name &Address: e�� �� / e� /3-7A S f '
/�'A" /=vim/ �L . 3C54% Phone: �D – -r.? ?
Contractor Name & Address: ✓ f� �L�j S 5�02�// L S IP to A%' ir0 &Pe-r/w.V 44
/'1A-Aj 7") ✓ % C– State License Number:
Phone & V42-02-2 Contact Person: _54e .Z" Phone: rF a7-Zd�Z '�dd G
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
Phone:
Fax:
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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: 1 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 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 requ* ent of Florida Lien Law, FS 713.
Signature of Owner/Agent Date t' ontra or Agent Alp
Ohre' (n f-ee tf1
Print Owner/Agent's Name drint Contractor/Agent's Name
Signattye of Notary -State of Florida Date ture of Notary -State of Florida Date
f Owner/Agent is_ Personally Known to Me or Contractor/Agent is% -- Personally Known to Me or
Produced ID Produced ID
APPLICATION APPROVED BY: Bldg: Zoning: Utilities: FD:
(Initial & Date) (Initial & Date) (Initial & Date) (Initial & Date)
Special Conditions:
LIMITED POWER 'OF ATTORNEY
Date:
I hereby name and appointl)ewo S AA/LC.za4,4t of 0/Z/1qAJDJa to be
my lawful attorney in fact to act for me and apply to '% S/ ovoczvtce for
a ��'r�/.A��c/,� permit for work to be performe at a location described as:
-? s /`r - 30 so 06:,- - pass o
Section Township Range
Lot S Block_ Subdivision 1I/Y% Sid %r o?iCJdQ $'u
C�7z Yyicff U5 /o 7 Ica- I(P 7
(Address of Job)
(O)1ner of Property and Address)
and to sign my name and do all things necessary to this appointment.
eS-
Printed a of Contractor add Ificense Number)
(Signature of Ce Bed ontractor)
STATE OF ZAnr t
COUNTY OF
The foregoing instrument was acknowledged this S day of
2 Cni t , by
who personally
appeared before me and acknowledged that he/she signed the instrument
voluntarily for the purpose expressed in it.
�P rsonally Known
0 Produced Identification
T e of Identification
STrnatuOe of Notary PubtState—of Fl r a
Print or Type Name of Notary Pub 'c
(SEAL)
LAURA CWM
Now Publlc . MGM of Fb
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577.