HomeMy WebLinkAbout115 E Jinkins Cirp
n CITY OF SANFORD PERMIT APPLICATION (`
Permit # :_ d H
Date: _2_0 ' 0(0 I
Job Address: Il S E J ►nk lt�S Er E04-) �rl (i2-77'3
Description of Work: (-e0 1c4 ei t 6L sy§Bz_ �(1 LD/oUd' 6ictwor
Ir—
Historic District: Zoning: Value of Work: $ 42 $ U • o0
Permit Type: Building Electrical Mechanical n Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — 4 of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential X Non -Residential Replacement New (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer L& # of Gas Lines
Plumbing/New Residential: # of Water Closets Plumbing Repair — Residential or Commercial
Occupancy Type: Residential X Commercial Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: 1 C. ' C_ V ' C
Owners Name 4 Address:
Contractor Name & Address:
Phone & Fax: �Q
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
(Attach Proof of Ownership & Legal Description)
Phone:
State License N1 u,,mber: _CR C O4Z(o(oQ
Contact Person: C'h'i -.Q WV) k: �e Phone: qm UQU661
Phone:
Fax: i
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. 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 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 require is of Florida Lien Law, FS 713.
Signature of Owner/Agent Date Signature of Contractor/Agent Date
Print Owner/Agent's Name Print Contractor/Agent's Name
A-7 Jwt� q /zo%lo
Signature of Notary -State of Florida Date 2rgnature of Notary -State of Florid'•••"' ""' d "'•••"••'••"'••""'�
FION ONNOR
""""• Comm# DD0424343
E:;:pires 5/1/2009
Owner/Agent isst
_ Personally Known to Me or Contractor/Agent is _ Per ySK a Wded thru (800)432-42540
Produced ID _Produced ID Flor da Notary Aasn.,�nc
APPLICATION APPROVED BY: Bldg:Zoning: Utilities: ' ) .,"ITV Q Al EnRD
(Initial & Date) (Initial & Date) (Initial & Date) r (Initial.& Date)
Special Conditions:
APR 2 1 2006
PLANNING AND DEVELOPMENT
POWER OF ATTORNEY
Date: �- `2(�) Oip
I hereby name and appoint �` \ � nQ� �jP,P� ooe- 1,���
of a Ma� -kwjj�- C l to be my lawful attorney
in fact to act for me and apply to the
Building Department for a I I SCh permit
for work to be performed at a location described as:
Section 12. Township_ Range 260 Lot 1Z Block
Subdivision 5u-�h P�recre.s-i- q fh BCH
X15 A tc&n `fi r E LMFord 32--7-7a
(Address of Job)
(Owner of Property and Address)
and to sign my name to do all things necessary to this appointment.
rW mna Ujk.LQ(4Z(a��l
Type of Print Name of C i ontractor and Contractor's License Number
Signature of Certified C
The foregoing instrument was acknowledged before me this ,2(-') day of � 20�
'H
who ' personally known to me produced
as identification and who did not take oath.
' .......... .. ..
....................
FIONA O'CONNOR .........
State of Florida 4,101, P1, Comma 000424343
Expires 5/1/2008
'�'"�Qe;' Bonded thru (800)432-025
COUrit Of,��" , Florida Notary Asan., Inc
y i ...........................................
otary Public, Orange County, Florida
r CITY OF SANrORD
Seal` ----P-
APA 2 1 2006
PLANNING AND DEVELOPMENT