HomeMy WebLinkAbout2550 Palmetto Ave (2)Permit # :_
Job Address:
_CITY OFSANFORD PERMf1APPLICATION
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Oa ��s Date:
Description of Work: 7206 'C • C! 2 Total SquareFootage
Historic District: Zoning: Value of Work: SCt r 0a
Permit Type: Building ✓ Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical- New Service - # of AMPS
Mechanical: Residential Non -Residential
Plumbing/ New Commercial: # of Fixtures _
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential Commercial
Construction Type: # of Stories.
Addition/Alteration Change of Service Temporary• Pole _
_ Replacement New (Duct Layout & Energy Calc. Required)
# of Water & Sewer Lines # of Gas Lines
Plumbing Repair - Residential or Commercial _
Industrial
# of Dwelling Units: _ Flood Zone: (FEMA form required)
Owners Name &Address: �y 6]&C&= k;:'e M y Le t�
7_ `tp PA-La,,4 r r o A d c -97l -,o t /1-o-" Phone:
Contractor Name & Address:
Phone & Fax:
Bonding Company:
Address:
Mortgage Lender:
State License Number:
Contact Person: Phone:
Address:
Architect/Engineer. Phone:
Address. 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' verification that 1 will notify the owner of the property of the requirements of Florida Lien Law, FS 713.
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Signature of Owner/Agent Date Signature of Contractor/Agent Date
o keA T C rk �:Xte e
Owner /Age ' Name Print Contractor/Agent's Name
Signature of Notary- tate of Florida Date Signature of Notary -State of Florida Date
Owner/Agent is _Personally Known o DEBBIant /Agent is _ Personally Known to Me or
Produced ID MY COMMISced ID
EXPIRES: r�WTARY APPROVALS: ZONING: F� ENG: BLDG: EV
Special Conditions:
Rev 03/2006
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Company:
AFFIDAVIT
REGARDING ROOF DRY -IN AND FLASHING INSPECTIONS
License #:
Project Information
Owner: jQ lv� • Permit #:
name
2-�i ri Oaf G tic C 7T o VCS
address
3oz-o��3
phone
Subdivision:
Lot #:
I, P—o4e- z-�
.77 , ►Vl "-� C_affiant, hereby affirm that I am the duly licensed
contractor of record for the above referenced permit, that all the foregoing information is true
and accurate, and that the dry -in, flashings at the above referenced address or lot has been
installed in accordance with the applicable codes and standards.
signature
Z�Zg p elZ%- , G14 C Q_ P
printed name
STATE OF FLORIDA
COUNTY OF
This instrument was acknowledged before me this day of 120 , by the
above referenced individual, , who acknowledged that he/she is a
duly licensed contractor with , and who acknowledged that
he/she was authorized to execute this document. He/she is either personally known to me or
produced as valid identification.
WITNESS my hand and seal this day of 41�, , 20
QDMy oEsBlEw..
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E4O�NOTARyXPIgENw ebr�e',� � 1
Q'0pwa Co.