HomeMy WebLinkAbout3050 Carrier Aveq CITY OF SANFORD PERMIT APPLICATION
Permit # :
Q� .. / S Date J-.� �i a }4 2tR34
Job Address: 30 Yo 0&-,-r r -1
Description of Work: < Qn40G7G-/'—
Historic District: Zoning: Value of Work: S�
Permit Type: Building Electrical 1Z Mechanical Plumbin Fire Sprinkler/Alarm Pool _
Electrical: New Service — # of AMPS Addition/Alteration 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 X Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: 61�; . Z a 3
Owners Name & Address:
—0010 - C300 0
- ZZ3
Proof of Ownership & Legal Description)
Phone:
Contractor Name & Address: vlgra.SUJw 6e=Q- C-.•/4JC.
State License Number. ;rctoo0
Phone& r LiO�-8S3-'�S� iF-dx%��'833`)���"ContactPerson: �r'S �0-af Phone: tel'8 9'757�
Beading Company:
Address
Mortgage Lender:
Address:
Architect/Engineer:
Address: Zros
C -
Phone:
086-43 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: 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 1 will notify the owner of the property of the
Signature of Owner/Agent
Print Owner/Agent's Name
Signature of Notary -State of Florida
Owner/Agent is _ Personally Known to Me or
Produced ID
APPLICATION APPROVED BY: Bldg:
(Initial & Date)
Special Conditions:
Date
Date
Zoning:
�-Z P� —U 6
Dau
Print
4-290 C.
Signature of N S e of Florida Date
eaN Nery VondermiKwitz
+ My CommiaWon DD32500
Contractor/Agent is _X_ Personally Known to Me dfart►+r% Ey*a June O3. 2004
Produced ID
(Initial & Date)
Utilities:
FD:
(Initial & Date) (Initial & Date)
i-�
POWER OF ATTORNEY
Date: l tz—& '
I hereby name and appoint Q,n-s112)4P Aao A)
of 8T-.,-SCxj a -U sk� vf-c 1/•-jL to be my lawful attorney
in fact to act for me and apply to the (2i -xi., a
Building Department for a � V -Aa. chi•,' cQJ - 6�v�u,�� �Y' �� ,ma y �-Cpermit
for work to be performed at a location described as:
Section Township Range Lot Block
Subdivision
�� (Address of Job)
74e q& XZ_01.7f2,iora azs►ti - zz �- er" e. gqvc( izx t&�a Sc . %1 I o '?(0z
(Owner of Property and Address)
and to sign my name and do all things necessary to this appointment.
Type or Print Name effaS�tel�and Contractor's License Number
of Certified Contractor
The foregoing instrument was acknowledged before me this Z day of 20 4 G
by IVi /S ,G 4 &j
who is personally known to metwho produced
as identification and who did not take oath.
State of Florida
County of
Noy Vim«
* CWM*11M ODMUS
EVinM JW. as, Tone
Seal