HomeMy WebLinkAbout1511 W Airport BlvdCITY OF SANFORD PERMIT APPLICATION
Permit # : 0-7 — ` q - Date:
Job Address: _�+)i _��S"� P� i rP*)` v �r, t� �c�y (-ClT-- L
Description of Work: �� �4 I / o,u �.x f�r� v r -�' /OGUC� i, -9,k)4- -For F /eL.C7 80/c,
t-jHistoric District: Zoning: Value of Work: $ 4/00 .00
Permit Type: Building ElectricalMechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service - # of AMPS-y_7mPS - 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 -�SIndustrial 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: Rr:O 00mr
1
CO—_<�.f,'T�'.I'
—
L L-0—
&5 Ave, r54-&
&5
/D!/0 A%ia/n,01?TC,SQ,-,1,4LPhone:
(1-10-7) R-30
-J 14 l
Contractor Name & Address: 0 -)c,,- -,--,;c.
� iec4 f r C'
CL' Yll FCL) F �f9f L1Csi_
Eno -
1 2S E , t� • ,"� (1 --jE
. >r bsCAO 1 �
State License Number: E�o )
Phone &Fax: /)65a — 3�UO
K50 - 775 Contact Person:
� KV Phone:
7 L/ 819
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. 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. 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: 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 requirements of Florida Lien Law, FS 713.
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Signature of Owner/Agent Date Signature of Contractor/Agent a/ ate I�) IoiOO'1
F-It-nec�or-)
Print Owner/Agent's Name PrinLContractor/Agent's Name
Signature of'Notary-State of Florida Date Signature of Notary -State of FloridaDa /y %
foxr ebecca Dann
My Commission D0251760
Owner/Agent is _ Personally Known to Me or Contractor/Agent isersonally Known t811ih91Exp1res October 03, 2007
Produced ID Produced ID \4
APPLICATION APPROVED BY: Bldg:
(Initial & Date)
Special Conditions:
Zoning:
Utilities:
FD:
(Initial & Date) (Initial & Date) (Initial & Date)
POWER OF A'TT'ORNEY
-N
Date: boa rl
I hereby name and appoint ( . C. \ L
of (. lass � c-_ L. 1 cc -i -r " -, to be my lawful attorney
in fact to act for me and apply to the
Building Department fora permit
for work to be performed at a location described as:
Section Township Range Lot Block
Subdivision
tralmOwri"
(Address of Job)
1-ibyQ
(Owner of Property and Address)
and to sign my name and do all things necessary to this appointment.
me rsar-) J_ Kell
Type or Print Name of Certified Contrac r and Contractor's License Number
[ �A� C -D2 S C C a 15 6 0 0
Signature Pf Certified Con actor
l ,+-�� OrwC-h
The foregoinA instrument was acknowledged before me this —I day of 20 0�
by
who is personally known to me/who produced
as identification and who did not take oath.
State of Florida
osPaY•�6g<. ELAINE V. MILLER
s � ; • ••,
** MY COMMISSION # DD 519903
EXPIRES: April 11, 2010
County of ���rfOFFLOP\Qe Bonded ThruBudget Notary Services
a
�hSeal
Notary Public, Orange Coun -,Florida