HomeMy WebLinkAbout162 Brushcreek Dr (4)Permit # :
Job Address: ' r
Description of Work: IhStC,I ( I?
Qj%TY OF SANFORD PERMIT APPLICATION
Date: A I•2_1 I O I
VOLJ_f'_�
Historic District: Zoning: t Value of Work: $ l u
Permit Type: Building Electrical Mechanical u'mbing Ir 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 Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: '5;3 —1 Q
Owners Name & Address:
Name & Address:
Phone & Fax:,
Bonding Company:
Address:
Mortgage Lender: _
Address:
Architect/Engineer:
Address:
LJ L.�� (Attach Proof of Ownership & Legal Description)
i
I Phone: n /�
. �� State License Number:
fCf
5'� ntact Person: cS %�Q Phone: ✓ 'COOY
rCk I
Phone:
Fax:
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 o the requirem t Florida Lien Law,.F 713.
Signature of Owner/Agent Date Signatur f Contractor Date
Print Owner/Agent's Name Pri Contractor/Agent's
Signature of Notary -State of Florida Date Signature of Notary -State a c{ Date. 0. l_
Owner/Agent is _ Personally Known to Me or Contractor/Agent is — Pi¢�nally Kip tg d�pr� • �
Produced ID Produced iD
RYP
APPLICATION APPROVED BY: Bldgbe~Zoning: Utilities: 11110,\\\t\\\
(initial k Date) (initial & Date) (Initial & Date) (initial & Date)
Special Conditions:
_----....
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PROPANEC.
546 South Shell Road
DeBary, Florida 32773
(407) 644-1432
(407) 330-7196
Fax (407) 668-8577
POWER OF ATTORNEY
Date,412-11 Vj
r /�� n
I hereby name and appoint 4a Ana -Hou skimf Discount Propane, Inc.
to be my lawful Attorney in fact to act for me and apply to the
Building Department for a G'"Cs
permit for work to be performed and to sign My name and do all things
necessary to this appointment.
(�1I�
Name of Certified Contractor
Signature of Certified Contractor
The foregoing instrument was acknowledged before me this 4 / 7 / M
By, I Q-Qn P.•�K o is e nown to me/who.propduced
as identification and who did not take an oath.
STATE OF FLORIDA, COUNTY OF VOLUSIA
Swo n nd Subscribed before me this day of 20
/`
Pm
Notary Pub c, ST ( o&doh
Commissio Expire 0 .-M'ssioNFXA��
® April 1, 2008 •
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®q • a�n�0nned'��w��� • Q a;�'
yIsumnnce
®0 ®�f SIG'+5i®� � �.
120 AG
PROPANE
TANK
50 FT 1/2" COPPER
,
REG
3/4 Hard pipe
2 foot
SPA HEATER
400,000 BTU
LAWRENCE TRAUTMAN 0-0
162 BRUSHCREEK DR.
SANFORD, FL 32771
DISCOUNT PROPANE, INC 400,000 BTU SPA HEATER
546 S. SHELL RD 120 AG PROPANE TANK
DEBARY, FL 32713 DELIVERY PRESSURE- 11 INCHES `
(386) 668-0111 10# GOES TO 11"
LICENSE #04172