HomeMy WebLinkAbout1673 WP Ball Blvd (2)CITY OF SANFORD PERMIT'APPLICATION
Permit #: ' lo
Job Address: , Date: 1
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Description of Work: 1V m (ter . Q I�— �h r I fl� r— t2td h //
Historic District: Zoning: Value of Work: S � q 4 -7 777
Permit Type: Building Electrical echani 1 PlumbingFire 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
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Occupancy Type: Residential Commercial n Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #:
Owners Name &Address: (Attach Proof of Ownership & Legal Description)
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Phone:
Contractor Name rAddress: _ �5, ick �t 177 S rL
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Phone &Fax: Contact Person: State License Number.
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Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer: Phone:
Address:
Fax:
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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 requirements Florida Law, 713.
Signature of Owner/Agent Date Signature of Contractor/Agent Date
Print Owner/Agent's Name tra
Contractor/Agen ' Name
Signature of Notary -State of Florida
Date Signature of Notary -State of Florida Date
r o Notary Public State of Florida
a Ivlafsh; inral
Owner/Agent is _ Personally Known to Me or Contractor/Agent iscr owMy '0"i`"'*;s,on DD554078
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APPLICATION APPROVED BY: Bldg: Zoning:
(Initial & Date)
Special Conditions:
(Initial & Date)
Utilities: FD:
(Initial & Date) (Initial & Date)
• AIR CONDITIONING
• REFRIGERATION
• ICE MACHINES
January 11, 2007
City of Sanford Building Department
300 N. Park Ave.
Sanford, FL 32771
Re: 1673 WP Ball Blvd., Sanford
To Whom It May Concern:
P.O. Box 180215
Casselberry, FL 32718-0215
407-695-6646
fax. 407-696-0003
By this letter, I hereby authorize Rick Smith to sign for and pick up the mechanical
permit for the above referenced address. My state certification number is CAC 05 853 1. If
you have any questions, you may reach me at 407-695-6646. Thank you.
Sincerely,
Mark Gembecki
President
Sworn to and subscribed before me this day of J , 2007.
Notary Public — State of Florida
r°,pY aoNcla a ' arts c State of Florida
OD554078