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HomeMy WebLinkAbout201 Bella Rosa CirCITY OF SANFORD PERMIT APPLICATION Application #: D7_5?:Q I Submittal Date: Job Address:GO/ � )� �1h C,Li /1&�� Value of Work: S / DC1J Parcel ID: Zoning: Historic District: Description of Work: O=LL) HVAC- Square Footage: .................................................................................................................... Permit Type: Building ❑ Electrical ❑ Mechanical Plumbing ❑ Fire Sprinkler/Alarm ❑ Pool ❑ Sign ❑ 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 Occupancy Type: Residential Commercial ❑ Industrial ❑ Plumbing Repair —Residential ❑ Commercial ❑ Occupancy Use Group(s): Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required) ..............................r.'.........................................-�... ................... Property Owner: • Le -nn r TT��©yxie_ ' / Contractor: I Address: �� I 1_4 H A l' 17iamo 'S*, �i 5;u Address:/ � j Phone: / -mail: Phone.0LAW State License Number UJ Bonding Company: Address: Architect/Engineer: Address: Plan Review Contact Person: Mortgage Lender: Address: Phone: Fax: Phone: Fax: E-mail: 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 applicabl7rida p�ripth may be found in the public records of this county, and there maybe additional permits required from other governmental entities as ment distri state agencies, or federal agencies. Acceptance of permit is verification that I will notify the owner of the property of th q ire nm of n Law, FS 7 3. of Owner/Agent DateSi afar erT7ient Date Print Owner/Agent's Name Signature of Notary -State of Florida Date ` S//ihnaftV" ot Date MIL. WaRS....... o m I "p& s Corn nx OD0335196 Eq*. 7!62009 <� Bonded thru (800)432.4256• Florid Ne!a� t Assn., Inc Owner/Agent is _ Personally Known to Me or ...... .....i't is _ Personally Kwn to Me or Contractor/Agentno Produced ID Produced ID APPROVALS: ZONING: Special Conditions: Rev 02/2007 !!1111 all ENG: BLDG: Gene) al Power of Attorney Form Page 1 of 1 — -k GENERAL POWER OF ATTORNEY I, Clt.d,sTr�ei , of hereby appoint LL x.14 a j41., of (r'- as my attorney in fact to act in my capacity to do eve act that I may legally do through an attorney in fact. This power shall be in full force and effect on the date below written and shall remain in full force and effect until 3I2tiT_ or unless specifically extended or rescinded earlier by ei`therpart�y. Dated Z q 20 L;,o`l• By: STATE OF COUNTY OF BEFORE ME, the undersigned authority, on this 1-199 day of 200 ? , personally appeared to me well known to be the person described in and who signed the Foregoing, and acknowledged to me that he executed the same freely and voluntarily for the uses and purposes therein expressed. WITNESS my hand and official NOTARY PUBLIC Q')'7zu,' My Commission Expires: seal the date aforesaid. % ANDREA STAIGER-AYERS MY COMMISSION # DD445651 OFi�op� EXPIRES: July8.2009 (407) 39"153 Rcxida Notary Service.com ...�.� http://www.lectlaw.com/forms/fD95.htm 3/22/2007