HomeMy WebLinkAbout203 Larkwood Dr (5)CITY OF SANFORD PERMIT APPLICATION
Permit # : 67507 _ Date:
Job Address: -,QQ klL r'ALt 1 oo.f?� l�� ��GL i� ?%—� �-. 3-7--? �i
Description of Rork: `(!%.F c+n c
Historic District: Zoning: Value of Work: C50
Permit Type: Building Electrical N Mechanical Plumbing 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 X Commercial Industrial 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: /-at'I. r --a
Contractor Name & Address:
CO.it_ al
Phone &Fax:
Bonding Company:
Address:
Mortgage Lender:
Address:
Contact
-7 Phone:
it
i /?Ifate License Number:
1-7-ma4f),L 62)c 3 Phone: _
Architect/Engineer: Phone:
Address: 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 it is verification that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713. Y
Signat •e•of 0wnce*r/Agrnt)bate Sisn(ya/t^ur\e o�-C"on�tracto^r/Aren(yt'' Date
Printner% e is Name Print Contractpro ent's Name
.3 ; /1i its
Owner/Agent
Produced
APPLICATION APPROVED BY: Bldg:
Special Conditions:
STACEY L. CHERRY
W(Cah L"WOD 447036 Contractor/Agent is
EXPIRES: September 10, 2009 Produced ID
Bowded u61^icUnderwriters -
of Florida r Date
STACEY L. CHERRY
s lly� nWr gM� WON # DD 447036
EXPIRES: September 10, 2009
oc r ;,a on ru o ry Public Underwriters
Zoning: Utilities: FD:
(Initial & Date) (Initial & Date) (Initial & Date) (Initial & Date)
Date: 3
I hereby name and appoint Eleanor Ellison to be my lawful attorney in fact
to act for me and apply for an electrical permit for work to be performed at the
location described as:
(Property ID)
(Address of job)
(Owner of Property)
And to sign my name and do all tliinjZs necessary to this appoi tme t.
Signature of Contractor)
Joseph Abrams EC0000148
(Printed name of Contractor and License Number)
STATE OF FLORIDA
COUNTY OF ..
The foregoing instrument was acknowledged before me this / day of (22M ,
11:i
[ ] produced
ignat6e of Not ublic, State of Fl 'd
Print/Type/Stamp Name of Notary Public
,who is [ ] personally known time or has
(type of identification) as identification.
(Seal)
ACEY L. CHERRY
>!�•• Yg�. ST
*! *- MY COMMISSION N pp 447036
EXPIRES: September 10, 2
Bonded Thru Notary Publk Uncle o09
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