HomeMy WebLinkAbout294 Live Oak Blvd (2)CITY OF SANFORD PERMIT APPLICATION
Permit # : ® -7-167 Date: " w-011
Job Address: r byF ce K�1 � ut)�9�t�il
Description of Work: 9IR–C�{4CA �'Y'i_ 0G � 6 12 t'— IVAILP W$D 4, otal Square Footage
Historic District: Y Zoning: Value of Work:S i g5fi 0
Permit Type: Building Electrical
Electrical: New Service – # of AMPS
Mechanical: Residential . Non -Residential
Mechanical Plumbing Fire Sprinkler/Alarm Pool
_ Addition/Alteration Change of Service Temporary Pole
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'm! Residential or Commercial
Occupancy Type: Residential�_ Commercial Industrial
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required )
Owners
��Name & Address:
a,q t L 111 e --ca LC 1 �! D A lri� 4 '-30� DEJ2� – Phone:
Contractor Name & Address: U'No
t? S State License Number.
Phone & Fax: 01--711 � Contact Person: PAP-e—k m r)-Lo-tf Yl Phone:
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. 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
Signature of Owner/Agent Date
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is _ Personally Known to Me or
Produced ID
APPROVALS: ZONING:
Special Conditions:
Rev 03/2006
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DEPARTMENT OF BU INE S AIS PA,6rESSIONAL REGULATION
Ci3NST iC 01�i IN?i'lSTRY ICENSiNG BARD SEQ#L060727010:
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The PLUMBING CONTRAdirft
Named below IS CERTIFIED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31, 200$..,`_
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BUTTS, GLENN C
U S"
HEATING,AND AIR CONDITIONING NC I
12 9 52 REA3TE3 .RD
i WINTER GARDEN FL: `34T87:-5503::
JEB BUSH $IMONE MARBTILLER
' GOVERNOR S3sCRETARY
i DISPLAY AS REQUIRED;3Y LAW
V
POWER OF ATTORNEY
Date: 1-17-07
I hereby name and appoint
Of &V'01%V to be my lawful attorney
In fact to act for me and apply to the
Building Department for a�f/lYI�'�C permit
For work to be performed at a location described as: -1-1.41
Section Township Range Lot Block
Subdivision
(Owner of Property and Address)
and to sign my name and do all things necessary to this appointment.
(A- 5
Type or Print Name of Register or Certified Contractor and Contractor's License Number
Signature o Register or Ciftihea c onuactor
The foregoing instrument was acknowledged before me this day of of 20rZ
AI 17 ll
By &HAI
Who is personally known to me/who produced
As identification and who did not take oath.
State of Florida /
County ofc�
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