HomeMy WebLinkAbout302 Reid Cta
CITY OF SANP,7RD PERMIT APPLICATION
Permit # : 7 —
�' Date:
Job Address:
Description of Work: 0(rl_'f
Historic District: Zoning:
Value of Work:
Permit Type: Building Electrical 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 Commercial
Industrial Total Square Footage:
Construction Type: # of Stories:
# of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: 16 PV _W 51d 1 ` —
Owners Name & Address 1 1 T—h "�' 1'r, (—Ln
ame &
Phone & Fax: Z(1
Bonding Company.
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
�!911;t-
(i (Attach Proof of Ownership & Legal Description)
Contact
Phone: " t(J F-1:44 —
License
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 limit is verification that I will notify the owner of the property of the requirements of F ef'ri21a ten Law, FS 713.
atur Owner/Agent Da e Signatu iitractor/.gent Date
f 1eck11\c1C 1� 1L Sar, E
Print Omner/ARent's Name e Print Contractor/Agent's Name
S antro-ofNotaryrStateofFlorida
Owner/Agent is_ Per .N•II n
_ Produced ID "+; •.,
APPLICATION APPROVED BY: Bldg:
Special Conditions:
Date
STACEY L. CHERRY
INIMMISSION # DD 4471,;36
EXPIRES: September 10, 2009
Notary public Undenvrrcr:
(Initial & Date)
of Florida
Contractor/Agent is Personally
Produced ID
Zoning: Utilities:
(Initial & Date)
J� 3-3
STACEY L CH R
MY COMMISSION # DD 447096
EXPIRES. September 10, 2009
boded Th u Notary PuW o Unde
�_ nwiters
FD:
(Initial & Date) (Initial & Date)
LIMITED POWER OF ATTORNEY
Date:
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)
S
(Address of job)
(Owner of Property)
And to sign my name and do all things necessary to this appointment.
(Signature of Contractor)
Joseph Abrams EC0000148
(Printed name of Contractor and License Number)
STATE OF FLORIDA
COUNTY OF \�� tR.
The foregoing instrument was acknowledged before me this �R day offflC'J\0-k i,
200, by ��a1MwtVy\,( ,who is ]'personally knov�)to me or has
[ ] produced (type of identification) as identification.
Signature of No ublic, State of Florida
(Seal)
Print/Type/Stamp Name of Notary Public tiY
• STACEY L CHERRY
MY COMMISSION # DD 447036
..... EXPIRES: EXPIRES: Se tember 10, 2009
Bonded TbruNotar
ry Public Underwriters
t