HomeMy WebLinkAbout242 Brazil CtApplication No: (Obi
NOV 8 2011
CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Documented Construction Value: $ S. 50 . no
Job Address: c LAo1 '6M2:11 &- - SQA -6<A, R, 32 Lq4I Historic District: Yes ❑ No ❑
Parcel 1D:
Zoning:
Description of Work:Ol�' r�Du'ISL� �O�LIC_ Y 6UC-I LP30rkL.
Plan Review Contact Person: O K� tn,/
A f IQ,UIrnan Title:
Phone: L`itn- Zal `- (lvyy Fax: L401. 522- OTS E-mail: r_hrl'L-7hna .
Property Owner Information ' i- ogac • Cly'"
Name ilaj0'lril,a S ML1 si&A Phone:
Street: Alia 'P% -U-20 C-1-. Resident of property?
City, State Zip: sn4ird , fl—
Contractor Information
Name ?(6 -Tec"
Kilt' Czlld1r16t\l
Phone: LA"_ oPq I- 1UL4,q
Street: zt12s 3-)wy-
S -►kc
i —CL
Fax: L-A ksi- 53a- omy 5
City, State Zip: 0M CLA"11
et,
32`6 oLA
State License No.: CAC- 02A3A3
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Building Permit O
Square Footage:
No. of Dwelling Units:
Electrical O
New Service — No. of AMPS:
Architect/Engineer Information
Phone:
Fax:
E-mail:
Mortgage Lender:
Address:
PERMIT INFORMATION
Construction Type: No. of Stories:
Flood Zone:
Plumbing O
New Construction - No. of Fixtures:
Mechanical 0 (Duct layout required for new systems) Fire Sprinkler/Alarm 0 No. of heads:
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. A NOTICE
OF COMMENCEMENT MUST BE RECORDED AND POSTED ON TIME JOB SITE BEFORE THE
FIRST INSPECTION. 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 pen -nits 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 of Florida
Lien Law, FS 713.
The City of Sanford requires payment of a plan review fee. A copy of the executed contract is required in order
to calculate a plan review charge. If the executed contract is not submitted, we reserve the right to calculate the
plan review fee based on past permit activity levels. Should calculated charges exceed the documented
construction value when the executed contract is submitted, credit will be applied to your pen -nit fees when the
permit is released.
Signature ofOwncr/Agent /j Date
Vol,v 14, !Ji lrH'
Print Owner/Agent's Name c
Sign ure of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
Rev 11.08
UTILITIES:
FIRE:
Signature of Contractor/Agent Date
Tho> -ms fllkcy\
Print Contractor/Agent's Name
ignature of Notary -State of Florida Date
CHRISTINA E. NEWMAN
MY COMMISSION II DD 1104130
r ; ° EXPIRES: July 8 2012
;`dA Bonded TAto Notary Public UndenWheta
11
Contractor/Agent is Personally Known to Me or
Produced ID Type of ID
WASTE WATER:
BUILDING:
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date:
I hereby name and appoint: 'jk u ovyn.�
an agent of:
to be my lawfui attorney-in-fact to act for me to apply for; receipt for, sign for and do all things
necessary to this appointment for (check only one option):
W All permits and applications submitted by this contractor.
C The specific permit and application for work located at:
(Strect Address)
Expiration Date for This Limited Power of Attorney:
License Holder Name: �( Off\ ;
State License Number: C)P(� ,02't3Q3
Signature of License Holder:' - g
r
STATE OF FLORIDA
COUNTY OF f1t-A114�2
The foregoing instrument was acknowledged before me this _L'� day of )C.
200_0, by -TVOn -,A<, Yli xCn who isW personally known
to me or o who has produced as
identification and who did (did not) takeanoath.
Signature"'
GREGORY MEISENBURG
49RY PUBLIC
o ^�STATE OF FLORIDA Print or type name J
Comm# D00936897
Expires t0/29/2v13
(Rev. 3/27/07)
Notary Public - State of _
Commission No.
My Commission Expires: