HomeMy WebLinkAbout126 Pinecrest DrCITY OF SANFORD PERMIT APPLICATION
ermit N :-(O(a - t2_{ -T1-.14 i Date: _
ob Address: ZCO Dr. . t & '3Z'1^,3
1
teseriptioa of Work:s.l_p ie3 V± Total Square Footage
listoric District Zoning: Value of Work:
ermit Type: Building Electrical Mechanical Plumbing —___ Fire Sprinkler/Alarm Pool —
3eclrical: New Service - N of AMPS Addition/Alteration ,— Change of Scrvicc ^_ Temporary Pole —
lechanieal. Residential — Nort-Residential Replacement -- New • _ (Duct Layout & Energy Gale. Required)
lumbing/ New Commercial: N of Fixtures N of Water & Sewer Linesp of' Gas Lines lambing/
New Residential: N of Water Closets Plumbing Repair - Residential or Commercial _ lecupancy
Type: Residential jt Commercial Industrial onstruction
Type: _ No Stories: N of Dwelling Units: _ -- Flood Lone. _— (FENIA form required nwaers
Name & Address: Ye, y c-,e, ^ O aOv ' -4e Pt 11G Z2Lnri `
S — Phone.' on -` 5oa - t4 f.(o5 ontractor
Name & Address: J c f 4G 1TIt'Yf1 1 g '" i Qr t_ iJC . _ Odaof,
Am 3Z J(o Stale license Number: —C ^C O ta_(p Z3 _ hoot
ax: S " g3Z Contact Person: pp L1n_Phoac: )405 - 9-5 a 44 omdiiig
Company: __--•_— ddress:
lortgage
Leader: ddress:
rchil"
ItEngineer: ddress:
Phone.
Fax:
pplication
is hereby made to obtain a permit to do the work and installations as indicated. 1 ccnify that no %vork or installation has commenced prior to the suance
of a permit and dud all work will be performed to mect standards of all laws regulating construction in this jurisdiction. I understand that a separate m
it must be secured for ELECTRICAL: WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS. TANKS, and IR
CONDITIONERS, etc. WNER'
S AFFIDAVIT: 1 certify that all,of the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating mstnuction
and zoning. WARNING TO.OWNER: YOUR FAILURE TO RECORD A NOTICE: OF COMMENCEMENT MAY RESULT IN YOUR PAYING WICE
FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN TTORNEY
BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. OTICE:
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 is
county, and there may be additional permits required from other governmental entities such as water management districts, state agencies, or federal agencies. cceptamce
of paZ):
r
t '
ll notify die owner of the property of the requirements of Florida Lien Law, FS 713. Signatwc
ofOwnm/Agent ; Date Signature of Contractor/Agent Date 94,
ce L 4.iNilAr.r y _ Print
Owner/Agent's Name I Print Contractor/Agent's Name SigrtaWre
of N -State o t.
1. Date
Signature of Notary -State of Florida Date rnl--
pIfD1N.' 8ww (;f F10tlt1tt tWr ,
I J Islook! My
Goommts3ion DD427055 OF
a Expires 0510812009 r
wa to Me or Contractor/Agent is _ Personally Known to Me or Produced
ID t Produced
ID PPROVAL.
S: ZONING: UTIL: FU: ENG: BLDG: tccial
Conditions: v
03/2006
MECHANICAL PLAN
NTS
POWER OF ATTORNEy
Date• C? 4r
I hereby name and appoint / %Let C /5jg,40
of .itJS.D/lI T/oryS T-itlitJO/?T/o.ys.to be my .lawful attorney
in fact to act for me and. apply to the 1i/Vi d JCLn Of
Building Department for a . I C/g t/C /. permit
for work to be performed at a location described as:
Section Township Ran ge Lot Block
Subdivision
ADA,.
Address of Job)
126, So-,kot-J. l 32.r1'`13
Owner of Propertyand Address)
and to sign my name'and do all things necessary to this appointment.
eE.v i`t 2 y .4lk a®v.0 ,f- 9T AA Q • Z;V e
Type or Print name of Cegified Contra or
w- i Div v - - - - v--.
Signature of Certified Contractor
The forego instrument was acknowledge before me this ff///TV
by
who is personally known to me/who produced
as identification and who did not take oath.
State of Florida County of 2
Commission I
Not r
My Commission Expires:
LEO R. WOODS
Notary Public; State of Florida
My Comm: exp. May 30, 2009
Comm. No: DO 435549