HomeMy WebLinkAbout2401 Key Ave (2)Permit # : L/ IV
CITY OF SANFORD PERMIT APPLICATION
Date:
Job Address: X'Y0 / ffE Y /y VIR'
Description of Work: R'C —IPOOF Total Square Footage
Historic District: Zoning oe— Value of Work: S I S o o
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 dt Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures # of Water dt Sewer Lines of Gas Lines
Plumbing(New Residential: # of Water Closets Plumbing Repair — Residential or Commercial
Occupancy Type: Residential _A,-, Commercial Industrial
Construction Type: # of Storks: # of Dwelling Units: Flood Zone: (FEMA form required)
Owners Name & Address: i4 TiC/CJ! C4/ AZ Z /' 1 G 6 QOD L AIKjc AP. /i%wi il,.yN
V46
Contractor Name Address:
SLt-k' c
Pboue & Fas: —
Bonding Company:
Address:
Mortgage Lender.
Address:
Arcbileet/Engioeer.
Address:
r I—L 3 z / % State License Number: [T 015 ss I CZ1
YO-] 5 G atactPenwn: h/r .c`cn Pbooe: _VO 7 ZZ$ — Z
Phone:
Fax:
Application is hereby made to obtain a permit to do the work and in,xalhrtions as indicate. I certify that no work or irstalbmon has commenced prior to theissuanceofapermitandthatallworkwillbeperformedtomeetstandardsofalllawsregulatingconstructioninthisjurisdiction. 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
conspvction end zoning. WARNING TO OWNER YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYINGTWICEFORIMPROVEMENTSTOYOURPROPERTY. 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 pro that may be found in the public records of
this county. and there may be additional permits required from other governmental unities such as water districts, state ks, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the property o(#w of La 71 .
Signature of Owner/Agent Date f Con /
Print Owner/Agem's Name n A
Signature of Notary -State of Florida Date S' of eta fQ Date
MY COMMISSION * ODtit
EXPIRES: February 25-2W7
wov FLN0tWYD'zCWr4A3WC-CQ
Owner/Agent is _ Personally Known to Me or
Produced ID
APPROVALS: ZONING: UTIL: FD:
Special Conditions:
Rev 03/2006
to me or
Produced ID
ENG: BLDG:
WE
LIMITED POWER OF ATTORNEY
I hereby name and appoint: ,
tJ i` 0 11 NS LU ,1,i Jo'y Printed Name of Appointee
Company Name of Appointee
5'A r'ts- Ca>
to be my lawful attomey-in-fact to act for me in applying to nty
Government Commercial/Residential Permitting for a permit enabling work to be
performed at the location below -described and to sign my name and do all things
necessary to this appointment:
Section
Township
Range
Subdivision
Block
n
u
State of FjWda
County o
to and
me or who has
Address
of Property
Address
Signed: ,Ln ryYt/r
certified con or signature
Date:
Certified Contractor y it'G OCN/}+%
printed name if
Contractor license #: _ C CC 0 S$ S l 1q
this - day of
Notary Public State of Florida I
an!«:_• Vebsquai
My Conmmsion DD442233 nary Public
a Expires o6/19/2ppg Commission expires:
by
is personally known
Sell)
FORMpower of anomeyA42501/dv
T '
r-
yFj