HomeMy WebLinkAbout2837 Gale Pl5/]
CITY OF SANFORD PERMIT APPLICATION
ermit#: 6
l )
ate: 10 - 3'Q(P
ob Address: J e I
tescription of Work: 1 ,r
OUstoricDistrict: Zoning: Value of Work: S 05
ermit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alaml Pool
lectrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary Pole
lechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Calc. Required)
lambing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
lambing/New Residential: # of Water Closets Plumbing Repair — Residential or Commercial
ccupancy Type: Residential Commercial Industrial Total Square Footage:
onstruction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Ircel #: 0(p • dO .51 • 5 O Fop • O a 30 (Attach Proof of Ownership & Legal Description)
Nners NamS4 AddfrY')CL Sep I a . aq,S`7 M e-. PL. 1-) antraetor
Name &
Address: i' vu C —D lone dktay —
nding Company:
dress: ortgage
Lender:
dress: A
Phone:
1
i hPr
1450 5. Pwv 1-1' Stale License
Number: C F( Conlact Person:
Su -Li Sand-,4y0ry-% I cbilecl/Engineer:
Phone: Idress: Fax:
3Vy-1753•
11173 placation 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 Vance ofapermitandthatallworkwillbeperformedtomeetstandardsofalllawsregulatingconstructioninthisjurisdiction. I understand that a separate rmit must
be secured for ELECTRICAL WORE PLUMBING, SIGNS, WELLS, POOLS, FURNACES. BOILERS, HEATERS, TANKS, and R CONDITIONERS,
etc. 1ER•S
AFFIDAVIT: I cerify that all of the forgoing information is accurate and that all %k wk -ill be done in compliance with all applicable laws regulating nsuucdon and
zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMh1ENCENEN7 MAY RESULT IN YOUR PAYING 47CE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSLLT WITH YOUR LENDER OR AN 1-fORN_
EY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT TICE: 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 s county,
and there may be additional permits required from other governmental entities such as water management districts, state agencies, or federal agencies. ceptance of
permit is verification that I will notify the owner of the property of the require nts of Floridn Li LFS 713, 0(a3h) Signature
of Owncr,
Agent Date iLan:re oftloVactodkuent Date Print Owner/Agent'
s N;une Signature of NOtary-
State of Florida Owner/Agent is _
Personally ]mown to Mc or Produced ID PLICATIOI
APPROVED BY:
Bldg: Initial & Date) xial
Conditions: Date
Zonul": Pr'.
t-
t:
toriA 's N TV-, Si=natvsc
of
Noutn•Stalc of Florida a DEBBIE BLMTON MY
COMMISSION # DD
IN081 Contractor Agent is _
Z Ily WPM Kwary2.Ir,2w Produced let A==
Co Utilities:
FD: Initial &
Date) (Initial &
Date) (Initial & Date)
Ak
FLORID PUBLIC
U T I L I T I E S
POWER OF ATTORNEY
Date:
I, i na(d k1 2.i , do hereby authorize Susao Sank+"M
to pull the gas plumbing permit for
Signature
rgA,
Notary
A I trna. Sel I a
owner's name
a3 -) C ct. e- P(-
address
o(D-31-505-OFOO. 1030
parcel number
Mtp1ELE MEDNA
Wry Pubic - Stab W rtatdo
My Comm. Egim Jon 25.2010
Cononinim 0 W 611118
ELy Qonald Kitner who is Personally known to me, State of Florida, County of
aCk on (D 30, day of 0 G'k _ 2006. DeBary:
450 S. Hwy. 17-92 DeBary, Florida 32713-9703 Phone: 386.668.2600 Fax: 386.668.2692 New
Smyrna Bch. 701 Eleanore Ave. New Smyrna Bch., Florida 32168 Phone: 386.428.5721 Fax: 386.427.6663 www.
fpuc.com Dunnellon: 11941 Bostick St., Suite A Dunnellon, Florida 34432 Phone: 352.489.5555 Fax: 352.489.0830