HomeMy WebLinkAbout1000 E 1 St (2)X, CITY OF SANFORD PERMIT APPLICATION
Application # : � v Submittal Date: t / 1 0 -7
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Job Addresk `00� - S} S�_ , So,N�� d �� 1 Value of Work: $ h `4 - \
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Parcel ED: 2-)O r \ 'O�, '- _�, — S O 6 "-- 0 WG _Qp Zoning: Historic District:
Description of Work: \ 0 skoff\ Do �ON % I C. S�� p(�1� Square Footage:
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Permit Type: Building ❑ Electrical ❑ Mechanical Plumbing ❑ Fire Sprinkler/Alarm ❑ Pool ❑ Sign ❑
Electrical: New Service — # of AMPS Addition/Alteration ❑ Change of Service ❑ Temporary Pole ❑
Mechanical: Residential ❑ Non -Residential 10, Replacement P( 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 ❑ Commercial ❑
Occupancy Type: Residential ❑ Commercial ❑ Industrial ❑ Occupancy Use Group(s):
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required)
...................`....................n....................................................................`................
Property Owner: Contractor: 1p1eo'�<'Ci/\
Address: ��O - �5�5���� Address: a`1�,�
U �iG izt co
Phone: 107- 3 a3 -�y 30 E-mail: Phone" �' �`��-�� �a State License Number. _ Ut4r
Bonding Company:
Address:
Architect/Engineer:
Address:
Plan Review Contact Person:
Mortgage Lender:
Address:
Phone: Fax:
Phone:
Fax:
E-mail:
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 THE 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 a additional permits required from other governmental entities such as water manage nt districts, state agencies, or federal agencies.
ptance of hermit is verification that I will notify the owner of the property of thq re ent&pf Florida Lien Law, FS 713.
o�nature Of Owner/Agent Date Signature of ContracWgene Date
`2�h�yf C .f eetSC' 1
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is _ Personally Known to Me or
Produced ID
APPROVALS: ZONING:
-----Special-Conditions:
---Rev-07-.07--
UTIL: FD:
Print Contractor/Agent's Name
2�7
•,. iR' I�StP�i Vlct'dge of Florida ate
•' : •'MyCommssionEThxNov9,2008
'"' •� Commission # DD'370822
� F OF F�OP•�`
Bonded By National NotaryAssn,
Contractor/Agent is Personally Known to Me or
Produced ID
ENG: BLDG:
LIMITED POWER OF ATTORNEY
I, Robert C. Teetsel, holding the certified Mechanical license #CMC1249685
do hereby grant Limited Power of Attorney to Larry D. Bell, to pull
permits, and inspections within the City of Sanford, Florida under the above
cited license.
l
Robert C. Teedsel
DATE: September 18, 2007 Witness
Witness:
STATE OF FLORIDA
COUNTY OF ORANGE
SIGNED, SEALED AND DELIVERED IN THE PRESENCE OF:
(l`y )-L 5 A V ; o��av PSB,, SHIVRANIE HIRALAL
NOTARY PUBLIC = • .`:Notary Public -State of Florida
N � :MYCommiSsbn BOM N00, 2008
j.F oa Commission # DD 370822
"� �;,0 Bonded By National NotoryAssn.
My Commission Expires: ►� ov q�
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