HomeMy WebLinkAbout106 Ramblewood Dr (2)........................................................................................................................
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 ❑ Replacement ❑ New ❑ (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential ❑ Commercial ❑ Industrial ❑
# of Gas Lines
Plumbing Repair—Residential ❑ Commercial ❑
Occupancy Use Group(s):
Construction Type: It of Stories: # of Dwelling Units: Flood Zone: (FEMA form required)
.......................•.'............................................................................. .. . 1 .........
Property Owner: iI VLf� �li Contractor: 11 KC - . _- �(--tll jl I.t W1
Address: / U10 r Y 1 ) e{lA-30-i Address
,fin Ford 3a_773 /-
Phone:ti0� 3d$• 0515 E-mail: Phone: ��3_' State License Number: CFCD5e71(o
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_ 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 permits 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 require ents of Florida Lien Law, FS 713.
1&,ZWff4_ _� 13��7
Signature of Owner/Agent Date SignaturOU Contractor/Agent Date
Print Owner/Agent's Name
Signature of Notary -State of Florida Date ,
Owner/Agent is _
_ Produced ID
APPROVALS: ZONING: _
Special Conditions:
Rev 02/2007
Personally Known to Me or
UTIL: FD:
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POWER OF ATTORNEY
Date:
I, Donald Kitner , do hereby authorize Susan L Sandstrom
to pull the gas plumbing permit for
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Signature
Notary Signature
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owner's e
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address
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parcel number
w MICHELEMEDINA
5 Notary Public • State of Florida
My Comm. Expires Jan 28, 201Q
Commission M DD 511118
Print, Type or Stamp Name of Notary
By Donald Kitner who is perso ally known to me, State of Florida, County of
y0 ( LQf a onr day of 20 07 .
DeBary: P.O. Box 530969 A DeBary, Florida 32753-0969 APhone: 3'86.668.2600 A Fax: 386.668.2692
www.fpuc.com New Smyrna Bch.: 701 Eleanore Ave. A New Smyrna Bch, Florida 32168 A Phone: 386.428. 5721 A Fax 386.427.6663