HomeMy WebLinkAbout1505 W 25 StCITY OF SANFORD PERMIT APPLICATION
Application 14.
Job Address: /505 A)' Z 5 f� tilnr�r
Parcel ID:
Zoning:
Submittal Date B /Z6 / 0
o�
Value of Work: S �$Z>•
Historic District:
Description of Work: gelut r / ej(i's4;ou I'%eJt,- 64 &G Square Footage:
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/ NewrCommercial: # 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: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required)
••• �
Property Ownero�ic.�n•a••da�t�t..ti.............Contractor:• �+►t'Y'�S>� •Erleo re• .1✓tc...........
Address: C�S0 10- ZSR7cSi� Address: ZZS rS►�t'?��'h.sdh !�i•
Jgvl�r�. Ft! U2� �� 0Vt
Phone: E-mail: Phone: ab5-99No State License Number: Ec-13001 q(e'K
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. 1 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 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 requirements of Florida Lien Law, FS 713.
9/�L/oma
Signature of Owner/Agent Date Si�ature of Contractor/Agent Date
Pnnt rhvner/Anent', Name Print Contra , r/Agent's Nam/
Signature of Notary -State of Florida
Oumer/Agent is
Produced ID
APPROVALS: ZONING:
Special Conditions:
Rev 07.07
Personally Known to Me or
UTIL
va&lo->
Date / gign o NotCry to of
Notary Public State of Florida
Elizabeth Jean Tuggl
,* My Commission DD3455
or n Fzxpires 411/20/2009
Contractor/Agent is _
Produced ID
FD: ENG:
Known to Me or
BLDG:
LIMITED POWER OF ATTORNEY
As an officer of Smithson Electric, Inc., I do hereby give limited power of attorney to
David Blagg as in which aforesaid may sign for
and receive permit(s) in the C of
Signed Z17 Date q l ZLL -
Title,
Before me thisday of 20Can officer duly authorized
in the state Florida in the county of Seminole aforesaid to take acknowledgements,
personally appeared as � ;;� "+ of
Smithson Electric, Inc. who is personally known to me.
NOTARY PUBLIC DATE�C.o-�
SEAL: ami:E
State of Florida-
n Tuggle
ion D0388455
012009