HomeMy WebLinkAbout166 Towne Center CirCITY OF SANFORD PERMIT APPLICATION
#: Submittal Date: 0, . %Co) .C)7
;ob Au�ress: (Pty ����-�tr rbc �% d 1' Value of Work: $ 6756:76 •
Parcel ID:
Zoning:
Historic District:
Description of Work: IPItt-( �(et`d�u�- Square Footage:
Permit Type: Building ❑ Electrical ❑ Mechanical ❑ Plumbing X Fire Sprinkler/Alarm ❑ Pool ❑ Sign ❑
Electrical: New Service - # of AMPS Addition/Alteration ❑ Change of Service ❑ Temporary Pole ❑
Mechanical: Residential ❑ Non -Residential ❑ Replacement ❑
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential ❑ Commercial Industrial ❑
New ❑ (Duct Layout & Energy Calc. Required)
# of Gas Lines
Plumbing Repair- Residential ❑ CommercialA
Occupancy Use Group(s):
Construction Type:.` # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required)
.........................................................................................c........ ...;..t...............
Property Owner: Contractor: S34( C.� t- I u nb .M r -h e i =V>—
Address: Address:C?, I�csri a�i_gb
I mc7 S ri tic` Tc-- .--3V-q-U_)
j57� �r V _ CFE Cko�l 1
Phone: E-mail: Phone: State License Number:
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. 1 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 this property that a e found in the public records of
this county, and there may be additional permits required from other governmental entities such ater management di rc ,state agencies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the rty o the r ui m s o lorida Lien law, FS 713.
Signature of Owner/Agent Date Signature of Contrac r/ nt Date
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is _ Personally Known to Me or
Produced ID
APPROVALS: ZONING:
UTIL: FD:
i c�ck-d E e kvyc r)
Print Contractor/Agent's Name
�—" "-`-�) ., * o f �Ala6iaM. KEPPEN
Signature of Notary -State o F orida 's,
' cDt COMMISSION # DD 666124
EXPIRES: May 13, 2011
N4T�OF F���`oP Bonded ihru Budget Notary Services
Contractor/Agent is Y Personally Known to Me or
Produced ID
ENG: BLDG:
Special Conditions: J
Rev 07.07 /1.�. b�
r
Sep 18 2007 12:50PM HP LASERJET FAX
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanfa`rd,
Seminole County, Winter Springs
Date: 9= 6 -a 7
1 hereby name and appoint:
an agent of:
(ria=
I --
to be my lawful attorney-in-fact to act for me to apply for, receipt for, sien for and do all
necessary to this appointment for (check only one option):
All pernlits and applications submitted by this contractor.
❑ The specific permit and application for work located at:
(Street Address)
Expiration Date for This Limited Power of Attorney:�T Z- '125"1
License Holder Name:
State License Number;
Signature of License P
STATE OF FLORIDA
COUNTY OFC.Aju�—
The foregoing instrument was acknowledged before me this J y 0
200 by —1(-XJA who is o personally known
to me dr who has produced as
identification and who did (did not) take an oath.
Signature
(Notary seal)
Print or type name
rp.�Pk PUB�iC SANDRA M. KEPPEN
* * MY COMMISSION t DD 666124
EXPIRES: May 13, 2011
�r9rFOF F���\OP Bonded lhru Budget Notary Services
(Rev. 3/27/07)
Notary Public - State of FY --
Commission No. � of o l
My Commission Expires: 5 - 13 -1 1
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