HomeMy WebLinkAbout332 Live Oak Blvdtr}'.:,,�•,M?KaA (->�.�.�SFti�
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CITY OF SANFORD PERMIT APPLICATION
Permit #: d? "" 21 (x—'S
Job Address: 3 12 Ay At�
Description of Work:W-1-7f G
Historic District: %/ .30"640ni
Date: T
7
Permit Type: Building Electrical ec Plumbing Fire Sprinkler/Alarm Pool
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Electrical: New Service # of AMPS Addition/Alteration Change of Service Tempot'ary Pole _
Mechanical: Residential Zl Non -Residential Replacement 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 or Commercial���
Occupancy Type: Residential Commercial Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: / 65 o 6 uv� /r �� D ( ttach Proof of Ownership & Legal Description)
Owners
�Njame,� Address{: � 1A �` .4q.
U/x �/Y/' �/�/)d Phone:
Contractor Name &) Address:"\.1I % Op rr44 o� Fj=i(�,�IG on�� P4 1'6 I J! up, b0 i y�,�y , ,
j � l t.y J[Jrn sa=115 {� State License Number: arncc 4—w
Phone & Fax: 3G 3C1% — Contact Person: 1 t"PDinp- Phone:403_._3 3�
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
Phone:
Fax:
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has corm r eared prior to tree
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 ITS YOti.}I', PAYMG
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER, OR All
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
NOTICE: In addition to the requirements of this permit, there maybe additional restrictions applicable to this
this county, and there may be additional permits required from other governmental entities such as water man
Acceptance of permit is verification that I will notify the owner of the property of the requirements of
4
that may be
districts, stat
Law,
Signature of Owner/Agent Date Signature of Contract7/At _
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is Personalh Known to Me or
Produced ID
APPLICATION APPROVED BY: Bldg:
(Initial & Date)
Special Conditions:
Zonins�:
the public rerds of
s, or federal genciV
P• • / 7
Signature of Notary -S ate of Flqg. anuu�yatCS%p . $J0 i
.n•° �� 0=
Contractor/Agent is Persoy.l4�pltri to F�Nr (S • "/`
Produced ID
/ Tq� '�'
Utilities: //�i„ 1:0,
(Initial & Date) (Initial & Date1i& Date)
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auto u
FEB -15-200E 12:40 From: 4079776025
o:14073394397
LIMITED PONVER OF ATTORNEY
P.1/1
1
I i
'I hereby naive and appoint .n t� a 001, to be
my lawful att rney in fact to act for me and apply to t' Q �(?� for
a __]'�.�e� AW -11-1 permit for work to bF partormed ata location described tis,
Section L / Township .,-!�>O Range
Lot BlookOX0 Subdivision C 2W6 /' �� IC.p9KG�
icl ��,�► �
(Addreu ordob)
aS2
of Property and
and to sign my name and do all things necessary to this appointment.
n=o or conirnawr and
of C6 -,d idd Contractor)
SrrKrT: OF 4t ()' r C
COUNTY OF
Tho foregoing instrument was aeicnowledged this l4 dny of
who personally
appeared before No and acknowledged d= he/she signed the buinumant
voluntarily I'or tho purpose expressed In It.
O- ersonal ly Known .
0 Produced Idendfloation
(SEAT.)
Type of Identitioitlon
r
ho
Signator of Noway Pu lic, State or Florldn
Print dr` ypc Mine ol'Notary Public ,,�CIS
rKR.r r. --- -
No�lr Pub1z. MW of Foida
�Noar18,2t107
CofnM,WW # DD268536
Bonded By NoW a1 N -00M �