HomeMy WebLinkAbout351 Central Park Dr (5)A CITY OF SANFORD PERMIT APPLICATION
Application 9: 07 1 � 7' Submittal Date: k
Job Address: y� �� r Value of Work: $ l I.LJ Q V
Parcel ID: Zoning: Historic District:
Description of Work: W i h , � ` { lbr '1'nl P_M ljCAX Square Footage: _
...........................................................................................................I..........
Permit Type: Building ❑ Electrical Mechanical ❑ Plumbing ❑ Fire Sprinkler/Alarm ❑ Pool ❑ Sign ❑
Electrical: New Service — # of AMPS Addition/Alteration ` Change of Service ❑ Temporary Pole 0
Mechanical: Residential ❑ 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
Occupancy Type: Residential ❑ Commercial ❑
Industrial ❑
Construction Type: # of Stories: # of Dwelling Units:
Plumbing Repair—Residential ❑ Commercial ❑
Occupancy Use Group(s):
Flood Zone: (FEMA form required )
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PropertyOwnerContractor:.
Address: Address: _ l
Phone:
Bonding Company:
Address:
Arch itect/Engineer.
Address:
E-mail:
Plan Review Contact Person:
Phone: State License Number:
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 requirements of Florida Lien Lary - S 713_
Signature of Owner/Agent Date S�e of Contract 7Agent Date
Print Owner/Agent's Name Pri ontractor/Agent's ame f
Signature of Notary -State of Florida Date Signature of Notary -State of Florida ��\\ P. • • / fj
�y GgMM�3y� �.ry f
• \�1\Ua;y fJm.
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Owner/Agent is _ Personally Known to Me or Contractor/Agent is Personal�g[Eiim4p
_ Produced i c
Produced ID
APPROVALS: ZONING: UTIL: FD: ENG:
Special Conditions:
Rev 02/2007
P 30,00
I hereby appoint
Electrical Petroleum Services Corp.
10223 Glacier ct.
Orlando, Florida 32821
Tel 407 722 1478
POWER OF ATTORNEY
to be my lawful attorney in fac
to act for me and apply to the; I d C— ( A,'L-Ccic
Building Department for permits for work to be performed at the location described
Below or for the purpose of attaining a license for the following:
Registered Electrical Coiitraetor:7
Signature of Registered Contractor i �7--t- A
Ramiro Ponce, who is personally kndw to m R'who did not take an c
Acknowledge this foregoing!instrument before me this day of
2007
Country of Volusia
State of Florida
o�0yr ave Notary Public State of Florida
? Lee T Hoyett
o try Commission DD484596
Notary Public: or ne Expires 10/23/2009
Signature �-
IN