HomeMy WebLinkAbout358 Willowbay Ridge StCITY OF SANFORD PERMIT APPLICATION
Application N: i L.. , �� ` ) Submittal Date: 07 - a 0 " o7
Job Address:.. 5_9 W I— 10W bC'y PLige�I- Sct� t,d, FL 3,277/ Value of Work: $ ( � JCS .O0
Parcel ID: 12— 0000 – a300
r Zoning: Historic District:
Description of Work: 5- S 1 — " S V t n � les S lope. 511d_ Square Footage: 5
•• • • • ........................
• • • • •• • • •
Permit Type:Building Electrical ❑ Mechanical ❑ Plumbing ❑ Fire Sprinkler/Alarm ❑ Pool ❑ Sign ❑
Electrical: New Service — # of AMPS Addition/Alteration ❑ Change of Service 0 Temporary Pole ❑
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 Plumbing Repair —Residential ❑ Commercial ❑
Occupancy Type: Residential 14 Commercial ❑ Industrial ❑ Occupancy Use Group(s):
Construction Type: Res, # of Stories: /_ # of Dwelling Units: _� Flood Zone: (FEMA form required)
.�(...................................................................
Sc /ya a ha ¢ R1ajj � c: 'a m Q'� Contractor: Pj)c) f Sery (Ls°s d f Cent , FL, ZNc.
Property Owner: l ��_,s;g A A (P 0 C -a ^ I
��A 1n/I//nr.thn,/ Rlc(4e Sf Address: IVSe((
D �C i�tJe��1
Address: — - - -
�Q+n-Foy<<, FL ,��177/ Ullinfc,r S�r�hgs ; FG. , 3oz7os
yo,? .
Phone: 407-71oZ-08q6 E-mail: Phone: wi(P% State License Number: Ct CC (�a 7y
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: 1_ 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.
Acceptanc permit is verification ►a will notify the owner of the property of the requirements of Florida Lien Law, FS 713.
.�� r"( (20��7 o - 1 -07
SigiiatureFofOwner1A - Date SigAatureofContractor/Ager Date
SELV8C1nNPQAi H> Krt'st-ad A, N-6?
;g,iature*f;Not
er/A em'.s`N a-=-4 Print Contractor/Agent's Name
�d 7
State:ofFlorida:_; Date Signature :tate o QBH K. PLYBON Dat
;.: MY OMMISSION # DD 459661
�•. a€
EXPIRES: September 4,2009
nawuuuuuuaaaaunnusoaauuaaw F of F:o� Bonded Thru Notary Public Underwriters
= s
TERRA" MHOWE
Wmmil{DW054 159
Owner/A� rlii
_ Prod A
waaaauaa asanaasowaswnanu a uuauu[•
APPROVALS: ZONING: UTIL: FD:
Special Conditions:
Rev 07.07
Contractor/Agent is`' Personally Known to Me or
Produced ID
ENG:
BLDG:
i U1,111"'1111 / �•.
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: 7-cao •- O Z
I hereby name and appoint: LA PCy
an agent of: k06 -� -7'o p Se r u L C eS o -C een jr VL : , L•iUe
(Name of Company)
to be my lawful attorney-in-fact to act for me to apply for, receipt for, sign for and do all things
necessaryto this appointment for (check only one options
O All permits and applications submitted by this contractor.
The specific permit and ayplication for work located
a 77/
Address)
Expiration Date for This Limited Power of Attorney: 'J" y zoos
License Holder Name: Kr S f-a� A
State License Number: c cG
Signature of License
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged before me thiso24'—"day of
200_1_, by L S _ O cel_ cZ who is *ersonalI known
to me or o who has produced Qas
identification and who did (did not) take an oath.
(Notary Sea])
DEBORAH K. PLYBON
*; *: MY COMMISSION # DD 459661
EXPIRES: September 4, 2009
oP°Q` Bonded Thru Notary Public underwriters
(Rev. 3/27/07)
Signature
betoro'k V.
Print or type name
Notary Public - State of �_
Commission No. I b tI
My Commission Expires: y .20o,9