HomeMy WebLinkAbout3852 Orlando AveCITY OF SANFORD PERMIT APPLICATIONC7 --62 7
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Application # : (J ��7 - * Submittal Date: �v
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Job Address: ZF`5 Value of Work: S-.
rrl.�,�s
Parcel ID: _ Zoning: �/ Historic District:
Description of Work: wy%�/ ���Y ��s /eG4�%�r�%�S"5Ww''.— Foot:
...............................................................................................:.......................
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/ New Commercial: # of F xture +# of Water &Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets Plumbing Repair– Residential ❑ Commercial ❑
Occupancy Type: Residential ❑ Commercial Pr Industrial ❑ Occupancy Use Group(s):
Construction Type: _ # of Stories:# of Dwelling Units: Flood Zoone/ _ (FENIA torn, required)
• ..................................................• •
PropertyOwneY Contractor:
///c%iso G7/iiCi
Address: Address: /01-091
Phone: E-mail: Phone: State License Number.
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer: — Phone:
Address: Fax:
Plan Review Contact'Person:
Phone: Fax:
E-mail:
Application is herebymade to obtain a pen -nit 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 ELECTRICAIL. 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 accyrate and that all work will be done in compliance with all applicable laws regulating
constructionand zoning.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTIGE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE J013 SITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, QONSULT WITH YOUR LENDER OR AN AT-FORNEY 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 veri lication that I wi I I noti fy the owner of the property of the
Signature of Owner/Agent
Date Signature
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced iD
APPROVALS: ZONING:
Special Conditions:
Rev 07.07
UTIL: FD:
Print
Name
of Notary -State of
Vida Lien Law, FS 713.
Date
a
DARLENE MORALES
I MY COMMISSION # DD297913
MIRES: March O8, .2(X13
FI, Notary Dismint ti0au6, CM
Contractor/Agent is X Personally Known to Me or
Produced ID.
ENG:
BLDG:
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, 'Winter Springs
Date: Y/8/0
I hereby name and appoint: Aje-Cel Ie c.G
an agent of "ecl A d I (,t
(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
necessary to this appointment for -(check -only oneoPtion):
kO -
- --
All permits and applications submitted by this contractor.
IN The specific permit and application for work located at:
3 Owl'L S.,n['j 3Z �3
(Street Address)
Expiration Date for This Limited Power of Attomey:__..2//,%
A
License Holder Name:
State Licens
Signature of
STATE OF
COUNTYC
The foregoing instrument was ac kms' ledged before me this j Aay of
200 ' by gpq-.(.t� who is personally known
to me or o who has produced
identification and who did (did not) laq an oath.
Signature
(Notary Seal) 'ba E'`/" ".yl'(DYCZ I �5
P"- DARLE1Vl %MORALES
My Cr6N"g9c0N k DD2978 t3
�a EXY Es Mard4, 00,`2
OF
c� Fi, Wnt4rY i���r�
1 -900F7 -NOTARY
(Rev. 3/27/07)
Print or type name
0
Notary Public - State of l —�� r lC/t-
Commission No. D D a 4 q? /- _
My Commission Expires: 3 0
as