HomeMy WebLinkAbout417 S Sanford AveCITY OF SANFORD PERMIT APPLICATION
A61ication fl: ®, J � 3 t� Submittal Date: 7
Job Address: i� 1 5 �N0�rA N Ve Value of Work: $JJ 00•
Parcel ID: S"�y " -�Q` 0�(�60 Zoning: Historic District:
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Description of LN,%i6
.........................................................
Permit Type: Building ❑ Electrical Mechanical ❑
A 4 ��e,r\ O°quare Footage:
.............................................................
Plumbing ❑ Fire Sprinkler/Alarm ❑ Pool ❑ Sign ❑
Electrical: New Service — # of AMPS V1,10e Addition/Alteration Change of Service ❑ 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 ❑ Commercial industrial ❑ Occupancy Use Group(s):
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required )
Property Owner: Wi `SNq 6nA 1—LC Contractor: �� }-,c. rY
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C� L
Address: S7, Address: 325 A_ ` Ch1 �e3'
3AM
Phone: E-mail: Phone: State License NumberAic D0exs/a__?
Bonding Company: M rt age enderx
Address:
Architect/Engineer:
Address
Plan Review Contact Person:
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. 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.
Acceptance of permit is verification that I will notify the owner of the property of t r irements of Florida Lien Law, FS 713.
Signature of Owner/Agent Date Signature of Contractor/Agent
r
Print Owner/Agent's Name Print yontractor/Agent's
Signature of Notary -State of Florida Date Signature of Notary -State of Florida Date
THOMAS M. MILLER
so W'4 NOTARY PUBLIC - STATE OF FLORIDA
COMMISSION # DD446174
^t o;: -.��
/29/2009"t�,��&A
Owner/Agent is _Personally Known to Me or Contractdh�js _ BO onall K vv �%g Nt�{'ARY1
Produced ID _ Produced ID
APPROVALS: ZONING:
Special Conditions:
Rev 07.07
UTIL: FD:
ENG: BLDG:
i
LIMITED POWER OF AT'T'ORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: 7
I hereby name and appoint:
an agent of:
(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 one option):
❑ All permits and applications submitted by this contractor.
U-'- The specific permit a}kd application for work located gt:
(Street
Expiration Date for This Limited Power of Attorney:
License Holder Name:
State License License Number:
Signature of License H
STATE OF FLOA
COUNTY OF
The foregoing ins rumentwas,a�j wle ged fore me thisAday of ,
200, by(tif - /� who is Wpersonally known
to me or ❑ who has produced as
identification and who did (did not) take an oath.
JAM
Signature
(Notary Seal) ���� THOMAS M. MILLER
ll `T y )-Alg'FAF�.X-RUBI.IC - STATE OF F1 nRIDA
PntV-.V
nMMISSION # DD446174
':. EXPIRES 29/2009
Notar}s'`ttb7ic - mfr - - Ti
Commission No.
My Commission Expires:
(Rev. 3/27/07)
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