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HomeMy WebLinkAbout437 S Scott AveCITY OF SANFORD PERMIT APPLICATION //`` Application # : V ­7� ©� Job Address: t-13-) S • SC_tD 7T,}l)e. SIwIa2o FL Parcel ID: Zoning: Submittal Date: Value of Work: Historic District: Description of Work: Ul (?0�9C W(Jt a (-ryw is-oA In 2-0col14 Square Footage: Permit Type: Building ❑ Electrical OF Mechanical ❑ Plumbing ❑ Fire Sprinkler/Alarm ❑ Pool ❑ Sign ❑ Electrical: New Service — # of AMPS 2CX> Addition/Alteration ❑ Change of Service qr 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 Occupancy Type: Residential �f Commercial ❑ Industrial ❑ Plumbing Repair —Residential ❑ Commercial ❑ Occupancy Use Group(s): Construction Type: # of Stories: I # of Dwelling Units: Flood Zone: (FEMA form required ) /"r ..........................p....................................................../....................................... Property Owner: �TCJ" Isrr, '14-k Contractor: PJ4tlryA1'Q L F_ 142C—Te" C. t Address: L137_,S- S S&aTr AU -e— Address: u-2",w2_:2Ar47� 4-44- C),1,4 R 4NT_0_421p r C- _? l I 15,`" -mm2e c FL 2 (7 CIL( Phone: L(C0 -221'69yl E-mail: Phone: 4(0T-Irl�Y61667_9tate License Number: EC •vim (8 J'6 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. 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: 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. 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 1 will notify the owner of the property of the requi nts of F r Lien L , FS 713. IK Signature of Owner/Agent Date SW r o Con ractor/Agent Date 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 02/2007 UTIL: FD: Prin tractor/ nt's Name Signature of Notary -State of Florida Date Contractor/Agent is Produced ID ENG: MY COMMISSION # DD62-9 9 EXPIRES: February 25, 201 l . w s1 Notary Discount Assoc Co. BLDG: �Ql " • EL ECTRIS- 875 Jackson Avenue Winter Park, FL 32789 POWER OF ATTORNEY I hereby name and appoint) e—y A� Aaw of 875 Jackson Avenue, Winter Park, Florida to be my lawful attorneys in fact to act for me and apply to the c2E S14 -PJ Fl -',n O for a 9 (el-- -1-9,t CAL permit and to sign my name and all things necessary to this appointment. PALMER ELECTRIC COMPANY rff4/61,im ROBERT N PARKER III Signature of Certified Contractor, EC0001858 875 Jackson Avenue, Winter Park, Fl. 32789 State of Florida, County of 5e e0 la - Sworn a.Sworn to and subscribed to before me thisD media. of ire 0 Signature of Notary Public Personally known: V LAFo=\POWER OF ATTORNEY (Ore alarm).DOC 1/4/2007 P�'%yP , DANIELLE I. ROUSE MY COMMISSION # DD486941 O o�ll EXPIRES: OcL 30.2009 (4p7) 399-0163 Fioride NOISTY Service.com