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HomeMy WebLinkAbout101 Clear Lake Cir (3)a 4 �ft4�rri 4 bV ( l0 11 \`� 4 cy� CITY OF SANFORD PERMIT APPLICATION ; a J / Permit # :_Oc�s — Date: Job Address: J �j 2a. �GL C't r Description of Work: ofCvCz �.Ft�,�Q 4 �oi c �t.�.. I n f e+i rl / r—OIJ Sy f T t �( S �(��'� y Historic District: YOU Zoning: Value of Work: $ T, Permit Type: Building Electrical Mechanical ✓ Plumbing Fire Sprinkler/Alarm Pool 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 Fixtures # of Water & Sewer Lines # of Gas Lines Plumbing/New Residential: # of Water Closets Plumbing Repair — Residential or Commercial Occupancy Type: Residential Commercial Industrial Total Square Footage: Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X) Parcel #: (Attach Pr 00 of Ownership &Legal Description) Owners Naamme�& Address: / G t 1 'Q Phone: Contractor Name &Address: fL[� , ► i�..c . (0 C7//�� I _ ��na rd � FJ (.Q �JZ�i C7 State�L�i�ce�se�Number. Phone & Fax: (� �ri�1�J ��� �� �`j p —� C7 Contact Person: 11,.11 E^�' ' � y10MPhone: WrSEMfF Bonding Company: ` Address: Mortgage Lender: Address: Architect/Engineer: Phone: Address: Fax: 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 Lac, -s e ulating construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN `4'OUN PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER rri,R;'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 fed.era! agencies. Acceptance of permit is verification that I will notify the owner of the property of the requir nts of Florida Li Law, FS 713. Signature of Owner/Agent Date 4Signa f Contractor gent Date Print Owner/Agent's Name actor/Agent's Name Signature of Notary -State of Florida Date f Notary -State of Florida Date / LYN TNxmE' M. CA-R"D MY COMMISSION tl DD44 i 631 +� EXPIRM: Jure 16, NCO Owner/Agent is _ Personally Known to Me or Contractor/Agent is Personally Kno tf$d or�Y n Nim Cq �.n�ac_. r�, Produced ID Produced ID 11P2o'� APPLICATION APPROVED BY: Bldg: Zoning: Utilities: FD: (Initial & Date) (Initial & Date) (Initial & Date) (Initial & Date) Special Conditions: IX i �ND1T101`1G PIR C KNOW ALL MEN BY THESE PRESENTS THAT: PNS I 0,3*41b,�'vW LI "EP�I�G LIMITED POWER OF ATTORNEY SALES - SERVICE - INSTALLATION PLANNED MAINTENANCE I, of , FL, have made, constituted and appointed 1 ([�I(-\drfmy true and lawful Attorney -In -Fact for me and in my name, place and stead: To execute.any and all documents, a idavits, applicaf ns or y other documents necessary to apply and obtain a permit. U lol C�ov� C1z- �� Herebygiving and granting unto m said Attorne -1 Fact, full ower and authority to do and perform all and every g g �' g Y Y p act and thing whatsoever requisite, necessary and proper to be done in and for my benefit as fully, to all intents and purposes, as I might or could do if personally present, with full power of substitution or revocation, hereby ratifying and confirming all that my said Attorney -in -Fact shall lawfully do, or cause to be done, by virtue hereof, unless I have sooner notified said financial institution in writing of my revocation or as so otherwise limited by number paragraph 1 and 2 above. THIS LIMITED POWER OF ATTORNEY SHALL NOT BE AFFECTED BY DISABILITY OF THE PRINCIPAL. IN WITNESS WHEREOF, I have hereunto set my hand to two (2) counterparts, hereof each of which shall be deemed an original, in the presence of the Notary Public in , FL, this day of , 20 Brian actings STATE OF FLORIDA COUNTY OF SS © Q r' %r�Ml ��P Z e arnotary public in and for County and State noted above, personally appeared the above named who acknowledged that he/she did sign the foregoing instrument and that the same is his/her free act and deed. �°� Y Sworn to and subscribed before me this da of O 20 1i -'b Y � who is personally known to me err hm wesoxted_ as identification. No Public ELYNNE M. CARD My (:NMSS0N # DD4416 3`2 ARY mwm: e 16.2009 � y 7110 Overland Road - Orlando, Florida 32810 Post Office Box 607903 - Orlando, Florida 32860-7903 Phone: (407) 295-9231 FAX (407) 298-4730