HomeMy WebLinkAbout101 Maplewood Dr (3)Permit #
CITY OF SANFORD PERMIT APPLICATION
DS - a a--1-')- Date: )0-3-05
Job Address:
Description of Work:
Historic District:
Permit Type: Building Electrical Mechanical Plumbing'y 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 I
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential tZ Commercial
Construction Type: # of Stories:
ri Co PJ-k�.—
Plumbing Repair - Residential or Commercial
Industrial Total Square Footage:
# of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: (Attach Proof
/oof Ownership & Legal Description)
Owners Name & Address:
Phone:
Contractor
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Contractor Name & Address: Ilti f�Jx t �JLe d i rU SSL S; 1i V cr- P, - � • , n -t.�CO-� C 0
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State License Number: G ---PCS- 6 ) (o (1 , q
Phone & Fax:` o -i- a -I 3 -i0 i - Contact Person: � alll- � /C ntj)� ( ( Phone: q0 7 - a 13 -6 �S1q
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. 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. 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 the require ents of Florida Lie w, FS 713.
►o - 3-05
Signature of Owner/Agent Date Sg to re of Conoictor/went Date
ecK f v1
Print Owner/Agent's Name Pri i C tractor enf ame
Signature of Notary -State of Florida Date atuEe'ij l>% 7y-$ fiAd@E GAVE Dale
,. MY COMMISSION # DD 16428(
EXPIRES: November 12, 200E
o�41 Bonded Thru Budget Notary Servim
Owner/Agent is _ Personally Known to Me or ContraTctor cent is Personally sown to Me or �l
Produced ID roduced ID P `{ a� -,- �%( aV
APPLICATION APPROVED BY: Bldg:
(Initial & Date)
Special Conditions:
Zoning:
(Initial & Date)
Utilities:
FD -
(Initial
D:
(Initial & Date) (Initial & Date)
LBUTED POWER OF ATTORNEY
I hereby naive and appoint
Date: t,-,-) -3i a
*-" r- o t.e_JC-A S: L-
of AmeriGas Propane to be my lawful attorney in factt to act for me and apply to
cel for a ��, permit for work
to be perfonned at a location described as: Section Township
Range Lot Block Subdivision
US
j br "
(Address of Jobb
"o y
(Owner of Property and Address)
and to sign my name and do all things necessary to this appointment.
(Type or Print name of Certified Contractor and License #)
(Signature of Certified Contractor)
--------------------------------------------------------------
ACKNOWLEDGEMENT CERTIFICATE.
State of Florida
County of Orange
t�
The foregoing instrument was acknowledged befor me this day of
5t t M t,( , 20 6S , by �, G� 1 J l� o v4c- 1
who is personally known to me, as Ce_rti Contr fctofor AmeriGas Propane.
SlgnLuib of Public, State of Florida
.••••� RE�WS J, HC)LLOWAY
NOTARY PUBLIC - STATE OF FLORIDA
COMMISSION# DD233012
':'',? �►?:� EXPIRES 7116/2007
BONDED THRU 1-888-NOTARYI
Print. Tvve of Stamp Commissioned Name of Notary Public
�,j :50-7-7 (
SKETCH PAGE
WORK TOBEIDO�I D -d � �°2 c-A-J
v I L tXs.c-i - 7- ; 2 Y Y 1(./
Suggested Delivery Schedule:
Monthly (77) J F M A M J J I A S O 1 N D
(Indicate with an "X" the MONTHS for delivery)
Daily (66) S M T W T F S
(Indicate with an "X" the DAYS for delivery)
Weeks: A B C
Other (Specify) D
(Indicate with an "X" the WEEKS for delivery)
(FRONT)
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