HomeMy WebLinkAbout103 Acadamy BlvdPermit# : 0 7,3g;o -c
CITY OF SANFORD PERMIT APPLICATION
Date:
Job Address: /02� -11CgQ1a0-/% /QfVG / y
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Description of Work:.= 1/ 00 1/v /f 2a a wr� C; . --ul T �i-c/ !`'!' ,�-7�;s�aS 4 ter,
Historic District: Zoning: Value of Work: $ / , /Dur d0
Permit Type: Building Electrical —X— Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/Alteration X 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 #:
Owners Name & Address:
(Attach Proof of Ownership & Legal Descript
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Phone:
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Contractor Name & Address: G/ff0 / S 1�6 C 7-,- � C j ��C - / 5"2 46 &,
do g W00 . 3 5so Siate License Number:
Phone' Contact Person:
Rnndinn (mmnanv-
Address:
Martnane Lender:
Address-
Ce 1"Ke Cr'Z,
E�?00111321
'Phone: 1/U—n
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 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 requirements of Florida Lie
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Signature of Owner/Agent Date Siig�n__ " e of ontractor/AA t Date
Print Owner/Agent's Name Print Contractor/Agent's Name
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Signature of Notary -State of Florida
Owner/Agent is _ Personally Known to Me or
Produced ID
APPLICATION APPROVED BY: Bldg:
(Initial & Date)
Special Conditions:
Date
Zoning:
of ate of Florida
DEBBIE BLANTON
h"y CC)M 'SSION # DD 188491
EXP RELS: Eebrun- gr n—
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Utilities: FD:
(Initial & Date) (Initial & Date) (Initial & Date)
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1578 Grace Lake Circle • Longwood, Florida 32750 • (407) 767-5661
POWER OF ATTORNEY
I, Scott L. Geesaman, of Carroll's Electric, Inc., hereby appoint Daniel S. Roth, of
Carroll's Electric, Inc., as my attorney in fact to act in my capacity to do every act
that I may legally do through an attorney in fact. This power shall be in full force
and; effect on the date below written and shall remain in full force and effect until
D'ec. r 31, 2005 or unless specifically extended or rescinded earlier by either
pa -
Dated 09/15/04
By:
Scott L. Geesaman, President (ER0011134)
STATE OF FLORIDA, COUNTY OF SEMINOLE
BEFORE ME, the undersigned authority, on this 15th day of September, 2004
personally appeared, Scott L. Geesaman, to me well known to be the person
described in and who signed the Foregoing, and acknowledged to me that he
executed the same freely and voluntarily for the uses and purposes therein
expressed.
WITNESS my hand and official seal the date aforesaid.
NOTARY PUBLIC: dzcn
My Commission Expires: � o-vw-oc rY 2Z, Zao
lawfi;� : KELLY HOWARD
MY COMMISSION # CC 995090
EXPIRES: January 22, 2005
Bonded Thru Notary Public Underwriters