HomeMy WebLinkAbout1119 S Myrtle Avew«dYvgf�
CITY OF SANFORD PERMIT APPLICATION
Permit #: f' 1 Date:
Job Address: 111 1 S - rVkIATiri- ,out-- Fi_ 32 -?7''(
Description of Work: 7NF.I
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Historic District:
Zoning:
Value of Work:
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
0q
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 J
Plumbing/New Residential: # of W ter Closets Plumbing Repair — Residential or Commercial _
Occupancy Type: Residential 7 Commercial Industrial Total Square Footage:
S�PcG.
1. A" -IEIP-
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FFMA form required for other than X)
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
(Attach Proof of Ownership & Legal Description)
_�yS,tate�Liiccense Number:�(p 0
Person: /abI��IL'� ittlj(—Et, Phone:,_ -660—J2159
Phone:
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 regulatine
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 applicab to thisOeth
may be found in the public records of
this county, and there may be additional permits required from other governmental entities such as t a cts, state agencies, or federal agencies.
Acceptance of permit is verification that 1 will notify the owner ofthe property ofthe requireme 713.Signature ofOwner/Agent Date Signature of ContracDate
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is _ Personally Known to Me or
Produced ID
APPLICATION APPROVED BY: Bldg O 44m gi
(1 ilial & Date)
Special Conditions:
Print iCc1ntractodAeent's
/V / r1" /Uy
N to ofFanrid�lE B `Y date
&EiA CANTON
MY COMMISSION # DD 188491
w EXPIRES: February 25, 2007
t� gNOTAR�erSOrfiil
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r6L- Ta3y--) i. 6 3 - a
(Initial & Date)
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Utilities: FD:
(Initial & Date) (Initial & Dat )
POWER OF ATTORNEY
Date'.
I, ,%At,J C l _ do hereby authorize -Zr�c']Jf�t .
�S
to pull the �W n13t N o\ permit for (� c� • N j'ZI i � Aue-
type of permit address
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Signature
Notary
A rJ ro F,$) ` --L- . 3 2-77 "71
Eulynn HartReck
Commission #DD292007
Expires: Mar 26, 2008
Bonded Tluu
ABatficBonding Co.,hr-
Personally k wn to me or
State of Flo da, County of on day of