HomeMy WebLinkAbout1200 S Scott Aver5im
CITY OF SANFORD PERMIT APPLICATION
Permit # : 0 V 1
Job Address:
Description of Work: X /t/6
Historic District: Zoning:
Date:
evv f l SSPer r k'GJ
Value of Work: $ YO 5,
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/AIteration Change of Service Temporary Pole
Mechanical: Residential —>�— Non -Residential Replacement K 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:
Contractor Name & Address:
Phone & Fax:
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer
Address:
(Attach Proof of Ownership & Legal Descrip y' n
�A r 1 0 S 9i0 �l
` Phone: — 0
r, S l MAIP C6,4 -d .I.�URAr e-
Vl K5 State License Number:
Contact Person: �.s
12,1,411% Phone,
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 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 verifica n that I will notify the owner of the property of the requirements of Florida_Lien Law, FS 713.
Signature of Owner/Ag t Date Signature of Contractor/Agent Date
:10A,l C
Print Owner/Agent'h Name Print Contractor/Agent's Name
,oOSignature of Notary -State of Florida Date Ooo�ignature of Notary -State of Florida Date
Owne Personally Known tom° e or
rroduced I L C; -Go 13J . / 00 F�
APPLICATION APPROVED BY: Bldg:
(Initial & Date)
Zoning:
Contractor/Agent is _ersonally Knownto or
Produced ID
(Initial & Date)
Utilities: FD:
(Initial & Date) (Initial & Date)
--------------------------•
Special Conditio «n««•uu«uu•u.«•••u•n•y
Canna 000424342 r Comm>7 000424342
Expires tIH/200p
�.(j�,A► .`' Expires limmi Y
M)IN oonded On (800)4324254: ted Il
Baw, (100)432-4254_
florida Notary Asan., Inc
........
I
r"
i
POWER OF A'T'TORNEY
To Whom It May Concern:
I, Brian Wrong, a legal resident of Orange County, Florida, have made
Constituted and appointed and by these present do make, constitute and appoint
whose business address is 980 Railroad Ave,
Winter Park, FL 32789 to execute, acknowledge and deliver in my name and all
application for mechanical permits to be signed in my name and a contractor license
under laws of the State of Florida pursuant to Chapter 489 Florida Statutes, in the
following counties in the State of Florida: Lake, Orange, Osceola, and Seminole, and
any and all cities or municipalities located in any one of the aforesaid counties,
together with and all other related documents or agreements reasonably required to
obtain such permits.
Job Location:
S Sc, �� Cu wl
.rx, a v'y' L F
Brian Wrong
Owner
Crums Climate Control
Sworn and subscribe before me this day of 06-4 L,",- , 200}
by Brian Wrong who is personally known to me and who did not take an oath.
ROM OCONNOR
Notary Publiccon+rcMI24M
VVIr" 2x1=0 e
at awdw Rau (mss -4254:
FFlorida Notary Asan., Inc
MeS...a«.e............................