HomeMy WebLinkAbout1316 Mellonville Ave (2)CITY OF SANFORD PERMIT APPLICATION
Permit #: D
Job Address: I 6 L L
2A. u t L. L T 0-V t= 3`Z
Description of Work:Z--
Historic District: Zoning:
Value of Work: S 1 o O -
Permit Type: Building Electrical
Mechanical Plumbing Fire Sprinkler/Alann 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 M
Address:
(Attach Proof orownersh•I & Legal Description)
I �D t t�C'�et`f T ---)r
a 1'honr. �•T7 � � � 3--z-T�
—lam V State License Nlwabcr: L C. L V_
Phone & Fax:�Z 0 �h�ct Person: IF�Yl.4h Yi UC�C./� Phone:
Bonding Company:
Address:
Mortgage Lender:
Address:
Arclutect/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, IIEATERS, 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 allapplicable 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 Olt 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 properly 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 pen it is verification thaw will notify the owner of the property of the requirements Fl ion Law, FS
Print Vivncr/pmt's
of
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F,.,
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a'!tt ro . —
�= NOTARY PUBLIC, STATE OF FLORIDA
MY Comm. Expires DEC. 2, 2008
AP W APl`BM JX
Initial ate)
Special Conditions:
i
Sig l at of C tractor/A&A Date
P actor/Agent's Name
i
r
S gnaturc o Nofafy} to cif•.I'I'orj i�.13 a
?''JJ MY COiAAtSS LAP4TON
tON # pG 7
L-110j-,�-No,wy�XFfCES: r" IbruarY 25, 00491
FL to 2007
Contractor/Agent is _ 'ersonall, Knowrnloiv oor
Produced ID
Utilities:
(Initial & Date)
FD:
(Initial & Date) (Initial & Date)
AFFIDAVIT
RE ARDING ROOF DRY -IN AND FLASHING INSPECTIONS
i
Company: C o [. f_ oo !nLicense #: GC- C- o o
aye 3z��
Project Information
Owner: v`- Permit #:
n4ne
V Yom. Subdivision:
D Y a(d'driss ,—� w t
- 3Z 3- O'�D b') Lot #:
phone
I, e�(ffiant, hereby affirm that I am the duly licensed
contractor of record for the above referenced permit, that all the foregoing information is true
and accurate, and that the dry -in, flashings at the above referenced address or lot has been
installed in accordance with the applicable codes and standards.
Contractor: ax
signat
printed name
STATE OF FLOTaA
COUNTY OF P�►�l.�u-��
This instrument was acknowledged before me thi '76 day of , 20 VS by the
above referenced individual, ( , who acknowledged that he/she is a
duly licensed contractor with , and who acknowledged that
he/she was authorized to execute this document. He/she is e' ersonally kno to me or
produced as vali i en 1 1 a ion.
WITNESS my hand and seal this Z 6 day I
DAFNEY FAYE ADCOCK
b' NOTARY PUBLIC, STATE OF FLORIDA
MY Comm. Expires DEC. 2, 2008
COMMIS 0 OD376609
POWER OF ATTORNEY
Date: o Z e o
I, Andrew J ndy-) Adcock do hereby authorize Ruben. Birch
To pull the Re r o o f permit for (�.� L
(type of permit)
�;z
N
Stamp
DAFNEY FAYE ADCOCK
_. NOTARY PUBLIC, STATE OF FLORIDA
^, as MY Comm. exp(ra1 CgC, 2, 2008
COMM, 0 0035609
--e'er cn e or driver license # , of State of Florida, County of
b day of
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