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/ tc (Sjr CITY OF SANFORD PERMIT APPLICATION
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Permit # : J — ' Date: U
Job Address: 0 1 nEdGie'wafeI/ 0 ro e– -G! n f o(A I'LL 3 2J %
Description of Work: Q_e S1 ll ep �) P' L 1__eX l Q E
r 0
Historic District: Zoning: Value of Work:
Permit Type: Building Electrical Mechanical Plumbing _X 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
Plumbing/New Residential: # of Water Closets Plumbing Repair – Residential or Commercial LS
Occupancy Type: Residential� Commercial Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
- -.. tI - e) o ll-Cift„�f1hnn -f1I_%t,7)
Bonding Company:
P n'1n Phone: q6,7 — .2 0 2',?,76 3
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. 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 PAYi "TTG
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 verifrcati n that I will notify the owner
off the/property of the requirements lorida Lien Law 13.
14-1
gnature of O ner/Agent Date Signature of Contracttoor/Agent Date
JAMES
SM i 7 PautL (i r1QId f
Print Owner/Agent's Name Print Contractor/e
n.ARKS
a — _ Notar
f F.'�:.
Signature of Notary -State of o '; � r �� ,. ",.mss DWI Signaturevt4QIWat �
1 b. 8, 2008 Date
7116reOM r0[T??li., 6 in DO 344597
Fbri : F
Inc.
Ow en T Perso ... „i Contractor/Agent is Personally Known to Me or
roducedlD Produced ID
APPLICATION APPROVED BY:(%L 1 t% 5].nmg: Utilities: FD:
(Initial & Date) (Initial & Date) (Initial & Date) (Initial & Date)
Special Conditions:
POWER OF ATTORNEY
Date --O k9l) [ q, 20 0
of ereby name an appoint tin n'S 12a1 /10.1 I
to act for me an apply tot ' � to be my lawful attorney in fact
t plumbing for — Building Department for
p g permit for work to be p, ormed at a location described as -
Section Township Range Lot Block
Subdivision—�1(0 .000 (2 1O 10 3
�I -��r r(L�or4 L 3 Z� -73
�^ n (Address of Job)
Ivwner or rroperty and Address)
and to sign my name and do all things necessary to this appointment.
() - I n . i
Type or print name of Registered Contractor
Signature of Registe ed Contractor
The foregoing instrument was acknowledggd. , before me this day
Of ) Otl by Q�a ��G� 1 (1�c 1�� who is personal) known
to me/who produced as identification and who did not take an oath.
State of Florida County of 6, -
Commission # n
My Commission expires -
(Notary
R. CRAIG PARKS
Notary Public, State of Florida
My comm. exp. Aug. 8, 2008
Comm. No. DD 344597