HomeMy WebLinkAbout203 Marc St• 61CO !�
Job Address: "LO'
description of Work:
CITY OF SANFORD PERMIT APPLICATION
Date; 10. 2,U ' q
Historic District: Zoning:
Permit Type: Building Electrical Mechanical —1L, Plumbing Fire Sprinkler/Alarm Pool
Electrical., New Sorvice – # of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: R ecidcrtial ✓ Non -Residential Rcplsoemeatt New V/ (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures # of Wgter & 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 UllitS Flood Zone: (FEMA form required for other than X
Parcel #' J Q Z(f '
Owners Name & Address;
(Attaeh Proof of Ownership & Legal
Phone:
11'' State License Number:
Phone & FaVA Intact Person: Y
Bonding Company:
Address:
Mortgage Lender:
Address;
Archtteetl9rigincer:
Phone:
Address: pax:
Application is hereby made to obtain z 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 eonstrttction in this jurisdiction. I understand that a separate
unit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACE$, BOILERS, HEATERS, TANKS, and
AIR CONDITIONERS, etc.
WN R' VIT; I certify that all of the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
co+tstruction 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 chis 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 entitles 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 req7n1a f Florida Lien Law, PS 713.
10 /LLf
Signature of Owner/Agent Date f Contractor/Agent V Date
Print Owner/Agent's Name Piigpnitur-e:
C}� ctoldl r ge L Name.�
io-a�-G
Signature of Notary-Statc of Flotilla Date of Notary -State ofFlVida a Date
Owner/Agave is _ Personally Known to Me or
_ Produced ID
APPLICATION APPROVED BY: Bldg:
(Initial & Date)
Special Conditions:
1 'd
Contractor/Agent is _ Personally Known to Me or
Produced ID
Zoning-, __._.. __. _.. Utilities: FD:
(initial At Date) (Initial & Date) I(initial & Date)
10Afidma Staiger-Ayers .
ftM t eslon DD026207
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�'or r o0 Expire's 61u Oil, 2005
IT[�1=1W►7AW:JF1JF0r�x�Zl
nL /�1,75 CITY OF SANFORD PERMIT APPLICATION
Permit # : 044 ' 00 U 0 Date: lo
Job Address: b �) (YA /ani � S
Description of Work: W 1 4l A) G 40 061 A QQ / r/U Ad
Historic District: Zoning: aValue of Work: $ / 0 �
Permit Type: Building Electrical X Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/Alteration iC Change of Service Temporary Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Calc. Reggired)
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 X_ Commercial Industrial Total Square Footage:
Construction. Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: O _ Q ' U d)Oach Proof of Ownership & Legal Description)
n
Owners Name & Address: C %,) )Q
�
=J 1 � Phone: _ ) — 3d3 -:139,z
ntractorr Name & Address: Zpm N
' Q 0)(0011' : AX � )3016 State License Number: V U
Phone &( Fax: 11o7 -:f3(2 --!g3 6 Contact Person: 1/k NAL– Phone: qo7 R3 L qoS)
Bonding Company:
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 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.
o
N
Acceptance of permit is verification that I will notify the owner of the property of the requirement FI a Lien 6.aw,
V N
0
Signature of Owner/Agent Date Signature of Contractor/Agent Date
a 3
a
CIIAae� L' OF-/)g
Print Owner/Agent's Name Pri t ntractor/Agent's Nam
161
Signature of Notary -State of Florida Date S gnature of Notary -State of Florida Date
Owner/Agent is _
Produced ID
Personally Known to Me or
APPLICATION APPROVED BY
Special Conditions:
Bldg 10-b 1�►dni�g:l
V (Initial & Date)
Contractor/Agent is X_ Personally Known to Me or
_ Produced ID
Utilities:
(Initial & Date) (Initial & Date)
FD:
(Initial & Dale)
4
LIMITED POWER OF ATTORNEY
10 . i FJo(4
Date
I hereby authorize rs/
of L
to sign his/her name on my behalf in order to apply for a
permit
for the work to be performed (it:
Lot Subdivision
Address_ 2 03 M A k C
_NEiy9Y COM P4N y 4n 00i0'73'6
Type or print name of comVan v and License # of -C—o-11 t—ra-`c—tor
Signature of Licensed Contractor
STATE OF FLORIDA
ORANGE COUNTY
T7►going instrument was acknolIwl
by,I
`I
d before me this Id`k-day of �C _
Zn, of person acknow ging).
(Signature of NotaDian anl7su lic-State of Florida)
ar er
My Commission DD048050
Expires August 10, 2005
(Print, Type or Stamp Commissioned Name)
Personally known_ OR produced identification
Type of identificati n produced__