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HomeMy WebLinkAbout2119 S Sanford Ave-aVPermit # : Job Address: ?—I I L S CITY OF SANFORD PERMIT APPLICATION awF-off Ade— Date: Description of Work: R(,9.7o r APP"Y. 06&. 1EAST -UVe- _ OF ZNP ,5] 047 Historic District: Zoning: Value of Work: $ d-5-0.00 Permit Type: Building Electrical Mechanical Plumbing 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 Occupancy Type: Residential / Commercial Industrial Total Square Footage: Construction Type: # of Stories: Z- # of Dwelling Units: Flood Zone: (FEMA form required for other than X) Parcel#: 31-19- 31 932-0 (Attach Proof of Ownership & Legal Description) Owners Name & Address: SCZtf-S Dsz-i+ MAS 2-1 11 S. SA*Jr-o0-D A-Ve- 54-OPv�D /1L- 327 ,PPh�one: 4©7 532- Ss3b Contractor Name & Address' n . L' Q-1 ca,,,% Ind f 1,4*, G-C'Nr-RA-L % miz • T we • `J _3412- S,,Ct �Q ,"tV Q. • S�FOA-� AL 32-773 State License Number: c e- / 3 Z S6 7S Phone & Fax: 3Z I ' Sb" (j % I 7 Contact Person:Toe- STD po 1'+ Phone: 3z/-2-77 2 018 Bonding Company: Address: Mortgage Lender: _ Address: Architect/Engineer: Address: 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 verification that I will notify the owner of the property of the requ' ents of F171, n Law, FS 713. /o-Zg—oy- Signature of Owner/Agent Date tgnatu e of Contractor/A ent Date e-� 3J o,v,k A - 1TU DO LA - Print Owner/Agent's Name Signature of Notary -State of Florida Date Owner/Agent is _ Personally Known to Me or Produced ID Print Contractor/Agent's DEBBIE BLANTON MY COMMISSION # DD 188491 it i �XPIREP: FebrY�ry 5, 2007 ersona y own tQ i ;pV :R- Notnry Discount Assoc. C:c APPLICATION APPROVED BY: Bl g rngp Utilities: (Initial & Date) (Initial & Date) Special Conditions: FD: (Initial & Date) (Initial & Date) Date: 10—Z-5-,04 I hereby name and appoint POWER OF ATTORNEY Do G-^ /� C� L r Of �'1'L(1.1Ca.iti %v�l/✓�' , � eeLq� g�/y7'�c to be my lawful attorney fn fact to act for me and apply to the Sem 1AII/c, Coawry r y Building Department for a le APOF permit For work to be performed at a location described as Section Subdivision Township se Range Couw_ T I I - l0j - 31 - s'/I -0000-0-32.0 Lot Block 1Vt,51 Z 119 S SA-av Ove- ,� %y�� G 3Z-7-71 (Owner of Property and Address) and to sign my name and do all things necessary to this appointment. �CHi �✓ /ot pe""n I> Type or Print Namo Register or Certified Contractor and Contractor's License Number of Register or Certified Contractor The foregoing instrument was acknowledged before me this ;�s day of. ock_�De,_ of 20 O � I: czC Who is personally known to me/who produced QDL M9_31"�w3?DC) As identification and who did not take oath. State of Florida County of S-r,�' k i n\ -4e Notaryis range County, FI a •`•""r"'"�• `•• SIA 4. MEGAN B. VANDEN BRINK s Notary Public - state of Florida ' E MY Commission Fops Aug 5,20M d Commission 9 DD113009 Bonded By National Notary Assn. Seal REGARDING ROOF DRY -IN AND FLASHINGS INSPECTIONS. � j,,, AFFIDAVIT COMPANY: H nexi cat/ A -0,01-v, LICENSE NO: _ C CC I -2, Z 's-6 q� PROJECT INFORMATION SUBDIVISION: ,� �S p L1 a - T - ADDRESS: 2J19 Y, Si+.) f'0xb Ave-- '94Nr-vK-D El- 3z-72 1 PERMIT NO: LOT: I, 1 affiant, hereby affirm that I am the duty licensed contractor of record for the above reference perm(t, that all of the foregoing information is true and accurate, and that the dry -in, flashings at the above referenced address/lot has been installed in accordance with all applicable codes and standards. CONTRACTOR"6fi_e -/_ -/// 0 (Printed in (ignature) STATE OF FLORIDA COUNTY OF This instrument was acknowledged before me this Sf� day of _� � _a;& S by the above referenced individual, M3j,, 1 5-- who � who acknowledged that he/she is a duly licensed contractor with e. Nyzl5f'�� L & i a?b C3 andwho acknowledged that he/she was authorized to execute this document- He/she is either personally known to me or produced Rx_ (�f1 a �^ C��C�j� as valid identification_ WI'T'NESS my hand and official, seal this day of _C_din""o f ,,•"",,,., MEOAN B. VANDEN ®RINK otary P lic S Notary Public - State of Florida ' Ah'�m EVkMAug 5,2W6 Printed Name: f` �`� COMMiSSion 0 OD113009 °' Bonded By National Notary Assn. -My Commission Expi