HomeMy WebLinkAbout2215 Oregon Ave (2)09/08/05 10:46 FAX
Z002/002
CITY OF SAIgFORD PERMIT APPLECATION
Permit # : V Vag �� Dale_
Job Address: 1! I �` t�1� G!'1,�� UN
tion
Descri of S U `�; ! \?1C�C_g��,,t,� q
Description 1 i'4 wC�; Ct l 1tt� �� V rii.x �( �1.•-tY- -- --- �tl� -\ t
Historic District: _ Zoning: Value of Work: S `� &�, 00
Permit Type: Building -�)4— ElCcLncal __ Mechanical - Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service -f; of AMPS � Addition/Aileration Change of Service Temporary Pole RECEIVED
Mechanical: Residential Non -Res -dent a! -_- ReplacementNew (Duct Layout &Energy Calc. RcGttCij�
P!umhing/ New Commercial: 2 of Fixtures r of Water & Sewer Lines # of Gas Lines J[1_ 2009
?iumbiugiNew [Residential: Tt of Water Closets — _._ J Plumbing Repair - Residential or Commercial
Occupancy Type: Residential Commercial :r+dus ial 1 otal Square Footage: _
{'Onctru rtinn Tv PC: ?! �f ^,;;" _. v,�cli,'ii uniis: Flood Z,une: ___ (FEMA loan required for nater [Ban X)
iA61161 Fruui of 0VVIIership & Legal Description)
d
00
-- C -1 Ll t- .1 a LV\ X--- �/+'� --- Phone: ---- - - -
d .A dresa' Cr i(liti 7 (_I , P",j le, L 3��y ppp
-C=
..
epi� ��Q 9� o.act....-soi'. .) it.. l dsd�.. Phtine:_�O%`Zgj�l�V
Address:
AmhitecUE.ngineer:
�tarre:
Ap^Li :;;+,�C^. ••: t.^ -v.!;.• r,�rir fa n^Cci. z -_•-., ; !o de `hc ..... and it c;3!!gtior:b a_ ..._.�iic�1. ! �e lily E.t2r no wot:[ :)r instaiiation has commenced prior to the
issuance. of a ern'.it and that all wzk -will be rori'ormed to ma . s;andards.of a!1 -loos -ec ;adno c =s4� c c• i.: hts juLisdic[ion. l understand that;; separte
v —i—mart + t:ecured for 6L,cCT;,iCAY,,.wi RK, PLIJMtJ1NC" SIGNS, WELLS, POOLE, FUr-NACLS, BOILS", HEATERS, TANKS, and
l+.}K :.U:V V L L IUI4CRJ; erc.
APFIDAL IT: i certify Tlizt all of the foregoing ia:r.rm_ ior'is accum.-.e arc4 thst all work will be drse in compliance with all applicable laws regulating
O, IN"N'G TO OWNE YOU: -iii-JRE TO RE-. OR:: _, NO T iCE OI: COIvIM1 NCITtvIEIII •f MAY RESULT IN YOGR PAYING
PRIDPER1 1. Lf Y UU 1N t eND 1U UU I ALN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY 6FFORE PECORDING YOUR NOTICE OF COMMENCEMENT.
NO i_ICE: 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
"' al pa.;, fro,., utLcr goveutmemai entities such as water management districts, state agencies, or federal agencies.
Acceptance of permit is Verification Gnat I will notify the o•.Vt1er of the property of the reouiremens of Florida Li I.,,w, FS ?l3.
Signature of Ow dAgent Date SiLnature o�f C~ontractor/Agent Date
Print Owner/Agent's Name _ Print Contractor/Aeent's Name
/ Signa[ of Nd ry-State of 1
7B0ndCd
ENN fE S Z
MMSION DD431161XP. onoThru is i6�tOFS
APPLICATION APPROVED BY'Bldg:
Special Conditions:
s - s -mss
q\ad
! Date Signatur�LtBTZQpiaMUSf fT idtf'd""' 'Date
— aP 'f My Commission DD229486
'Pia Expires July 06, 2007
Known to Me Contractor/Agent is _ Personally Knownito_Me or
Produced ID
Zo Zo"- 0�5- Utilities: FD:
(Initial & Date) (Initial Dace) (Initial & Date) (Initial & Date)
10, ccs 117 J.7: ZS VAA
POWER OF ATTORNEY
Date:
CORPORATI�. f7]jon��un
I hereby name and appoint E) --,5z to O of
yQ-Cto be my lawful attorney in fact to act for me and
apply to the C %� . O V'
Building Department for a F� '1Cc permit for work
to be performed at a location described as:
Section Township Range __ Lot Block
Subdivison
( Address of lob )
r3tor f ,Sor) 10 c 1S 1 Ste• h�na�, �G S \ c . 0 (7
( Owner of Property and Address )
and to sign my name and do all things necessary to this appointment.
Lc: 11 ,�IQ cc so ,-, C)C L
Type or Pri a f Ceritifed Contractor and Contractor's License Number
" Signature oC ified Contractor
\�.
The foregoing instrument was acknowledged before me this d9 day of 200_
V ,1 Cci
Who is personally known to me/ who produced
As identification and who did not take oath.
State of Florida
County of
Seal
Notary Public, Orange County, Florida
meooe Rtherdw