HomeMy WebLinkAbout2565 Park DrJob Address:
Description of -Work: -
Historic District:
Zoning:
kso c) C),
CITY OF SANFORD PERMIT APPLICATION
Dater
Permit Type: Building Electrical 4C_ Mechanical Plumbing Fire Sprinkler/Alarm Pool _
Electrical: New Service – # of AMPS Additio Alteratio 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 ommercial
Occupancy Type: Residential Commercial � Industrial Total Square Footage:
Construction Type:. # of Stories: --I— # of Dwelling Units: _L__ Flood Zone: (FEMA form required for other than X)
Parcel #:
-Owners Name & Address:
Contractor Name & Address:
Phone -& Fax:
Bonding Company:
Address:
Mortgage Lender:
Address:
(Attach Proof of Ownership & Legal Description)
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.
Acceptance of permit is verification that I will notify the owner of the property of the r uirement lorida Lien Law, F 13.
Signature of Owner/Agent Date gnature of Contractor/Agent .. Date -
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is _ Personally Known to Me or
_ Produced ID
APPLICATION APPROVED BY: Bldg:
(Initial & Date)
Special Conditions:
Zoning:
ri-ontracroue,genr s tx �, p
S' ture of oItaryistat LQFII A. DE GRAVE Date
* MY COMMISSION # DD 164280
0EXPIRES: November 12,2006
s��TFOF F-,�\o¢- Bonded Thru Budget Notary Services
Contractor/Agent is Personally Known to Me or
Produced IDiNA-9 '�1 S'�_SC - g2009
Utilities:
FD:
(Initial & Date) (Initial & Date) (Initial & Date)
POWER OF ATTORNEY
Date: ' fj Z,c
r
I, . , , do hereby authorize R. U t,_, !A' -
to pull the t�te4 L permit for
type of permit
address
Notary
Personally known to me or drivers license �2/IV
State of Florida, County of Oleon day of
ii Y
GUDRUN CARN
MY OOM4 EY
EXPIRESSION # DD 201224
aolnedn,m APri119,2007
Notary
c U^Mers