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HomeMy WebLinkAbout2491 S Park Ave (2)Permit #� Job Address: CITY OF SANFORD PERMIT APPLICATION Date: Q , / 0 - U q Description of Work: In'), Historic District: Zoning: Value of Work: Permit Type: Building Electrical Electrical: New Service — # of AMPS Mechanical: Residential Non -Residential Plumbing/ New Commercial: # of Fixtures Plumbing/New Residential: # of Water Closets Occupancy Type: Residential Commercial Construction Type: # of Stories: Parcel #: Owners Name & Address: Contractor Name & Address: Phone & FaxJ - Z60- Uc i56' Bonding Company: Address: Mortgage Lender: Address: Architeet/Engineer: Address: Mechanical Plumbing Fire Sprinkler/Alarm Pool _ Addition/Alteration Change of Service Temporary Pole Replacement New (Duct Layout & Energy Calc. Required) # of Water & Sewer Lines # of Gas Lines Plumbing Repair — Residential or Commercial Industrial Total Square Footage: _ # of Dwelling Units: Flood Zone: (FEMA form required for other than X) Proof of Phone: —tO / Legal Description) / State License Number: G FLS o 5 7 cf Contact Person: V L IP � l�L6z f 1. Phone: 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. Z'73 Sr - 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 aszwater management districts, state agencies, or federal agencies. Acceptance of permit is verification that I will notify the owner of the property of the requ�crrydt3ts of Florida �ien I,a ,IFS 713. Signature of Owner/Agent Print Owner/Agent's Name Date Signature of Notary -State of Florida Date Owner/Agent is Personally Known to Me or Produced ID APPLICATION APPROVED BY: Bldg:Zoning: (Initia Special Conditions: g lteIC-q Date JJASc Q Date * * MY COMMISSION # DD 16428 N, e EXPIRE ovember 12; 2006 9rF Bond udR' N. -M sGSR n to Me or Contractor/Ag,nds Persona iy Produced ID (Initial & Date) Utilities: FD: (initial & Date) (Initial & Date) I hereby name and appoint Of r �+ 1n Gi= J Date: 01-Io-oy p to be my lawful attomey in fact to act for me and apply to for a permit for work to be perforated at a location described as: Section Township Range Lot Block Subdivision 4 q( S. (Address of (OWMW offtVaty and Address) and to sign my name and do all things necessary to this appointment. (Type or Pzhrt Octad and Luse (sem of ed C= tecoor) AcI owledged: Sworn to and subscribed before me this _ Day of k LaQjW kAl A.D.p� Notary Public, State of Florida (seas) My Commission Expires: �u� y ©O MICHELE A 'AWATSKY Nottxy Pu )II -hate of Florida NvCOM,nM nExpiW An24.2W8 �,,i, , ��;.' Commission # DD331967 I ,�.."„ Bonded By NO*ml Notary Assn. FLORiDA,PUBLIC UTILITIES 386) 668-2600 FAX (386) 668-2692 Permit # License # License Holder �S Builder Address a4a 1 MzrA t" 5, Pgntl� AV -L t: Lot # Gas type Qat LP Type of Pie CSST Galy. Lon est Run 110, Appl. BTU Load Range 50,01>0 Water Heater Notal load @ I2�oQ Sizing table used: .r 2 &1P