HomeMy WebLinkAbout3280 W 1 St (6)CITY OF SANFORD PERMIT APPLICATION
Permit # : i^ C L/ � Date: #— //�,(� 0 /
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Job Address: 3 r-86 �" , /s 1 6 � 5,0q- , 'T
Description of Work:
Historic District: Zoning: Value of Work: $
Permit Type: Building Electrical echanical 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: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #:
Owners Name & Address:
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Name & Address: A 2
M n ^),/C)" 40 L
Phone & Fax:
Bonding Company:
Address:
Mortgage Lender: .
Address:
Architect/Engineer:
Address:
(Attach Proof of Ownership & Legal Description)
O �' s? Phone: `Y � ;? - 3 -7 -
e�'ZLical `S 5&;X1s
Contact Person:
State License Number: c� e �Q .(.� 3 01._
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 requireme is of Florida Li Law, FS 713.
40
Signature of Owner/Agent Date Signator of Contractor/Agen Dat
IL ZGL
Print Owner/Agent's Name Pri r Contractor gent Name
2
Signature of Notary -State of Florida Date
Owner/Agent is _ Personally Known to Me or
Produced ID
APPLICATION APPROVED BY: Bldg.Y 10-b III 19 J DZoning:
(Initial & Date)
Special Conditions:
(Initial & Date)
DEBBIE BLANTON`
MY COMMISSION # DD 188491
is EXPI%*di9l t3%7Me
o Av FL Notwv Discoupt'Assoc. Co.
Utilities: FD:
(Initial & Date) (Initial & Date)
POWER OF ATTORNEY
DATE:—/ I -7-04
I HEREBY NAME AND APPOINT
(.L z ac_. ✓1 �t -e d aU r Vl �-�
OF _NR - 0 K "54 -TO BE MY LAWFUL ATTORNEY IN
FACT TO ACT FOR ME AND APPLY TO THE 0 Z14 .1)r— 9 !Lz
BUILDING DEPARTMENT FOR A C'�U l C GL- ( PERMIT
FOR WORK TO BE PERFORMED AT A LOCATION DESCRIBES AS:
SECTION _,_._...TOWNSHIP_______RANG}$ LOT BLOCK
SUBDIVISION ALL j, -&c _/s
(ADDRESS OF JOB)
-3��� 1.4,) 15 t
1,rArAto . tf-(, 3?111
(OWNER OF PROPERTY AND ADDRESS)
AND TO SIGN MY NAME AND DO ALL THINGS NECESSARY TO THIS
APPOINTMENT.
M t chi ice_. i J. o y
�OR PRINT NAME OF CERTIFIED'
r ^
SIGNATURE OPtERTIFIED CONTRACTOR
THIS FOREGOING INSTRUMENT WAS ACKNOWLEDGE BEFORE ME THIS
BY t �V 1 XPi/ /ve a �'/ /T ✓v
WHO IS PERSONALLY KNOWN TO ARE/WHO PRODUCED
AS IDENTIFICATION AND WHO DID NOT TAKE OA
STATE OF FLORIDA COUNTY OF
MY COMMISSION EXPIRES:
KUBEKT A.
aONDED TMRU i4se.NOTARyt
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