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Permit # :y
Job Address:
Description of Work:
Historic District:
CITY OF SANFORD PERMIT APPLICATION
Zoning:
6A -F
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 Wa r Closets Plumbing Repair—Residential or Commercial
Occupancy Type: Residential Commercial Industrial I Square Footage: 30QDO
Construction Type: auA If-# of Stories: --L # of Dwelling iJnFlood Zone: (FEMA form requfred for other than X)
Parcel #: -
_1
Owners Name & Address:
Contractor l� & Address:
Phone & Fax:
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
Contact
(Attach Proof of Ownership &al Deser
.�:r� G
Phone:
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State Lice se Nu ber: G `�
o�6l5A�a?Ci 612!6 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.
5W
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 f�
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 itional permits required fro r governmental entities such as water management districts, state agencies, or federal agencies.
Acceptance it ' erifica ' ti tify er of the prope of a uireme lorida Lien Law, FS 713.
Si wner/ ge Date
/ SignatureofContrac gent. Date
Print
(/-2
DV,
Signature of Notary-State-urrllonda Date
` OF Pio DON G00DSON
9 `r
OTARY o MY Comm Exp. 1/9/05
PUBLIC a wner/ nall Known to a or
Prod c `V 4r� Qr
LGL
APPLICATION APPROVED BY: BI �I LVoning: _
(Initis & Date)
Special Conditions:
Print Cgnc or/Agent's Name
Signature of Notary-$iate of Florida
Contractor/Agent is — Pe nail
_ Produced ID rl V
(Initial & Date)
Utilities:
(Initial & Date)
y y Comm Exp. 1/9/05
No. CC 971_W-`
1 ! Petsonaly W W M 14
FD:
(Initial & Date)
�F
DATI
I HEREBY NAME AND APPOINT CKL(S A --I1. OF L� TO BE
MY LAWFUL ATTORNEY IN FACT TO ACT AND APPLY TO THE
SIAIJ �-b (Q BUILDING DEPARTMENT FOR A t?&D F— PERMIT FOR
WORK TO BE PERFORMED AT LOCATION DESCRIBEDAS:
OWNER: 1�OB S t��U CSL
AS WELL AS TO SIGN MY NAME AND DO ALL OF THE THINGS NECESSARY
TO THIS APPOINTMENT.
NAME OF CERTIFIED CONTRACTOR LISCENCE NUMBER
SIGNATURE OF TIF TRACTOR
THIS FORGOING INSTRUMENT WAS ACKNOWLEDGED BEFORE ME THIS
�f�DAYOF Sets-��n1�erZO� BYWHO IS
PERSONALLY KNOWN TO ME.
NQTARY SIGNATURE
PRINTED NAME OF NOVARY
5' �-- 3— "..) b
MY COMMISSION EXPIRES
I
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Caravlo D00=256
r" V'sy Expires 512312008
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1 RAtitil tQ.
Nacre: WA 9400 Setvioes of MRYRNNE MORSE, CLERIC OF CIRCUIT COURT
D Wswam, Inc, SENINOLE COUNTY
mdress: 32M Cobb Gaueria Pips• ate• BK 05467 FIG 1574
204, Atlaatk GA 3033:
CLERK'S ## 2004151473
This Instrument Prgmt.i Or RECORDED 8913i12M 11101F.7 AN
Noma: Pelt'RY Pont RECORDING FEES 14L OS '
Address: 3200 Cobb Col; me Pky. Ste. RECORDED BY S D' Ke11�Py
zoo, Aclantm, GA 3Q339 CERTIFIED COPY
Property Appnim" parcel - MARYANNE MORSE
Identittcanott:
A INTY, FLOWA
r
Permit Na. - Follo No.
STATE OF FLORWA
' cnvN'ry OF E ,
The undersigned gives ootiee that iasptoveeterrt will be trade to certain teal prop"? and in accordswo with Chapter 713,'F�`p St. Jyt 2
the fotbwing infonratiort IRS previded is this NOTICE ()F (: