HomeMy WebLinkAbout4175 S Orlando DrPermit #: 39 —17
Job Address: 40 75 J 1)41LAAA
Description of Work:
Historic District:
Zoning:
CITY OF SANFORD PERMIT APPLICATION _
Date:
MOCSL, I.—p ;400 ,41"00 S
Value of Work: $ '.20o l
Permit Type: Building Electrical V 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 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:
L9 TAM,N
Contractor Nat & Address:
Yo L GA � v"
Phone & Fax: 913 ` 'P4 t
Bonding Company: A 1 n
Address: W-113—
Mortgage Lender:
Address:
Architect/Engineer:
Address:
Contact Person:
(Attach Proof of Ownership & Legal Description)
Phone:
State Licenses Number: V� 00D
Phone: _
Fax
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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. 1 understand that a separate
permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, and
AIR CONDITIONERS, etc.
R'
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 requiremenZofFIch Lien w, FS 7
Signature of Owner/Agent Date Signatw'e of Contract r/Agent Date
etLK-i Q J u 64W
Print Owner/Agent's Name Print Contractor/Agee N ame
Signature of Notary -State of Florida Date ffature of Notary -State of ori a Date
?°� :a ' P&'
JO ANN M. JOHNSON
* MY COMMISSION # DO 285622
Owner/Agent is Personally Known to Me or Connactor/AAM , PAX21L I4iara4 or
Produced ID �oduced 16"" °Q� S
i
,g•tt�
APPLICATION APPROVED BY: Bldg: Zoning: Utilities:
(Initial ate) (Initial & Dale)
Special Conditions:
FD:
(Initial & Date) (Initial & Date)
POWER OF ATTORNEY
Date: ?' 9. Deo
I hereby name and appoint Kurt D. Jurado of E M Enterprises General
Contractors, Inc., to by lawful attorney in fact to act for me and apply to the
C'�rq 37r- Building Department for a/an
rls: 1 ✓Llerq L permit for work to be performed at a location
described as:
Section Township Range
Lot Block
Subdivision
of Job)
aizoku lWiizrLe� 5
(Owner of Property and Address)
and to sign my name and do all things necessary to this appointment.
Lawrence Tony Pasetti, III
Type or print name of Certified Contractor
Signature of Certified Contractor
The foregoing instrument was acknowledged before me this day
of � , 2004 by �� c,� Q-9 er, S,'l , w o is personally
known to a or who produced
i ication and who did not take an oath.
STATE OF FLORIDA
COUNTY OF HILLSBOROUGH
Notary Public
Commission Number: Dov Pu Dana D Quillen
My Commission Expires: +� a My Commission DD149979
�i�wcl� Expires October 04, 2006
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