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HomeMy WebLinkAbout60-63 William Clark CtPermit # :04 < /_ Job Address: %0 = 46 3 CITY OF SANFORD PERMIT APPLICATION Date: % 2 - go 7 Description of Work: u/Qy'I911- i 0l IAIVt�' e Historic District: Zoning: Value of Work: $ t� C, 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.: F.,*,�,,� New (Duct Layout & Energy Calc. Required) Plumbing/ New Commercial: # of Fixtures # of Water & S er Lines # of Gas Lines Plumbing/New Residential: # of Water Closets _I•umbing Repair — Residential or Commercial Occupancy Type: Residential Commercial s al Total Square Footage: Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X) Parcel #: (Attach Proof of Ownership & Legal Description) Owners Name & Address: __ C�i✓.�M/ _��lf��>�� Phone: Contractor Name & Address: State License Number. Phone & Fax: � '2, f yam- Contact Person: Phone:�� (iQ� Bonding Company: Address: Mortgage Lender: Address: Architect/Engineer: Phone: Address: Fax: z i 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 require n of Florida Lien Law, FS 713. Signature of Owner/Agent Date Si cure of Contractor/Aggentt /� ate ® Print Owner/Agent's Name Pri ontractor/Agent's Name Ila Signature of Notary -State of Florida Date/D Sig ttr*Notary-Stateof FloridaDEBBIE BLANTON COMMISSION # DD 188491 Owner/Agent is _ Personally Known to Me or ContracProduced ID Pr �.. M tFvy Clscow } n�aM ro. APPLICATION APPROVED BY: Bldg: Zoning: Utilities: FD: (Initial & Date) (Initial & Date) (Initial & Date (Initial &Date) Special Conditions: CITY OF SANFORD PERMIT APPLICATION Permit # : o -'� — `1 k "6 Date: 1-:\- 'C� Job Address: Q-0 0 - !0 3 W i uL Q -M e �.+i�2�L Q-4. Description of Work: 2 - Historic Historic District: Zoning: 'N to o-\,3 , \ v.Si•, w v. Value of Work: $ 2 w 0 0 Permit Type: Building Electrical Electrical: New Service - # of AMPS Mechanical Plumbing ----)Fine Sprinkler/Alarm Pool Addition/Alteration Change of Service Temporary Pole Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Cald. Required) Plumbing/ New Commercial: # of Fixtures �# of Water & Sewer Lines # of Gas Lines 1 Plumbing/New Residential: # of Water Closets ` Plumbing Repair - Residential or CommercialT 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 #: (Attach Proof of Ownership & Legal Description) Owners Name & Address: _ S �v 'R©Ek-o 0s f ti G �U T FSO l Phone: Contractor Name & Address: t E S WtV\%IOZ G Phone & Faz �01 ^ Bonding Company: Address: Mortgage Lender: Address: Arch itect/Engineer: Address: �O State License Number. C �� ContactPerson: V-PtipV A*�'bCk-t�'S-'f —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. 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 YOEFlt. 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 requ' ents of Florida Lien FS 713. Signature ofOwner/AgentDate Signature of Contra or/Agent Date Print Owner/Agent's Name Print contract /A ant's Name Uy Signature of Notary -State of Florida Date Signature of Notary -State of Florida Date =od LANTONOwner/Agent is _ Personally Known to Me or ContraN o#wDD 18849`Produced ID t}�°M7°PruaryDiscoun - APPLICATION APPROVED BY: Bldg: (Initial & Date) Special Conditions: Zoning: (Initial & Date) Utilities: (Initial & Date) FD: (Initial & Date) SEP -9-2004 13:43 FROM:F&H CONTRACTORS 352 326 3307 TO:14073245843 P.2/2 SEP -'-2004 09.33A FROM: --, TO:13527959042 P:1/1 Ptmh M :o([' CITY Of SA14FORD rERMIT AITLICATION 7 - Q - - Date: Js► Adams: Q A Doeripum orwea: ✓Gi G ll*wk Diurkc Zostes: rnR- I—Valet of Work 5 ZF1 LPOO Ptrmft.lyer Hatldnb kkatncal Mpshunictt t'llmebmg 15rtSPnMelnr/Alarm POW RIaOkat New Service N of AMPS AddMWAtWrKm Chtstge or Service Tsmponry Pok — _-- bMscflaaieaL Raedadial _ Nv"cWudial — Rwbpc m -& Hm low Low at taap Cak. Rid) "MMF/ NM ( 411110 erdal' A of F(aaum A of Wass s Scwa uocs tt or (hs Liars PlasblayNew Re" albl: a of water Closdlt —.. -- Platabl" Ropak Rctldwilal or Ccnlm=wl Occal an y Type: RmiclaRial,,Cumrnwvial Indwbial Teta) Sgaan Fe": Co rwyc " Tjpe/ tfA N or SIMeJ B d0teft Ua* PIW 7Ae : (FKKA fano tagr4aed illilr adm Ms 7Q raltct K:d 17 - J Omm NmehA4dnw: t:osWrstoor Mast & Aadrt Most at Fax: Castatt Ptiraaa: ! a�ac: Beadled Ovati any: Ad&m: _ Merflop Leader: _ Addresrc ✓ .. __ _.._ AmNlIctltagioue clear Address - - _ - - -Fax: Appl(eation b flacby msdc a obtain a patten to stn the wmk and inmallstions to indica" I a=* dash no wq* err InsmUlsloa halt commcaood priortD Oc Ixsaamac of a pnaxit ed dos ail wmit wig be Oarfanrad n alta atieedtanb of all laws aguhule6 e4ef4uai0ml Jn Ihapa�dittion. I atdPgataO Ileac a atFvate Pa Nk maarbo SOMW lot ELEC7RiCAL WORK, PLUMBINU, SIGNS, WELLS, MOOS. FURNACES. 8011CRS, MnMS. TANK.%and AIA CXJNDMONU' LS, ac. 0WNERN ADFIOAVIT: I cvtify that all of din rnra:(be erg inih matin 1%wXwule amd dud all wmtc will tic dpne in ootnphom with all "pliable Inwlt fcpAmtng awAftainn-and amimg WARNTN(G TO OWNP: YOJJR FAMURF TO RF MT) A WOTICF. QF CAMINFIk tMwT MAY PXSUL I' IN YOUR PAYING TWICE FOR IMPROVIDAMM TO YOUR PROPERTY. IF YOU INTtND TO ADTAIN FINANCING, C1)NRI H.T WITH YrXJR 1.f IOWN (W A N A1-WlU4RY BNxOU RIiCORUtNG YOUR W)J'eM (Jt+ COMMHK*k'MEM,. N017104-. A addidw to dto mgtlircmmb of tltb pamiy dxm may be ad*dwm7 Rsciatate appikok to MIS P1.1wty there maybe bland is dee pablie roam or dtia MOM, and 044 aw be allftimul pamigt tailtbnd Am otW 6RaCetla►Oaa11sntitf011teGh OF*" mome,aslcal dorsi" atsls ogmim ad Ibdstal agencim Aaocptrlme OrBamil a eror(tbtioo ttatl 1 wiU ttstiy tlDo owacr of llc t>nopatr lraaptot of Flails Lim Staymtm of Owtetr/ABalt Dar of con Orae Prnr tlaeCdAMalra Iela6e �: - sA Mak Cidl+ature orNulary S1aio of FltKida fkte lVwft c oFNotmy- Dam fJfPIRES FeMtaN 24 2006 Oww/Agent is __ Psnunatlly Kmewn In Me nr C cmtrueps/A(gesl n TRIl4 WN WU2ANCE aC Ptodwx d TO Produmd U) APPLICATION APPROV>CI)11Y:1%* uwftj : -, _ _ _ _ TD: ('initial at am) Spoclal cu l dkbm: (tenial A iA to) (Wind a Date) (initial t Dsaj SEP -9-2004 THU 01:55PM ID: PAGE:2 SEP -9-2004 15:17 FROM:F&H CONTRACTORS 352 326 3307 TO:14073245543 P.1/1 a H Electrical Contractors, Inc. _ ..�vi _ _ .i:::�Yt3-� .J�`,•,..-ih.'4':� ... ...n:-w.MY+'�:f- 4ii%S.:e�'�....-a....u.- rf414..ar.. T3f' ae..� EC0001900 / C.4 C057753 AUTHORIZATION LETTER TO: City of Sanford 3684 North Citrus Avenue Crystal River, Flodda 34428 901 Phone (352) 795-0525 Fax (352) 795-0134 I, Daniel F. Williams, Jr., Contractors License Number CA CO 57753, hereby authorize the following person(s) to act as my agent in ordering, purchasing, and to pick-up permits in City of Sanford: s John Erickson This Authorization is to remain in effect until such time as your agency is notified in writing that said person(s) authorization has been terminated- 09-09-04 erminated. - - 09 09 04 Contractor's Stinature Date Sworn to and subscribed to before me this 9th of Sept.2004, by Daniel F lilliams, Jr. who is personally lrnown to me or has produced / did not take an oath. as identification and who did , V j 6/ My Commission Expires Notary Public SEP -9-2004 THU 03:29PM IG: +� r,H Con+m�auor+ oo2�aens ==swoc=w,s,2007 PAGE:1