HomeMy WebLinkAbout725 Town Center BlvdPermit #:
Job Address: / J
Description of Work: Li
Historic District:
Zoning:
CITY OF SANFORD PERMIT APPLICATION�� 1'\
Date: b e DU i
Value of Work: $
Permit Type: Building
Electrical
Mechanical Plumbing
Fire Sprinkler/Alarm Pool
Electrical: New Service —
# of AMPS I OG
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
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential Commercial ✓ Industrial
# of Gas Lines
Plumbing Repair — Residential or Commercial
Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #:
Owners Name & Address: r
100 VVi () nfn
-N\Contractor Name & Address:
Ph e & Fax:'L - 03
L mpany:
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
(Attach Proof of Ownership & Legal Description)
Phone:
H • Jct I i State License Number: Ca
Contact Person: 2 Q13C_ Phone: Sal' as t��t3
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 XSgna
AFlaen
Signature of Owner/Agent Date ure of Contractor/Agent Date
iL% % J19
Print Owner/Agent's Name Pri t ntractor/Agent's ame
C
Signature of Notary -State of Florida Date Si 4 e of N°r���� � 1"t�42R': Date
* MY COMMISSION # DD
EXPIRES. November 12, 20u�
APTW.ced
dedThruBudQatNotaOwner/Agent is Personally Known to Me or Ag�{ is Personally Known o MProduced ID ID
Wz)APPLICATION APPROVED BY: Bldg Zoning:
(Initial
Special Conditions:
(Initial & Date)
Utilities:
FD:
(Initial & Date) (Initial & Date)
POWER OF ATTORNEb'
I. hereby name and appoint
ot,
hA fact to act for ine and apply to thF:
Building Department for:
For work to be performed at a location described as,
Section Township
Subdiv[SIOEI
to be my lawful atl,oruey
Kange Lot
Block
and to Sign lily nname and do all things necessary to this appointment,
'Vype or Print Name of Register or Certified Contractor and Contractor's License Number
D .,%
L V)'U a
Signature of Register or
Certified Contractor
The f0feguing Instrument was acknowledged before me this 26) day of of 20(o
Puts D, e nry-) hr i
Who Is ersunally known to me who produced
As identification and who did not take oatti.
State of Florida
County wf—a
r TOw
A BRITTON
My COMMISSION # DD 333105
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