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0 `J i ^ IQ ` CITY OF SANPORD PERMIT APPUCATION
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Date:
job emu-. 20 S'P,Afi9& iA)6--. ?jg4 CTS'n/ 1 c otrsrripf(
etr of work .— H ' N'
Merie Dittrlct: 7.ostiwf _ VS%M of work: !--11 Permit
Type: Building Elcclricsl Mechanics) Plusabiag Fire Sprinkler/Alemt Pool Eteetried:
New Servioe - N of AMPS AdditioW^fterstion Chenle of Service _ Temporary Pole Mocbsn";
Residential Non -Residential Replacement New (Duct Layout & Envgy Cale. Requited) riumUgM(
pW" C%m=ftWt: N of Fitmns a of Weser k Sewer Lines N of Gat Lines rIvmIslttiMeW
RaldMdal: R of Weser Qoode Plumbing Repair - Residential or Co nmerwal Ovngmney
Type: Ro3iduatial CoMmcmisl ln411511 l TOW Square TOOtI411- Coaseneedon
Type N of Stone/: R of DwdUnr Vulb: Flood 7ene (FZMA Ibrre rogdne for r Wa x) rared
s: ao-17` S/-eS 01 Mrco ^ ac yci — (Aaseb P oNef OwaaNIP a Law Dwer4o") Owes"
Noa•s All A""Iss: Al PMet: /
Contractor
Masson Address: Ststt
License Nesbar: now
sr wow contact Peesow Bo
aiat Cavvor Ades,.,
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tpjaens: Pa.et: Ardrsaa:
Pan: Application
is beroby mode to obtain a pemris a do the work and isuollavow W indieawd 1 eatify that so work or isotallsom Isis oommeaced prior e issawe
of a permit add dw au apt will be per(onasd ar oxen sundnnIr *ten taws rcDdstinS smostructiso in "jurirdiW= In I, &and dw a asp pelma
mm be tetwed Ibr ELECTRICAL WORK. PLUMBING, SIGNS. WELLS. POOLS, FURNACES. BOILERS, HEATERS. TANKS, and AIR
CONDITIONERS, tea OWNER'
S AFT: [)AVIT: t oartify "all of the foraBpist infewmion is accurate nod *0 *11 work will be done is cmMlimes with all tppliwble lava conancdoe
and soaicW WARNING TO OWNER YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR TWICE
FOR (INFROVEMBNTS TO YOUR PROPBRTY. IF YOU INTEND TO OBTAIN FINANCING. CONSULT WITH YOUR LENDER OR Al ATTORNEY
BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. NOTICE:
la o"Aion to the rsgvirprrena of Ibis psrmi4 there troy be odditiooal restriction applicabloto Win properry Onmy bs held in the public n a" scurry, and
0— -" be tddi tA*4?"MW vo%wAwi f ow%serer ysrawt M%W ttniYri tech to W" ratesstmm Marisa. waso opsciw. or fedetf! A e nit
is van on shot i y tiro owner of P P nr of the regaill!n t I Florido LkD Low, FS 713. Of Fling S&
attiv
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SWa Florida Doi 7easr( IK0,A,
it,4c;3Vt-.IOU1 O'MW#AScm
is Pcroonally Known a M rodurwd 10 5r
Date i
of
Hoary
Stier of Florida au DEBBIE BLANTON MY
COMMISSION * DO
188491 i IRES:ii
lij;o or APPLICATION APPROVED BY:
Bid$; losing: Utilities: FO. Initial A Oste)
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05596 PG 1779 CLERK'
S 0 200512115727- RECORDED
611 M EM 12:53:4L RMRDINB
FEES 1F&@% RECORDED
BY t holden., CERTIFIED
COPY, I MARYANNE
MORSE CLE
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tdeutitioation. \ %• • of -
Not f (notensI-sral +ust •bc1001'1 rm.
wr.:.d: i9r JESSICA
KENDALL MY
COMMISSION # DD 207424 EXPIRES:
April 30 2007 fed:
I Bonded Thru Nolary Public Underwrilers
REGARDING ROOF DRY -IN AND FLASHINGS
INSPECTIONS.
COMPANY: Aurn'*'V K Qm/--q
SUBDIVISION:
PERMIT NO:
AFFIDAVIT
LICENSE NO: eze / 3 a l J
PROJECT INFORMATION
ADDRESS: 02/7 AS
LOT:
I,1 l ig0M A C, /¢llal0r affiant, hereby affirm that I am the duly licensed contractor of record for the above reference
permit, thit all of the foregoing information is true and accurate, and that the dry -in, flashings at the above referenced address/lot has
been installed in accordance with all applicable codes and standards.
ed
7 (Signature)
STATE OF FLORIDA
COUNTY OF VOlE—
This instrument was acknowledged before me this / day of U S , by the above referenced
individual, N& C'. irswho acknowledged that he/she is a duly licensed contractor with h'
1 d who acknowledged that he/she was authorized to execute this document. lie/she is either
personally known to nid "---or produced as valid identification. WITNESS
my hand and official seal this day of rye 4 , _ DEBBIE
BLANTON Printed
N MY COMMISSION x DD 188491 My
Conn ' i S: EXPIRES: February 25, 2001 1400,
3-NOTARY FL NOWY Discount Atsoa. Co_