HomeMy WebLinkAbout1415 Palmetto DrCi'CY OF SANFORD PERMIT APPLICATION
Permit #: O — 32 Date:
ob Address: 11413- P4 1 ,,y
Description of Work: Plt v N, a> f , (F car
Historic District: Zoning: of Work: $ Oo'd
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS I )O Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential Non -Residential
Plumbing/ New Commercial. # of Fixtures
Plumbing/New Residential: # of Water Closets _
Occupancy Type: Residential Commercial
Construction Type: # of Stories:
reel #:
Owners Name & Address:
Replacement New (Duct Layout & Energy Cale. Required)
of Water & Sewer Lines # of Gas Lines
Plumbing Repair — Residential or Commercial
Industrial Total Square Footage:
of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Attach Proof of Ownership & Legal Description)
Phone:
Contractor Name & Address: Op 1 "Na (C / • G Xh C
147 Z State Licen77see Number: EC GOO z 7 7 Z
Pbooe & Fax: Contact Person: %, E." tun Phone: 6 ` S`AZ` s FS
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engioeer:
Address:
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, BEATERS, 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 govemmental entities such as water management districts, state agencies, or federal agencies.
Acceptance of permit is verification that t will notify the owner of the property of the requirements of Florida Lien law, FS 713.
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Signature of Owner/Agent Date Signature of Co for/Agent Date
C14 t t FaOlAe^
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is _ Personally Known to Me or
Produced ID
APPLICATION APPROVED BY: Bldg: dt Zoning:
Initial
Special Conditions:
I 1 t on /A is Name
Sig DF4#otaft4X I6F11t&Date
MY COMMISSION # DD 1642M
EXPIRES: November 12, 20061 `
O' gendedThru 8UW Notaty Setrkee
tlt gent is Personally Known to Me or
Produced V-
Utilities: FD:
Initial & Date) (Initial & Date) (initial & Date)
Power of Attorney
I Floyd David Smothers. 42123 Maggie Jones Rd. Paisley, FI. 32767. Designate Cory Franzen to
act on my behalf in matters relating to State of Florida license # EC0002772 and Optimal Electric,
Inc.
This Power of Attorney shall become effective immediately and shall not be affected by my
disability or an applicable state statute may provide lack of mental competence, except as
otherwise. This is a Durable Power of Attorney. This Power of Attorney shall continue effective
until my death. This Power of Attorney may be revoked by me at any time by providing written
notice to my Agent.
Dated 20 O at Lam wooa 4
Signed:
Floyd D Smothers
Acknowledgement:
STATE OF
COUNTY OF S-P•h,.c : • o Le
The foregoing instrument was ac nowledged before me this .,/6 6f- day of
jar-4- , 20by Floyd D Smothers who is personally known to me or who
has produced as identification.
oLa"C- ,,:;< _/--
Sig ature of persorflaking acknowledgment
SHARI LIVINGSTON
Notary Public, Stale of Florida
My comm. exp. Mey 12, 2006
Comm. No. DD 130973