HomeMy WebLinkAbout1901 Lake AveY
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Permit # :ya
Job Address: /106)
Description of Work: I
Historic District: Zoning:
CITY OF SANFORD PERMIT APPLICATION
Date: /;2
Value of Work: S
P 'G!CTTV
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 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 M
Owners Name & Address: 90%
Attach Proof of Ownership
iPk a-,e S1Nr
Phone: Y477- 3
Contractor Name & Address: .1,oeem ac1k. 1,^V S%? t aa, — &ye C.
a r:e10
i.
765 State License Number:
Phone &Fax: c4,96 3/3 (a A07.36s" 9D// Contact Person: % c m Phone: Z497' 826 —t 3ro
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer:
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, 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 requirements of Florid LT
FS 713.
Signature of Owner/Agent Date Si r of Contra ent Date
Print Owner/Agent's Name Print C tractor/Agent's Name
uj
Signature of Notary -State of Florida Date
Owner/Agent is _ Personally Known to Me or
Produced ID
APPLICATION APPROVED BY: Bldg:
Initial & Date)
Special Conditions:
Zoning:
Initial & Date)
Idol
Mi Date
DEBBIE BLANTON
M`/ COPd , 18SION # DD 18W1
EXPIRES: February 25, 2007
TIt is FL r$r6]1,1f,AQ'4.11
Utilities:
Initial & Date)
1403
4-dS) 01
Initial & Date)
RESTPLUMBING & EMODELING inc.
Best Work Best Prices
PO Box 621231 — Oviedo, FL 32765 — 407.896.3136 — Fax: 407.365.9011
Special Power of Attorney
I, , 5 (Name of License Holder), license #CFC/512G 3/ 7 ,
hereinafter feferred to as the "License Holder," the I s412& it f- (title), of
f A, .414 t tZe^.4, 6If4 T9c, (Name of Company), hereinafter referred to as the
Company", hereby appoint the following persons as Attorney -in -Fact of the License Holder/Company,
in order to (a) sign and submit building permit applications, (b) obtain building permits, and (c) obtain the
certificate of occupancy from the City of Sanford on behalf of the License Holder/Com an
t+rt G • eL.LA:'l r) t/ rC1 "/t-L.S[stC,u''`
LICENSE 110LDER
r
Sign: /
Print Name: q —"4 A /4
Title: /,e/ P(,c<f
Company: ear vr lvi zip
Address:-6 &>< (z,z a/ 0V4eC6
FL. SZ7C.Z-
Phone #: 62 *U, _ Z16
WITNESSES
II
Sign:
Print Name w ERWiE y
Sign: ;'
Print Name: 1 11X5 Se E &>,OeA/E j
JOB ADDRESS
Address:l fU / GQk A-e
15raotk,-al/. . 3 Z 771
Fax #: V07 35- 9 ge,
State of }— (z ma County of S vc W O LC
The foregoing instrument was acknowledged before me this ? day of , 200, by
n
the 1"rbeNl of i I , a :L oP t-O/t
Dt<L1 uG,
corporation, on behalf of the corporation. He/she is personally know to me or has produced 10MAD&lhU MiVowtV
as identification.
Notary Public
THOMAS Q. SWEENEY
Notary Public, State of Florida Commission Expires:
My comm. expires Jan. 24, 2005
No. CC996357
Bonded thru Ashton Agency, Inc.1800 451-4854