HomeMy WebLinkAbout220 Kays Landing Drr /{
Permit #
Job Address:-? K A V 5 LA
Description of Work:
CITY OF SANFORD PERMIT APPLICATION
Date:
V
Historic District: Zoning: Value of Work: $
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS 4; Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Cale. 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 #: a tD I " J 5 b 7 v O • o (% 6-0 (
Attach Proof of Ownership & Legal Description)
Owners Name & Address: XIA, 41,7ilk.. __ . _ -Z- . / H .s _
lr
State License Number.
Phone &Fax: -1O t/ 4 % r] i 3 br(p 77 y/dv/ Contact Person: f( Phone: yd 7 7 /
Bonding Company:
Address:
Mortgage Lender:
Address:
ArchitectlEngineer: 'VXwlhi U
n[
Li-
Address: ,%00 PA k H'iP
Llc . Phone: 40 -1 (1{ (40Q'
3 2 / _ 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 theissuanceofapermitandthatallworkwillbeperformedtomeetstandardsofalllawsregulatingconstructioninthisjurisdiction. I understand that a separatepermitmustbesecuredforELECTRICALWORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, andAIRCONDITIONERS, 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. law: regulatingconstructionandzoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN TrOU), PAYINGTWICEFORIMPROVEMENTSTOYOURPROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR ANATTORNEYBEFORERECORDINGYOURNOTICEOFCOMMENCEMENT.
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 ofthiscounty, 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 requireme is f Florida Lien , FS 713.
Signature ofOwner/Agent Date Signature of Contracto ate
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Print Owner/Agent's Name Print Contractor/Agent's Name I'
Signature ofNotary-State of Florida Date Signa"tture N t f F
Owner/Agent is _ Personally Known to Me or
Produced [D
APPLICATION APPROVED BY: Blkoz d—a' oning:
Initial & Date)
Special Conditions:
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DEMIE BLANTuaONto
MY
COW"v jS10N # DD 188491 1-
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Utilities: FD:
Initial & Date) (
Initial & Date)
Form 20
LI ITED POWER OF ATTORNEY
ez (
the Grantor) hereby grants to
the "Agent") a limited power of
attorney. As the Grantor's at orney in fact, the Agent shall have full power and authority to
undertake and perform the followin on behalf of the Grantor: (
C dGiaJCb-un 4-, CS i (A P'/
C) r i A
By
accepting this grant, the Agent agrees to act in a fiduciary capacity consistent with the
reasonable best interests of the Grantor. This power of attorney may be revoked by the Grantor
at any time; however, any person dealing with the Agent as attorney in fact may rely on
this appointment until receipt of actual notice of termination. IN
WITNESS WHEREOF, the undersigned grantor has executed this power of attorney under
seal as of the date stated above. Attest. (
Seal) Secretary ,
Grantor STATE
OF COUNTY
OF I
certify that ( ,who is personally known to
me to be the person whose name is subscribed to the foregoing instrument produced as
identification, personally appeared before me on
O0 /p /e?oos' , and *cknowledged the execution of the foregoing instrument
acknowledged that (s)he is (Assistant) Secretary of and
that by aut o ity duly given and as
the act of the corporation, the foregoing insRin was signed in i s name by its (Vic President,
sealed with its corporate seal an at by him/ er as its Assistant)..Secr aacy
p`'4 Bill C Wainwright Jr l / My
Commission DD143236 Expires
August 18, 2006 Notary Public, State of Notary'
s commission expires: I
hereby accept the foregoing appointment as attorney in fact on Attorney
in Fact 130