HomeMy WebLinkAbout226 Krider Rd (3)CITY OF SANFORD PERMIT APPLICATION
Permit # :_ C iJ
Job Address: Z Z (o
Date: 311 X IO
r; der Rd. . 'a., /a . / 3.?
Description of Work: QGQIctcc.. McA-,r bOLSL O.d Mt~11A Par`e.l
Historic District: Zoning: Value of Work: $ 300
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS — 7'59— Addition/Alteration -A 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 --A--- Commercial Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #:
Owners Name & Address:
Attach Proof of Ownership & Legal Description)
Phone:
Contractor Name & Address: SM iv)n / E I C c7r,'G - r c
4,76 sm • )k SOn br•• QV r C ci d r F/ 3a 7(v State License Number: i6G 13001 Q (p S Phone
Fa: 401 36,5 - -7 -7 3 3 Contact Person: 'Dom- G 1c4 R Phone: (4U:2) 3(05- 8i o 1D Bonding Company:
Address: Mortgage
Lender:
Address: Architect/
Engineer:
Address: Phone:
Fa::
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 Florida Lien Law, FS 713. 3 l
lsl o• Signature of
Owner/Agent Date Signature of Contractor/Agent 0ow-, N(
XAS Print Owner/
Agent's Na Print Contractor/Agent's Name Signature of
Notary -State of Florida Date Owner/Agent
is _ Personally Known to Me or Produced ID
APPLICATION APPROVED
BY: B141—f 1 dJ 3) I A] Ong: Initial & Date)
Special Conditions:
Signature of
Notary -State of Florida Date s
Contractor/
Agent
is _ Personally Known to Me or Produced ID
Utilities: FD:
Initial & Data) (
Initial & Date) (Initial & Date)
LIMITED POWER OF ATTORNEY
As an officer of Smithson Electric, Inc., I do hereby give limited power of attorney to
7DL1V C ( A q ) as in which aforesaid may sign for
permits in the city of Sa 40 C- Cj
Sign
Title
ed Date
Before me this I 4"'- day of i ACkr(-k 20 DSO, an officer duly authorized
In the state Florida in the county of Seminole aforesaid to take acknowledgements,
personally appeared 20 d SN+' 44'so'-, as & S i cQgnfi of
Smithson Electric, Inc. who is personally known to me.
NOTARY PUBLIC DATE 3 —
SEAL:
X Notary Public State of FloridaElizabethJeanTuggleMyCommissionD0388455
Expires ONpO/M