HomeMy WebLinkAbout2501 S French AveCITY OF SANFORD PERMIT APPLICATION
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Permit # : 0S — a, a~ I
Job Address: .25 O1 S • Free
Description of Work: uJJ
HisteFic4NstriM: AM acru Zeet
W
Date:
Value of Work: S /, 2 UO
Permit Type: Building Electrical sT 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 #: /' O- 3 0 "
Owners Name & Address: L/
Vl .- n r— , .t
Name & Address:
86 O0 — O O / O (Attach Proof of Ownership & Legal
Phone:
v h _l 3 3o& 9 State License N her: ocioll'3 Z ,
p . /
Phone F. DD ' 0 Contact Person: a 0'r-1 Q L Phone: 77y - Y `y / O?
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer: Phone:
Address: 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: 1 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, CONSUL7:VWTH•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 ify the own r of he property of the requirements of Florida Lien Law, F 3.
3 2Q p5'
Signature of Owner/Agent ate Signature ofContractor/Agent Date
Owner/Agent's
of
Owner/Agent is V Personally
Produced ID
coming 000285M
F.mitea IrAffl000
Bonded Vru (800)MA2
Florida Nolery Assn.. Ir
APPLICATION APPROVED BY: Bld Id, 41 Q3 '?hg:
Initial & Date)
Special Conditions:
V A4,L(X.t1? OLA
Prinractor/Agent's Name
54:
C&tractor/Agent is"Personally Known
Produced ID
Initial & Date)
Utilities:
Date
COM! { 0002857a,'t
E)ires 112&2008
Bondetl thru (800)432-4254:
Florioa NMgryr . n.:: 1 : i FD:
Initial &
Date) (Initial & Date)
t
P
ADVANCED POWER TECHNOLGIES, INC.
1500 N. Powerline Road *Pompano Beach, FL 33069
Tel 954-984-4100 Fax 954-984-4050
EC-A000432)
POWER OF ATTORNEY
t - cx!
DATE
I, Cullen Blackmon, hereby appoint (/ lAt-&,o"rk ) to be my lawful attorney in
fact to act for me and apply to the Building Division for a permit for work to be performed at a
location described as:
Job Address: Walgreens- 2501 S. French Avenue- Install (2) 250-watt metal halide wallpaks east
side of bidg and add photocell.. 3
And to sign my name and do all things necessary to this appointment.
Cullen Blackmon EC-A000432
Contractor's Name and License Number
Signature of Contractor
Sworn to and subscribed before me this _day of r t 20 by
Who is personally known to me, and whom did take an oath.
Va -, '-L PSeal.
Nota Public
My Commission Expires
a ............................ ..............
MARIA D. PEREZ
y i COM"W 0002MM S
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