HomeMy WebLinkAbout300 Rose DrPermit #:
Mob Address:
Description of Work:
Historic District:
CITY OF SANFORD PERMIT APPLICATION
I' Date: ' l Z- t (d
C>
Zoning:
Permit Type: Building Electrical
Electrical: New Service — # of AMPS
Mechanical: Residential Non -Residential
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential Commercial
Construction Type: # of Stories:
Parcel #:
Owners Name & Address:
Value of Work: $ Z YOO
Mechanical Plumbing Fire Sprinkler/Alarm Pool
Addition/Alteration Change of Service Temporary Pole
Replacement New (Duct Layout & Energy Calc. 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: (My- "v-'A— Q, C-
5-71 1 ]W • M_ %Ag 4U_,vr f- l'(" 1 C_e State License Number:
Phone & Fax: S`cl o Z 3c+ Contact Person: t Phone: Lk 1
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: 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.
N TI E: 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, 'fication that I will no ' e owner of
727,(o
of t/he
reqE
orida Lien S 3.
yw
at of Owner/Agent ate Contaac r/Agent Date
Print Owner/Agent's Name tor/Agent's Name
Signature of Notary -State of Florida IT Date Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced1D7D, ti — -T raS.3L7• 107(.• t/yL
eV-p • Z / 13 /v (o
APPLICATION APPROVED BY: Bldg: Zoning:
Special Conditions:
Contractor/Agent is _ Personally Known to Me or
Produced ID
Initial & Date) (Initial & Date)
Utilities: FD:
Initial & Date) (Initial & Date)
8
01/19/20051 19:37 4073968265 HOLIDAY RESORT MGMT PAGE 01
POWER OF ATTORNEY
Date: A e
I hereby name and appoint--
of to be my lawful attorney
in fact to act for me and apply to the tJ I, f N 15, n, . o r \r,
Building Department for a permit
for work to be performed at a location described as:'
Section Township Range Jot Block
Subdivision . 44; W-0
M_s4 .300 kv$e Q0.
Address of Job)
Owner of Property and Address)
and to sign my name and do all things necessary to tb.i.s appointment.
A &
Type or Print N6ne of Certified Contractor and Contractor's License Number
The fore ping instrument was acknowledged before me this
o `
day of 20r0_
by Mar1`f KAAS A
who is personally known to me/who produce bce klac
as identification and who did not take oath. '
State of Florida
0._ RAX;?l!'•1E t,P.RIE KAASA
q.:t y •^ NOYAl/Y P%iHOC MINNESOTA
County of 0011S 1-314007
i
J
AFFIDAVIT
REGARDING ROOF DRY -IN AND FLASHING INSPECTIONS
Company:License #:
Project Information
Owner: s, "^'
s"y
name
address
JAI A crd 4-
phone
Permit M (5 - _ /) L V
Subdivision:
Lot #:
I , affiant, hereby affirm that I am the duly licensed
co or of recor for the a referenced permit, that all the foregoing information is true
ccurate, and that the dry -in, flashings at the above referenced address or lot has been
installed in accordance with the applicable codes and standards.
Contracto>G•
signature
vi e
printed name
STATE OF FL O
COUNTY OF
This instrument was acknowledged before me this day of (q , 2 y the
above referenced individual, 9nne, r c, 1111 a frn who acknowledged that he/she is a
duly licensed contractor with )C -iYt r. Q- and who acknowledged that
he/she was authorized to execute this document. He/she is either personally known to me or
produced as valid identification.
WITNESS my hand and seal this 0 / day of 3 , 200
Q2 ac_
Notary Puuilic
QDDE_IGIE BLANTON
MY C 'k"ACi.,;C)UN 8 DD i8M, G i3:': February 25, 2007aNOTARY_
FL Not Discount Assoc. Co.