HomeMy WebLinkAbout3405 Mellonville RdCITY OF SANFORD PERMIT APPLICATION
Permit # : (Ip I ODate:
Job'Address:: pM CL
Description of Work:
Historic District: Zoning: Value of Work: $ 15,1 O . D D
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential —4— 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 #:
Owners Name & Address:
Contractor Name & Addry
r1D Q
Phone & Fax: O
Bonding Company.
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
Attach Proof of Ownership & Legal Description)
Phone:
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 theissuanceofapermitandthatallworkwillbeperformedtomeetstandardsofalllawsregulatingconstructioninthisjurisdiction. I understand that a separate
permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, and
AIR CONDITIONERS, etc.
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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 regulatingconstructionandzoning. 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 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 requirements of Flon ien La 713.
Signature of Owner/Agent Date Signature of Contractor/Agent ate +
7
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is _ Personally Known to Me or
Produced ID
APPLICATION APPROVED BY: Bldg: Zoning:
Initial & Date)
Special Conditions:
Initial & Date)
try-ataawana"7 to HORAL t
Notary Public - St to of Florida
My Carntnission E*hw Jul20, 20M
Utilities:
Initial & Date)
FD:
Initial & Date)
i
MECHANICAL SERVICES, INC.
AIR CONDITIONING P.O. Box 180215
REFRIGERATION Casselberry, FL 32718-0215
ICE MACHINES 407-695-6646
fax: 407-696-0003
January 20, 2005
City of Sanford Bldg. Dept.
300 N. Park Ave.
Sanford, Fl 32771
Re: Barker residence, 3405 Mellonville Rd. — Building Permit #04 2926
To Whom It May Concern:
By this letter, I hereby authorize Thomas Beesing to sign for and pick up the mechanical
permit for the above referenced job. My state certification number is CAC 058531. Feel
free to contact me at 407-695-6646 if you have any questions. Thank you.
Sincerely,
Mark Gembecki
President
Sworn to and subscribed before me this 2- 0) day of 2005.
40_Air4
Notary Public — State of Florida
ji'r'""'•.,, MARSHA HORAL
Notary Public - Stitt of Motlde
BOW Jul 20, 2008
Commiselon 0 OD135303
Sandal By Na!loiW Notary Assn.