HomeMy WebLinkAbout104 23 AvePermit #: ,,
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Job Address: / Li `I' 2 3 (d X1,
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CITY OF SANFORD PERMIT APPLICATION
Date: Z, - 0 4
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Description of Work: /e:'%' fie. wc L tr>IZ
Historic District: Zoning: Value of Work: $ ' DO. 00
Permit Type: Building Electrical 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 #: (Attach Proof of Ownership & Legal Description)
Owners Name & Address:r
1A"e J S T to Phone: 40 ^ t018 -
Contractor Name & Address: Cyr+ n C 1 n
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C. 410 4106-b A . *L N o -
e S2 State
License Number: C+# G 05(D D J Phone &
Fax: L101- 331— Contact Person: Phone: 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. 1 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, CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. NOTICE:
In addition to the requirements of this permit, there maybe additional restrictiMase ispro rty that may be found in th ublic records of this county,
and there may be additional permits required from other governmental entitige nt districts, state e r federal agencies. Acceptanceofpermit is
verification that I will notify the owner ofthe property ofthe rei La 1Signature ofOwner/Agent
Datector/A entAhaK s rn
Ctark.1 Print Owner/Agent'
s Name Print ontractor/Agent's Name t Signature of
Notary -
State of Florida Date gnature of Notary -State of Florida 0,Nat esucra ee VRu kmf' MyCommissionDD043695
Vol a w Expires
July 22. 2005 Owner/Agent is _ Personally
Known to Me or Contractor/Agcnt is _ Personally Known to Me or Produced ID _ Produced ID
1) L APPLICATION APPROVED BY: Bldg:
Initial & Date) Special Conditions:
Zoning: Initial &
Date) Utilities:
FD:
Initial & Date) (
Initial & Date)
Histciric
Lon ood
Florida
I
2003 •- 2004
i75 °i,3,
8750OCCUPATIONALLICENSE
410 NORTH ST
For The Occupation
CONTRACTOR/OVER 30 EMP
EO.L.# 04 - 05425
STATE#
CG C015387
LICENSE FEE $ 200. 00
ADMINISTRATIVE FEE $ 10. 00
TRANSFER FEE $ .00
PENALTY % $ .00
COUNTY TAX $ 45.00
CHARLES M. CLARK, INC. yam•..• ••.•• pf
410 NORTH ST # 162
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CITY CLER
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ACC O;J 12 4 STATE OF FLORIDA
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DEPARTMENT -OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD-, SEQ#.L02080100666
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The PLUMBING: -CONTRACTOR-
Named: below_IS... CERTIFIED
Linde r''ihit provisiona-of Chapter 489 F§. + "
Expiration date: AUG ' 31
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CLARR • CHARLES MARTIN JR
CHARLES=. M CLARR' lNC
2350 WESTMINSTER TERRACE
OVIEDO ." ;, .. FL 32765
JEB.; BUSH:-.',,-`* , r.
GOVERNOR .' - DISPLAY AS REQUIRED BY LAW
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RIM;'BINRLEY=SEYE$;
SECRETARY