HomeMy WebLinkAbout169 Walnut Creek RunU Af el
CITY OF SANFORD PERM91T APPLICATION
Permit # : O T' Date:
Job Address:
Description of Work:
Historic District: Zoning: Value of Work: $ 3 %
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/AIteration 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 #:
Owners Name & Address:
Attach Proof of Ownership & Legal Description)
Contractor Name & Address: N \ t N \_
G1 State License Number: L
Phone & Fax: No 7 oZ 9 ,/— /,/to Contact Person: M \U _ Phone: ! U 7
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. 1 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 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 1 will notify the owner of the property of the plfments
of Florida ien Law, S 713. _
01118-
Signature of Owner/Agent Date Signature of Cont ctor/Agent 73ate
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is _ Personally Known to Me or
Produced ID ,
2,,_J0
APPLICATION APPROVED BY: Bldg: Zoning:
Initial & )
Special Conditions:
Print Contractor/Agent's
nature of Ng! tary:Stetl
Contractor/Agent is,,op
rods ced ID
Utilities: _
Initial & Date)
e of 10'W' J,IN I.I. Jr,'wmCDate
M OM1PSSi0N n CC 921W8
EXPIRES: MF.-ch 23.23)4
Perso ally Known to"Me or is
FD:
Initial & Date) (Initial & Date)
POWER OF ATTORNEY
Date: r4.—""01A. _
I hereby name and appoint V of
li C3c.tJ Sr-,c , to be my lawful attorney in fact to act for me and apply
to the Building
Department for a e rt- C permit for work to
be performed at a location described as: Section - •
Township 'Range Lot LO ? Block _ Subdivison
e e5ervt AT Lc-ue.P iv-)0c%r0C Cfee-v krzur\ Address
of Job ) Owner
of Property and Address ) and
to sign my name and do all things necessary to this appointment. O
C L, (.aU`I Print
Name oneritifed Contractor and Contractor's License Number Signaturq
certified Contractor A-
c2 \;7r, rvar-1 The
foregoing instrument was acknowledged before me this day of By
Who
is personally known to me/ who produced As
identification and who did not take oath. State
of Florida County
of Q tory
Public, Orange Co -da Seal .
WWI*
Mr
c°""nl" On Ex0mg
duly oe, Tpp
h 02 10 04:51p p• 1
r
PLOW PLAN
DL'.S(.RIPTION; (AS I k)NNISHFD)
LOT 1CM, RL'SLIwF. AT I.AKL MONROF
iN PI AT BOOK , P AGFr••i OF THE PIJUL.IC; PRFCORD Ut ;;[MINOL.E" COUNTY, Y, FLORIDA.
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NOTE -
WE DO NOT ACCEPT RESPONSIBILITY FOR
ANY ERRORS THAT MAY OCCUR FROM THE
U5E Or THE UNRECORDED / PROPOSED
PLAT THIS PLOT PLAN IS BASED ON.
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THIS IS NOT A SURVEY
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S. N077 VAUU VarlIUIIT Pir SIL-NAIURE AND rl1[ OV,1NAI
RNSW SEAL Or A I I QKIUA LICCNST'D 5I110VOR
AND MAPPER.
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