HomeMy WebLinkAbout704 Palmetto AveCITI" OF SANFORD PERMIT APPLICATION
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Permit # : (D , 0 ' ( Date: I — 0 b
Job Address: -i O tR. v,,e— A O c/ r O Z `7`1
Description of Work: >! o b t' ` `
Historic District: Zoning: Value of Work: S z ?i 00 .OD
Permit Type: Building Electrical Mechancal 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 \)
Parcel tl: _
Owners Name & Address: k
Contractor Name & Address:
Phone & Fax: L
Bonding Company:
Address:
Mortgage Lender:
Address:
Arcldtect/Engincer:
Address:
CO
Attach Proof of Ownership & Legal
Phone: (-/ V / - 3 _Z S -
Sttya te License Nyunber:
Contact Pelson: <Phone:
Phone:
Fax:
0% 3
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 he performed to meet standards of all laws regulating construction in this jurisdiction. I understand that a separate
permit must be secured for ELL•'CTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, and
AIR CONDITIONERS, cic.
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.
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 pe it is verification that I ill notify the owner of the property of the require is of o ida ien Law, 13.
Agnatury ofOwncr/Agent 1)atc Sign• c Vonlrrclor/Age _ Date
1.:r. 0
Print
yWmuny
gip"-•'"y°: DAFNEY FAY
3 i NOTARY . DCOCK
cMA(vbNNfj 481 to Mc or
Z
1ifdp Prod
APPLICATION APPROVED BY:
Initial & Date)
Special Conditions:
Pr- ntractor/ cn11 Name
I (V)JOP Signaturc'of NoL•Iry=Statc of-Flsriitr= v' ' Datc
S MY COM.M:SSION O DD 166491
E.XF:RES: February CZ5, 2707
S'T-,r_N0TAR`! Ft. Nolwy 01=oW.t A==. G,.
Contractor/Agcrit'is _ Person311y'Kno m rc Mc &—
Produced 1D
Zoning: Utilities: 64Initi. & Datc)
90
Initial & Date) (Initial & Date)
J
CITY OF SANFORD HISTORIC PRESERVATION BOARD
APPLICATION FOR A CERTIFICATE OF APPROPRIATENESS
P.O. Box 1788, Sanford, FL 32772-1788
Phone: 407 330-5672 Fax: 407 330-5679
TO: THE HISTORIC PRESERVATION BOARD OF THE CITY OF SANFORD, FLORIDA
D Downtown Commercial Historic District D Residential Historic District
D This application is filed in response to a notice from the Code Enforcement l
ADDRESS OF PROPERTY:
PrORerty Own
Signature: Print Name:
Mailing Address:
Phone: _ Fax:
Signature:
Mailing Address:
Phone: 11-149'
I certify that all in1!:Mn this icati is — d accurate to the best of my knowl ge.
Applicant/Owner: Date:
Please use the attached criteria checklist -as a guide to completing the application. Incomplete applications cannot be
reviewed and will be returned to you for more information. You are encouraged to contact the preservation planner at
407-330-5672 to make sure your application is complete.
Description of Proposed Work/Application Category: (Check all that apply)
D Site Improvements/driveway/walkway D Storage shed D Moving structures
D Replacement windows or doors D Underskirting D Awnings
D N onstruction/additions D Signs D Demolition
oofs/gutters/downspouts D AC/Mechanical D Fences/Gates/Pergolas
D Replacement siding/flooring/porch D Paint D Other
Completely describe the entire scope of work: all changes in material, color or location to the exterior of the building,
whe theproperty the work will occur and how the work will be accomplis)d. For large projects, an itemized list is
A Certificate of Appropriateness is valid for six montbs unless otherwise noted
Historic Preservation Board Meeting Date:
Application is Approved
Conditions:
Signed:
OFFICIAL USE ONLY
Staff Review Date:
Approved with Conditions Denied
Date:
This Certificate must be prominently displayed on the building when work is in progress***
FASHA_ENGWistoric Preservation Board\C of A Application.doc
POWER OF ATTORNEY
Date:
1, _Andrew J. (Andy) Adcock do liereby'I'authorize
To pull the geroof permit for 1OLI Rt. KA-f40 4e- typc
of periiiil) (address)S
i g n\a-t*u/ On
4DAFNEY
FAYE ADCOCK NOTARY
PUSUC, STATE OF FLORIDA MY
Comm. Expires DEC. 2,2008 COMM, #
DD376609 StampNotAry
Personally
sonallvii to me or driver license of State of Florida, County of day
of \IJ 7-
AFFIDAVIT
RE ARDING ROOF DRY -IN AND FLASHING INSPECTIONS
Company: t 0C,& o License #:
Project Information
Owner: D ,_ Permit #:
name
1> 4 -
address //
A +
p fJt 1`
7 i
0'7-25,Z25--
phone
Subdivision:
Lot #:
affiant, hereby affirm that I am the duly licensed
contractor of record for the above referenced permit, that all the foregoing information is true
and accurate, and that the dry -in, flashings at the above referenced address or lot has been
installed in accordance with the applicable codes and standards.
Contractor:
Ognature 41,
r C o CAC_
printed name
STATE OF FLO
COUNTY OF %- N& 0 Le
1 ,4—
This instrument was acknowledge before me t 's day of , 200 b, by the
above referenced individual, r co who acknowledged t at I,e/she is a
duly licensed contractor with kfr eZt_F. L o7-t, and who acknowledged that
he/she was authorized to execute this document. He/she is ei personally 1 wn to r :e or
produced as valid i en i ica ion.
WITNESS my hand and seal this I J'— day of
A;.:'""u DAFNEY FAME ADCOCK
NOTARY PUBLIC. STATE OF FLORIDA
i MY Comm. Expires DEC. 2.2008
GOMM: # DD376609