HomeMy WebLinkAbout1601 Rinehart Rd (3)CITY OF SANFORD PERMIT APPLICATION Z
Permit # : I 1K�Jt Date: h1lo
J
Job Address: 1'4e- A A /' T lea/ �
Description of Work:
Historic District:
Value of Work:
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 #:
Owners Name & Address:
(Attach Proof of Ownership & Legal Description)
Phone:
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Contractor Name & Address: l � � � � Re crPr S eon eQ- �/
We.5 T AWq o % ve LO L.>d0 F1 327 D'. State License N�uumber: G G C � T
Phone & Fax: YP - 33 "10'0/ �a rev> -s39 -`f9// Contact Person: "1+'rT WPW,t -c- G Phone: 'VO "J - -33f— �V/
Bonding Company:
Address:
Mortgage Lender:
Address:
t 7 /
Architect/Engineer:/—*Pfi�• < «� f r " �' Phone:
Address: SBS W,�foti S�•3177? —2C{0 Fax: yDl- 330
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 PA.YfL�G
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 I will notify the owner of the property of the requirements f Florida Li n Law FS 7 3.
3
Signature of Owner/Agent Date Signa of Contractor/Agent Date
Print Owner/Agent's Name 'nt Con ractor/Agent' Na e
Signature of Notary -State of Florida Date Si nature of,Notary"-S `te of 1 °a+Slwiv" �';Clryate
COMMISSION # CC 92'1808,
EXPIRES: March 23;20 4.
g ly v
60ndR`—'u8irdq�tt�ctary$:t:l,es
Owner/Agent is _ Personally Known to Me or Con ctor/Agent rs " personally Known to Me or 3 i
Produced ID Produced ID �Z IAC -111 �Jr �i
s.2i•L3
APPLICATION APPROVED BY: Bldg: • Zoning: Utilities: FD:
(Initial M Ibatc) �' (Initial & Date) (Initial & Date) (Initial & Date)
Special Conditions:
Lam" 5o' off Rkvetvr� ok AE; S/2//63
R.-A.ROGERS
CON S T R UCTION
TO WHOM IT MAY CONCERN:
COMPANY
CITY OF SANFORD
BUILDING DEPARTMENT
SANFORD, FLORIDA
Please accept the following list of those persons authorized by R.A.ROGERS CONSTRUCTION
COMPANY to sign for permits.
Company Name: R.A.ROGERS CONSTRUCTION COMPANY
Address: 111 West Magnolia Avenue
City: Longwood State: FL Zip: 32750
Phone No.: 407-339-4001
Name of Cardholder: Robert A. Rogers
Permit Number:
Signature: ) LCA
State Cert./Reg. No.: CGC 045424
Name of Person authorized to sign:
Wyatt Nodine
Signature:
This form is to be signed, Notarized and returned to the Bureau of Building Code Enforcement, Florida.
Subscribed and sworn efore me this 215` day of May 12003
Notary Public:
My Commission Expires
04/27/2007
flow "�i:•� OFFICIAL SEAL
f •t Lori L. Harper
s ? My comm. expires 4-27-07
�•'!�+,,wo Comm. No. DD 181727
111 West Magnolia Avenue, Suite 2000 • Longwood, Florida 32750 • Phone (407) 339-4001 • Facsimile (407) 339-4911
License # CGC045424 • www.rarogers.com
(VANCANT)
ZONING: PD
FUTURE LANDUSE:
12.
HI -INTENSITY 1-4 , mr" . C" ( A '0TY" R1: 5 ?1 I;OLEW 7
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FOLK 1. PAGE WT
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RINEHART ROAD
-(140'R[W)
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LINE, SEC. 2
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