HomeMy WebLinkAbout232 Krider Rd.Job Address Oh V +
Description of Work: Q t
Historic District: Zoning:
Value
Date: ` ` �0P
Permit Type: Building Electrical Mechanical C Plumbing Fire Sprinkler/Alarm Pool .
Electrical: New Service — # of AMPS Addition/Alteration Change of Service Tempoi*y Pole
Mechanical: Residential Y, Non -Residential Replacement _)Z_ New(Duct Layout &Energy Ca1 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:
Constructtiioonn Type: # of Stories: Q# of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: lJ / AD 3 �[�j��tt,, D C7) ^^ (Attacb Proof of Ownership I Descri tion)
Owners Name & Address: (�l_ P`�u i — �{�Z r Q — �� C►�!1 fiw
Contractor Name &'Address:
Phone:
Phone & Fax: 11 L-1
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
Phone:
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. 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 AFFIDAVff: 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 M 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 applic
this county, and there may be additional permits required from other governmental entities such as
Acceptance of permit is verification that 1 will notify the owner of the property of the
Signature of Owner/Agent Date
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent isPersonall% Kno%%n to Me or
Produced ID_
APPLICATION API'ItOVED BY: Bldg:
:Initial & Date)
Spec i;j! Conditions:
Zoning:
ble7ot
may be fou in the public oC
tects, state a cies, or genies
of Fl713 "• •••
Signature
.Agent's Name
ofFlorida / ' Date
Contractor/Ag:-: is Personally Known to Me or
Producec* :D
(Initial & Date)
(Initial & Date) (Itritial & Dat:
3
06/17/2003 02:44 4078166306
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TM[ WYF1k M111: r"CEL TWO TPA"ACIION AT ANY TIME PRIOR TO MIDMIGHT DF FME TRIRO BUd1FIEd�
M OAT IM 411144111111 pI I NUMEAO DAY IR IIORIM DAKOTA IF YOU ARE A0E E! OR OIDEOq AFRiA T,1E DATE
>)[{ THAT ATti1Ci1FD NOTICE DF CAN
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A
LEMED POWER OF ATTORNEY
I hereby name and appoint
of
to be my lawful attorney
in fact to act for me and apply to ��rj for
a JMTA an l permit for work to be performed
at a location described as: Section Township Range
Lot Block Subdivision
6rcj Q.R.. Pld. .
(Address of Job)
al �QX � aW
(Owner of Property and
and to sign my name and do all things necessary to this appointment
Acknowledged:
Sworn to and subscribed before nae this
cl � �
Jq Day of T LL."
Notary
(sew)
My Commission Expires:
A.D. 100-3
SUSAN I YplllVG
Commission 0 DD0191350
Expires &9/2007