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CITY OF SANFORD rv.Rmff 'iPPLICATION
Permit #:
Job Address:
Description of Work:
IVA
/o y O
Historic District: Zoning: Value of Work:
Date
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm PoQI .
Electrical: New Service — # of AMPS Addition/Alteration Change of Service Tempodry Pole
Mechanical: Residential Non -Residential _
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets _
Occupancy Type: Residential t_ Commercial
_ Replacement New (Duct Layout & Energy Cil . Required)
# of Water & Sewer Lines # of Gas Lines
Plumbing Repair— Residential or 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: -1, a )rt/Ard d1 A., —rK& A44
iL 7 71 Phone:
Contractor Name&'Address: ((,T X I 16,19�F�.t� at" f tlyTOl� %L
2 2Z7/ State License.Number: e CC d.Z ZJO/
Phone & Fax: 0 7 -.7 1 2 9 -PT Contact Person: --Url a
—Phone:. 40 7 - ZI_. 0-T Z L
Bonding Company:
Address: 7
Mortgage Lender:
Address:
Architect/Engineer: 4 o 14 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. 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 PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. EF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
N Tl : 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 fed I agencies.
Acceptance of permit is verification that I will notify the owner of the property of the require o orijeLien Law, FS 71
r
Signature of Owner/Agent Date Date
Print Owner/Agent's Name
Signature of Notary -State of Florida
Omer/Agent is _ Personalh <no%%n to Me or
Produced ID
AITLICAI ION APPROVED BY
Spccij! Conditions:
Date
6�D
Bldg: Zoning:
riniti3! d Date)
of No:ay-State of Florida
inn `
Date a mn
ba�::
ro��
O = . . y.
Contractor/Ae:-: is _ I'crsonaliv Known to Me or 5 � =00
st Produce" :7 w'p d
• c �obC
Nw
I:D: n vpi w "f
(Initial & Daw) (Initial & Date) (Initial & Dau
POWER OF ATTORNEY
Date: S- 2 tr—D.3
do hereby authorize /,e& w /O 60
to pull the E:�OQF permit for _2-�LJO S I LtAf t 4V -S,
type of pennit address
Signature
R
otary
Personally know to me or drivers license #
ortda, County of
.► 2002.
J
$Wft- f UndaAKeoling
. W COrnMMSM CC98W28
a ^� ExPres December tm 2W4
on Z _day of
•
STATEMENT
State Certification A -
ROOFING
No. CCCO22501 AND SHEET METAL
Since 1963 800 French Ave. • Sanford, Florida 32771
Phone: (407) 322-9558
TO: & f A A t &d-�,
ADDRESS: 7
DATE -T / Z/ / 206 T
CITY: 1 �� ye"G�� STATE: / ZIP: J ?,