HomeMy WebLinkAbout601 E Seminole Blvdd-11-203 7:2dAM FROM P 1
CRY OF SANFORD PERMIT APPLICATION
Permit P
Job Address: .n
Description of Work: o ,� CO�d t.� Z i
Historic District: Toning:Value of Work:
/ /.,
Permit Type: Building Ekctrica _ _ v ���
Mechanical Plumbing— Ponl
Electrical: New Service - p of AMPS v Addition/Alteration 'Change of�Service TemposSiy PoIZ
Mechanical: Residential Non -Residential Replacement — _ New y_ (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures # of water & Scwcr Lines ^. 8 of Gas Lincs
Plumbing/New Residential: n of Water Closets Plumbing Repair- Residential or Commercial
Occupancy Type: Residential Commercial Industrial lyl_ Total Square Footage:
Construction Type. ,_ # of Stories: M of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel M: (Attach Proof of Ownership & Legal Description)
Owners Name & Address: _ 0, Ly 5d_ Vt, 0co ,1
_ _ _ •�� PAUae:
Contractor Nnme & Addrece•i/G 8
7. "tom �r�n �TJon/ /i%I �Ar►/�rtc4mG.,o����n iCr----�--' — �. � ---- . -
Phone & Fax: •b9 rl�p3%
Contact Person:
Bonding Company:
Mortgage bender:
Address:
Architect/Engineer: f.! . ►j -.-�_ Phoma: D%
Address: 5&0 (44 5514VIFOr� -fir'-3%i'F Y/ Fax:. g�
Application Is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work err installation has cummenced prior :. , r:w
issuance of a permit and that all work will be performed to meet standards of all laws « gulaiing construction in Ibis jurisdiction. 1 understand that a sryanlc
permit must be secured for ELECTRICAL WORD PLUMBING, SIGNS, WELLS. POOLS, FURNACES, BOILERS. HEATERS, TANKS, and
AIR CONDITIONERS, etc.
OWNER :S AFFIDAVIT: l ecnily that all of the foregoing inibtrnalietn is accurate and that all work will be dome in compliance with all applicable laws regulating
cotutruction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR I)AYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSVLT wfrH YOUR LENDER OK AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
TI An addition to the requirements or 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 endtics such as water management districts, state agencies, or federal agencies.
Au cptance of permit is verification that f will notify the owner of the property of the requirements of FI "d - any, F$
SiSnalurcofOwner/Agent Date ' Signaturoot'Conractor/Agent
Print Owncr/Agent's Name Prior nnPl� actor/A¢cnr c N„w�
Sign:dure of Notary -Stole of FluriJa Date
Owncr/Agum is. _-. Personal)• Knower to Me or
Produced II)
APPLICATION AITROVIiU BY: Uldl;:
SPocial C'ontliti6ns:
Luning:
(Inioill A Dotc)
lip
of f lurid; .
Cunuacior/Agcnl k-, crIv n to Me or
_. induced II).yson y7 'fo
Utiliti4s: _ I:V,
(initial & Dow) (Initial dL Date) (Iriitial & Dncl
TMC
LIMITED POWER OF ATTORNEY
DATE:
I HEREBY NAME AND APPOINT �! ► l V� �'' I I� Z -
OF TeKONTROL INC. TO BE Y LAWFUL A TORNEY IN FACT TO ACT FOR ME AND
APPLY TO \ ` b � K U �
FOR A( n) �-�` _PERMIT FOR WORK
TO BE PERFORMED AT A LOCATION DESCRIBED AS:
SECTION.
RANGE LOT.
BLOCK SUBDMSION
01 (to
\4t -
TOWNSHIP
(ADDRESS OF JOB) ,
OF PROPERTY AND
ESS).,
AND TO SIGN MY NAME AND DO ALL THINGS NECESSARY TO THIS APPOINTMENT.
1AA\4 y., 1?,,Ass ERAO13 50Ck
TYPE OR PRINT NAME OF CER D CONTRACTOR, LICENSE #
• . arK 12uss
SIGNATURE OF CERTIFIED CONTRACTOR
ACKNOWLEDGE:
SWORN TO AND SUBSCRIBED BEFORE ME THIS 3
I DAY OF a, 200,
(SEAL)
My commission Expires:
t�/as/v 3
Notary Public, State of Florida:
Arlene E Lorene
* *My Commission CC690522
Fires November 28.2003