1210 Tropic Park Dr 08-2682CITY OF SANFORD PERMIT APPLICATION
Application Submittal Date: z c 1 `6
Job Address: �Zl/) f ► f� 21L ,1�/�1 �t- -7% 3 Value of Work: S
Parcel ID' 14-2066 -13 ° ()60 Zoning: Historic District:
Description of Work: 1•.,�- =:3 1............................................. 1 J.1 T l�S K f- l�Y r}�? .N C 1YDQC�►.� : Square Footage : ..........................
Permit Type: Building ❑ Electrical ❑ Mechanical ❑ Plumbing &_ Fire Sprinkler /Alarm ❑ Pool ❑ Sign ❑
Electrical: New Service - # of AMPS Addition/Alteration ❑ Change of Service ❑ Temporary Pole ❑
Mechanical: Residential ❑ Non - Residential ❑ Replacement ❑ New ❑ (Duct Layout & Energy Cale. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets Plumbing Repair- Residential ❑ Commercial ❑
Occupancy Type: Residential ❑ Commercial K Industrial ❑ Occupancy Use Group(s):
Construction Type: 11 # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required)
rPropertyOwner• 4C l F_e_ q9_1 . 6% l5- ................ ...Contractor: �3
ccePIOMil`Kc s''lhCl�_:
Address: Q 0 1 LV-111 r-- � �� Address: _ X37) ,S LeAVIT WI� —
5-
Phone: E -mail: Phone: 27Y' State License Number: (JFe 0 S�2940
Bonding Company:
Address:
Architect/Engineer:
Address:
Plan Review Contact Person:
Mortgage Lender:
Address:
Phone:
Fax:
Phone: Fax:
E -mail:
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 PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
FIRST INSPECTION. 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 thi pr r that may be found in the public records of
this county, and there may be additional permits required from other governmental entities such as wr ma a t d icts, state agencies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the
Signature of Owner /Agent
Print Owner /Agent's Name
Signature of Notary -State
Owner /Agent is _
Produced ID
APPROVALS: ZONING:
Special Conditions:
Rev 07.07
Date
the re ant of Florida Lien Law, FS 713.
of Co�racte /^ ent Date
Print Contractor /Agent's Name
I n
MIC eE A.1AWATSKY 'g'
\fff• pV •�
Notary Public - State of Florida
•: My Comm. Expires Sep 2, 2012
a>' Commission #► 00 819575
OF ri�` National Notary Assn.
••�Illtlfff 8orxted TflrOtfQh
` `reactor /Agent is _ Personally Known to Me or
_ Produced ID
FD: ENG: BLDG:
of Notary-State of
UTIL:
9 9
iii
PERMIT
AUTHORIZATION
zztl hereby authorize
(License Holder)
k6M (-64cP ,fA0 to obtain a gas plumbing permit
(Authorized Person)
on my behalf under my license # CFC057948
for the job described below
DESCRIPTION
Owner f ci EEL 1121 N OI E
Site Address 1Z.O 'SAt\k► -)q-0
Tax Parcel # 7 � - Z0 - 30- Sl (o - OOCO -- CC 5-0
'(Kicennse4lolder signature)
Date
State of Florida
County of
Affirme d- subser-ib fore me thisday of 20 by,
Who i personally known to me o has produced (type of ID) as identification
Signature of Notary PoSlic, State of lorida Print, Type or Stamp Name of Notary
MICHELE A. ZAWATM
Notary Public • State of Florida
• •= My Comm. Expires Sep 2, 2012
Notaries Seal .',�Fa v��;�• Commission #� DD 819575
„t# to,•• fiOndeC ftWh Assn.'
GAS PLUMBING SERVICES, INC.
1377 S. Leavitt Drive
Suite 103 & 104
OF
ANI
3E CITY, FL 32763
(3E
6) 7
74-8244 • FAX (386) 775-1749
En
all:
sharkman@cfl.rr.com
M V
N kA
(2)
L)
00
W
qw
�j
-4
U)
LU
Q:
0
ui
A m 6
LLI
L)
LL
LL
0
c;) 01
j
10
,A)
hx
2
ff)
> .e
LU
T
LLJ U. J ce
(D Uj
W z a: Z' LU
U- o r3 caS o c
M ga zt
M V
N kA
(2)
L)
00
N
W
qw
�j
-4
U)
LU
Q:
0
ui
A m 6
LLI
L)
LL
LL
0
c;) 01
j
10
,A)
hx
2
ff)
> .e
LU
T
LLJ U. J ce
(D Uj
W z a: Z' LU
U- o r3 caS o c