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100 Hidden Lake Dr 09-237CITY OF SANFORD PERMIT APPLICATION Application H: 0,5- j/, -)_-/ � / �� ", Submittal Date: //1^ Job Address: I1�) l�]c,�ern / /J/-r � Vep Value of Work: $ Parcel ID: / " ��tr3la ' L( �� Zoning: Historic District: Description of Work: ,pryv -C e1r1 -fy1 ,1_' -5e2r ✓I ,,'L" to 6T I / -7- dabj E quare 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 Plumbing/New Residential: # of Water Closets Occupancy Type: Residential ❑ Commercialx Industrial ❑ Construction Type: # of Stories: # of Dwelling Units: # of Gas Lines Plumbing Repair -Residential ❑ Commercial ❑ Occupancy Use Group(s): Flood Zone: (FEMA form required ) ............................................ ............................... ........................... ....... .. . // ....... Property Owner: J T Contractor: fr 00 ;QO it . Address: i� )b 10, Address: ,/ EL Phone:4PT271-L)L"//E -mail: Phone #b7 -q9J /3/ - tate License NumberEkt -301 3Z& Bonding Company: Mortgage Lender: !�[ Address: Address: Arch itect/Engineer: N 6 Phone: Address: Plan Review Contact Person: Fax: -7�J- a'/-2/0 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 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 pr rty the requirements of Florida Lien aw, FS 713. Signature of Owner /Agent Date Signature of Contractor /Agent Date h V V Print Owner /Agent's Name t o ractor /Agent's N e Signature of Notary-State of Florida Date Signature of Nota DALE NOETHEN MY COMMISSION # DD831283 •.,,;rF;,d!`:;• EXPIRES October 15, 2012 Owner /Agent is _ Personally Known to Me or Cont (407) 398 -0153 - FlondallotarySerncill Lo me or Produced ID _ Produced ID APPROVALS: ZONING: Special Conditions: Rev 07.07 UTIL: FD: ENG: BLDG: -1, d..) LIMITED POWER OF ATTORNEY Altamonte Springs, Casselberry, Lance Mary, Longwood, Sanford, Seminole County, Winter Springs Date: I hereby name and appoint: Nq4al S an agent of. (Name of Company) Y to be my lawful attorney -in -fact to act for me to apply for, receipt for, sign for and do all things necessary to this appointment for: The specific permit and application for work located at: (ou lA ddc n La Ise 'Dow- (Street Address) Expiration Date for This Limited Power of Attorney: Xt I License Holder Name: ' Qs� Elorj State License Number: Signature of License H STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this�Q day of ©c_rt)3. ez , 200_x, by " F'tc:: -v., who is Kpersonally known to me or ❑ who has produced as identification and who did (did not) take an oath. (Notary Seal) ;•e"Y •" DALE NOETHEN A L MY COMMISSION # DD831283 EXPIRES October 15, 2012 (407) 398 -0153 Flondallotary$ervice.com (Rev. 3/27/07) Signature Print or type name Notary Public - State of � o - .•c�, s}• Commission No. 0 0§ -" *1 � My Commission Expires: ©cr