2351 Holly Ave 09-24CITY OF SANFORD-PERMIT APPLICATION RECEIVED
Application #: Submittal Date: OCT ® 3 2008
Job Address: Value of Work: S f , �o 0 • U�
Parcel ID: 3C0 _1q_ (Yd - - ' 1Zoning: Historic District:
Description of Work: l7r OQ tde C.IGC�rtLl Selo I Ce 10 E-%_7 p11011e L�1�tuare Footage:
..................................... .........................................P ...... ............................ ....
Permit Type: Building ❑ Electricals Mechanical ❑ Plumbing ❑ ' Fire S rinkler /Alarm ❑ Pool ❑ Si ❑
Electrical: New Service — # of AMPS I Addition/Alteration ❑ Change of Service ❑ Temporary Pole ❑
Mechanical: Residential ❑ Non - Residential .X 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
Occupancy Type: Residential ❑ Commercial ❑ Industrial ❑
Construction Type: # of Stories: # of Dwelling Units:
Plumbing Repair— Residential ❑ Commercial ❑
Occupancy Use Group(s):
Flood Zone: (FEMA form required )
........................................... ...............................
Property Owner: 4T4 4 Contractor: /mac ff\aC '.ICDV) fleriV Inns 0_01 p0c I i gin
Address: N1 • Lr IiQ-c vim • Address:149 i� UQ Q \)Q T D • ,�{'�. 7J-2— - 35�
Cult° I d0 t P-L
Phone: q0:1-Z1_mail: Phone-14b7 -371 q /rate License Number: gR /30-3a -Lo,;�
Bonding Company: Ll 14 Mortgage Lender: ±
Address:
Address:
Architect/Engineer: hl / ig- Phone:
Address: Fax: _
Plan Review Contact Person: I'Phone Z M ,JZS-� % x: 7 %5-f,5y -;?(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 RECORDfNG YOUR
NOTICE OF COMMENCEMENT.
N TI E: 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
Signature of Owner /Agent Date
Print Owner /Agent's Name
Signature of Notary-State of Florida Date
Owner /Agent is _ Personally Known to Me-or
_ Produced ID
APPROVALS: ZONING:
Special Conditions:
Rev 07.07
UTIL: FD:
the requirements of Florio Lien Law, FS 713.
0
of Contractor /Agent Date
s Name
of Notary-§tate ol Fl `! ' I3AKt3AtAaj�EANBEATTY
•� MY COMMISSION # DD519634
9 of �e EXF!RE2: Feb. 16,2010
(407) Se^,0153 Flor:s Uotary Service.com
Contractor /Agent is .Personally Known DMe
Produced ID
ENG:
BLDG:
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: l CJ /3 106
I hereby name and appoint: (zo
an agent of-
(Name
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 (check only one option):
All permits and applications submitted by this contractor.
The specific permit and applicption_for work located at:
(S&eet Address)
Expiration Date for This Limited Power of Attorney:
License Holder Name: J US c 0 r /
State License Number:
Signature of License H
STATE OF FLORIDA
COUNTY OF S Semi
The foregoing instrument was acknowledged before me this I q day _ cr,,Vr
200c7`� , by �L15 �n �Ut�n� who is ?�erson_y -- o
o me o ? who has produced as
identification and who did (did not) take an oath.
Signature
(Notary Seal) V G' 16a fq �xcIl 13
Print or type name
L BARA SEAN BEATTY ' - / COMMISSION # DD519634 otary Public -State of 5 I� l ��Or\ �� I EXPIRES: Feb. 16,2010 onunisslon No.
Florida Notary Sarvice.com Tly Commission Expires:
(Rev. 3/27/07)