2612 S Marshall Ave 04-188 Natural gas line for range11f,50
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CITY OF SANFORD PERMIT APPLICATION /
Permit #: ` `
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Date:
Job Address:, r 7/ 5 • f l Ake_-4 6 -AU
Description ofWork: (&)5T1" LAl tUN Or NA`7-04AL 9.4S SUE-(_ C.)A)E— RA/E-
Historic District: Zoning: Value
Permit Type: Building Electrical Mechanical Plumbing / Fire Sprinkler/Alarm Pool
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 or Commercial _
Occupancy Type: Residential Commercial Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #:
Owners Name & Address:
Contractor Name & Address:
Phone & Fax:,
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer
Address:
Attach Proof of Ownership & Legal Description)
A N t Z- 5 • A 2 fa C.-i.
Phone:
1 _:. > State License Number:y
t ContactPerson:Phone:
Phone:
Fax:
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. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITHYOUR 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 at may be found in the public records of
this county, and there may be additional permits required from other governmental entities such as wAterjmaBAgemenyd stricts, state agencies, or federal agencies.
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Acceptance of permit is verification that I will notify the owner of the property of the requirement n FS 713.
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Signature of Owner/Agent Date Signatureof Con c1tork6gent Date Print
Owner/Agent's Name Print a
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7' SignatureofNotary -State of Florida Date Signature of Notary -State ofFIdS& V D* oEn a ..
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Owner/
Agent is _ Personally Known to Me or Produced
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tractor/Agent is Perso ally Known to Me or Produced
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w y..x APPLICATION
APPROVED BY: Bldg: Zoning: Utilities: FD: Initial &
Date) Initial & Date) (Initial & Date) (Initial & Date) Special
Conditions:
POWER OF ATTORNEY
Date: 10/22/03
1:, Donald E. Kitner , do hereby authorize Robert Thistel
to pull the plumbing permit for 2612 ,'." Marshall AV., Sanford, F1. .32773
type of pernut address
signature
Martha Jackson Hartman
Donald E. Kitner
Commission #DD244694
Expires: Oct 10, 2007
FOF tip. Bonded Thru
Atlantic Bonding Co., Inc.
tMarthaJaconHartman
Personally known to me or drivers license # known to me
State of Florida, County ofyolusia on 22nd day of October
2-,- 2003