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149 Bristol Forest Trl - G08-001581 (LPG TANK FOR GENERATOR) DOCUMENTSCITY OF SANFORD PERMIT APPLICATION Application #: Job Address: I br% S.1 > _ T(- Submittal Date: Value of Work: $ /Soo , oo Parcel ID: T Zoning: Historic District: Description of Work: -fQAOK 7(CC- GlfPet_CL_G('` Square Footage: Permit Type: Building Electrical Mechanical Plumbing )d Fire Sprinkler/Alarm Pool Sign Electrical: New Service - # of AMPS Addition/Alteration Mechanical: Residential . Non -Residential Replacement Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines Plumbing/New Residential: # of Water Closets Occupancy Type: Residential. Commercial Industrial Construction Type: # of Stories: # of Dwelling Units: _ Change of Service Temporary Pole New (Duct Layout & Energy Calc. Required) of Gas Lines Plumbing Repair -Residential Commercial Occupancy Use Group(s): Flood Zone: (FEMA form required) Property Owner: V ' ` AQ` e n 1 J Xm jt T_ Z Contractor: ©6 (rU-Ot. irb(Ax n e Address: I `1`1 rl S 1 pc trf?ST t c Address: 3• 1 • Pho e E-mail: Phooey S-Wga o State License Number:olq- I (0 Bonding Company: Address: Architect/Engineer: Address: Mortgage Lender: Address: Phone: Fax: Plan Review Contact Person: 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 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. 0 Acceptance of permit is verification that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713. N e gs _ Signature of Owner/AgentDate gnature of ractor/Agent Date S _ ' Z O ; a,,. X I , Tee rJ InfcL e(1 y N 0 m ` % Pri Owner/Agent's Name Pri Contractor Agent's Name 3 S a z Y. e -0 tea'. I tllstrnIxcQa¢ , D m 3 3 Signature lof Notary -State of Florida Date Signaturi of Notary -State of Florida Date > Z U o zo S m m Co Q0m Owner/Agent is ersonall Known to Me or Contractor/Agent isonally Known to Me or y w c _Produced ID 1a CS 3 " 7 _Produced ID o ALS: ZONING: UTIL: FD: ENG: BLDG: Special Conditions: Rev 07.07 j 4 a Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford, Seminole County, Winter Springs Date: _ S -"t- ©% I hereby name and appoint: Nkv r V\i5 WeA1 an agent of: et-n em l C Cep (fit rl Name of Company) 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 application for work located at: Street Address) Expiration Date for This Limited Power of Attorney: License Holder Name: State License Number: Signature of License Holder: Div STATE OF FLORIDA COUNTY OF The foregoing instrument was acknowledged before me this b day of, 200_, by "VQ_,C'C`4 Qckc mn who isQ<Zersonally known to me or who has produced identification and who did (did not take an oath. Vt*A(1,N'\k'N nd Sign -a re Notary Seal) Viroia',(\ "c4f i cX-10- nd Print ol type name y ., VIRGINIA STRICKLAND Notary Public - State of Fbfda Y Commission Expires May 8, 2010 p"W" Commission # DO 549823 Bonded By National Notary Assn. Rev. 3/27/07) Notary Public - State of UvlkkQk Commission No. DD a My Commission Expires: 0 as T-Vvy C 0 /As'/ 644 PERMIT # -f E - I 5 V -- DATE: --j - 9 - o X US b GenLowRates07.728X90 Page 1 of 1 b A i http://view.atdmt.com/IWC/iview/mpgstbO6003000001Oiwc/direct/01/2754909?click=http... 9/19/2007 i1