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121 Andrews Rd - BR08-001143 (SKYLIGHT REPAIR) DOCUMENTSt 5 6v}'i't'`'yi CITY OF SANFORD PERMIT APPLICATION Permit # Date: J r 11 Job Address: o< l 4 jJ h P—P_ t 7_ K k Description of Work: H Historic District: Zoning: Value of Work: Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool Electrical: New Service — # of AMPS Mechanical: Residential Non -Residential Plumbing/ New Commercial: # of Fixtures Plumbing/New Residential: # of Water Closets Occupancy Type: Residential Commercial Addition/Alteration Replacement Change of Service Temporary Pole New (Duct Layout & Energy Calc. Required) of Water & Sewer Lines # of Gas Lines Plumbing Repair — Residential or Commercial Industrial Total Square Footage: Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X) Parcel #: /d `deq — 3 / -0, Owners Name & Address: bed o R iq Attach Proof of Ownership & Legal Description) Phone: 1V % - 6 Contractor Name& Address: I-IRA+A 1VtA. J I / 30(" 'f.:J_= S T' r—i Lft/`ii_w A7y 3196.). State License Number: D S" kA >Ft Phone & Fax: .J 9—J41 i9 Contact Person: -lkVA) Phone: %s%• Bonding Company: Address: Mortgage Lender: . Address: Architect/Engineer Phone: Address: ' " . 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 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 verificati n that I will notify the owner of the property of the reqaa ts of Florida Lien aw, FS 713. rgn ure of Owner/Agent Da t re of Contractor/A Date F1UCZ• i b;4vl Print Owner/ ent's Name OP\O Oh N'•• % • •/' Print Contractor/A e s Name Z I ignature of Nirotary-S of Flonda > ° Dad ; a Signature of N a 4 eta rida 3 5 ; e_ _ m Notary Public, State of Florida k 7. p` My comm. expires Sept.12, 2009 dr . ' k No. DD 471019 w Agent is _Personally Known t ,af•;Y 1a "b1r .* O`\` Contractor/Age 1 roduced [D NA 30Q 12A G.2 7! YYj 1' ""• b,\ \ oduced ID FTC Y • i 11111111t `\\\ APPLICATION APPROVED BY: Special Conditions: Zoning: Utilities: F D: Initial & Date) (Initial & Date) (Initial & Date) 16 Handyman Home Repair Service of Pinellas Inc 11327 43`d St. N. Clearwater, Fl. 33762 — 727-577-2468 - License # CCC057454 — CRCB26297 LIMITED POWER OF ATTORNEY Date: — l ©y I hereby name and appoint David Buczek of Handyman Home Repair Service of Pinellas, Inc. to be my lawful attorney in fact to represent me and apply to G t1 ©F SA for a Roofing permit for work to be performed at a location described as: Section / k- Township ® Range Lot Block Subdivision kose t1,,LC. l A I A w-oP-aw-s 4, f L 12723. Address of Job) he-&k h L MeA Ia t A,;+Wul5 A SA>3F oRk FL d'-?» 3 Owner of Property and Address) and to sign my name and do all things necessary to this appointment. James K. Allbritten CCC057454 Type or Print name of Certified Contractor and License #) Acknowledged: Sworn to and subscribed before me this Y Day of A.D.a006 who is personally known to me/who produced as iiddenti d and who did not take an oath. Notary Public State of Florikttx—i iar Lynn M. Wright Sea My Commission DD304420 a,dr Expires May 21, 2008 My Commission Expires: j