3705 S Orlando Ave - BC07-002324 (INSTALL PROPANE TANKS) DOCUMENTS0
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CITY OF SANFORD PERMIT APPLICATION
Application # : Submittal Date:
Job Address: 3105 S Orlando Ave, Sanford, FL 32773 Value of Work: $1084
Parcel ID: Zoning: Historic District:
Description of Work: Install two 120 gallon propane tanks and 20' of 1/4" gas pipe to generator. Square Footage: n/a
Permit Type: Building Electrical Mechanical Plumb ng Fire Sprinkler/Alarm Pool Sign
Electrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary Pole D
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Cale. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines _1
Plumbing/New Residential: # of Water Closets Plumbing Repair —Residential Commercial
Occupancy Type: Residential Commercials Industrial Occupancy Use Group(s):
Construction Type: _existing_ # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required )
Property Owner: V,&,C n Contractor: AmeriGas Propane
Address: Address: 2812 Silver Star Road, Orlando, FL 32808
Phone:
Bonding Company:
Address:
E-mail:
Architect/Engineer:
Address:
Plan Review Contact Person:
Phone: 407-293-6644 State License Number: 01614
Mortgage Lender:
Address:
Phone: Fax:
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 constriction 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 verification that I will notify the owner of the property of the requipITMRts of Florida Lien Law S-7
Signature of Owner/Agent Date re of C ntractor/Agent D to
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is _
Produced ID
APPROVALS: ZONING:
Special Conditions:
Rev 02/2007
Personally Known to Me or
UTIL: FD:
Name
Date
M g
MY COMMISSION # DD629096
s±,. 677 IRES: February25, 201 I
1.8tMk7'NbTARV FI. Notary Discount Azm. Co. JP
Contractor/Agent is —
t —F' li {
erbonae Wt to Me or
Produced ID
ENG: BLDG: Mal
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7-
POWER OF ATTORNEY
Date: T -
I hereby name and appoint fogy nU,g s
of `l(=w imw to be my lawful attorney
in fact to act for me and apply to the eF ,Ao ep
Building Department for a_e&47 Mj permit
for work to be performed at a location described as:
Section Township Ranae Lot Block
Subdivision
G;y ti!/w iOL i
Owner of Property and Address)
and to sign my name and do all things necessary- to this appointment.
Type or0int Name Contractor's License Number
Signature of Certified ntractor
OZO w&-1t5
The 0iag ins nt was acknowledged before me this 2``da ofe7y LOV, 6by
who
who produced
as identification and who did not take oath.
rjptAFiY
REFUS J. HOLLOWAY
PUBLIC STATE OF FLORIDA
COMMISSION # DD233012
EXPIRES 7/16/2007
BONDED THRU 1-888-NOTARYI
Seal
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PERMIT # _
DATE:
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Generator
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Install approx.
15' of/4"
galvanized pipe
from tank to
generator.
2) 120 gallon
propane tanks
Back parking lot of
shopping center.
Kimco Realty
3705 S Orlando Ave
Sanford, FL 32773
01/17/2006 02:56:24 PM Faxserver FAXSEPNER Page 21
ACORD.
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DATE(MM/1D/Yy W4i')0117105PRODUCERTHISCERTIFICATE
I$ ISSUED AS A MATTER OF INFORMATION Mn R.Sk
Serv! ces, Inc, of Pennsylvania ONLY ANO CONFERS NO RIGHTS UPON THE CERTIFICATE one Liberty Place.
16SO Market Street
suite 1000 Philadelphia
PA 19103
HOLDER. THIS CERTIFICATE
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PHONE,-(866) 26G-
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