2850 Sanford Ave - E08-001148 DOCUMENTSti
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CITY OVSANFORD PERMIT APPLICATION
I8!As c b " ID tApphcahon # : U ml a a e.
Job Address: Z T ;o scar { .*1 '1 7 7 / Value o('Work: $ 7au
Parcel ID: 0 > — of G ; 3o S"i d'uo o} 6Iq 3o Zoning: Historic District:
Description of Work:
s .. .. ........ ...................................................
Square Footage:,
Permit Type: Building Electrical 50 Mechanical Plumbing Fire Sprinkler/Alarm Pool Sign
Electrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary Pole 5a
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 Commercial
Occupancy Type: Residential Commercial IR Industrial Occupancy Use Group(s):
Construction Type: # of Stories: of Dwelling Units: Flood Zone: (FEMA form, required.)
Property Owner: %(c, m A ur?5 4r.1 pler Yr •/' Sd t/!/ Contractor: zf /
Address: Address: %`%a G cry,(„ f A v e_
i
Phone:49y7) ST7 =(rQJ E-mail: PhonehO7) State License Number:
Bonding Company: Mortgage Lender:
IAddress: Address:
Arch itect/Engineer:
Address:
Plan Review Contact Person. 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 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 tliere 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 requirements of Florida Lien Law, FS 713.
Signature of Owner/Agent Date Signature of Contractor/Agent Date
Print Owner/Agent's
Signature of Notary -State of Florida Date
Prin ntractor/A ent's i ame
Si ature of Notary -State of Florida Date
I
iwn to Me or
y
l
k
1
111897
LIMMD POWER OF ATTORNEY
Date: 14 og
I hereby name and appoint o ` o d fin%
Of 0to be my lawful attorney
in fact to act for me and apply to C .r , v-r sg qcc/ for
a permit for work to be performed
at a location described as: Section Township Range
Lot Block Subdivision
B 50 SAir rod aw S ,,,d C1 3 2--771
Address of Job)
Owner of Property and Address)
and to sign my name and do all things necessary to this appointment.
Type or)riat na450 Certified Contractor and License #)
Simatum of Certified
Acknowledged:
Sworn to and subscribed before me this
Day of
Notary Public, State of Florida
Seal)
My commission Expires:'? 1
ti,r'•••,, GEORGIA ANN CHAMBERS
DD 737189RCommissionmission
Expires November 27, 2011
J;,,,t BonWThmTroy Fain lnsuanceWOW7019