HomeMy WebLinkAbout806 Willow Ave 04-1048 remodelPERMIT . =, k,&>,\\ 100A "
CONTRACTOR
ADDRESS
PHONE NUMBER
0L
61.*Ma.a%
it lv 1
PROPERTY OWNER to.w"sk ,, rftamw*.
ADDRESS S
PHONE NUMBER
ELECTRICAL CONTRACTOR
MECHANICAL CONTRACTOR
PLUMBING CONTRACTOR
MISCELLANEOUS CONTRACTOR
PERMIT NUMBER
MISCELLANEOUS CONTRACTOR
FEE
PERMIT NUMBER FEE
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SUBDIVISION En
PERMIT # 0k -I 104t DATE 19 • 1 ,; :;q
PERMIT DESCRIPTION 1&4.&%44ftj2.00n -- low
PERMIT VALUATION %9 4 % 06
SQUARE FOOTAGE 146
CITY OF SANFORD PERMIT APPLICATION
Permit # w l
q
Date: 1
Job Address: huO 6 L) (Ll2ENA2 I 1 j -1N 6 A JD Description
of Work: RC+'L ri t 1 a'l eL t S % ' Z <-.
61py .
Qy C8 L t7_n1 7 u% t z!+ ) Historic District: "
Zoning: Value of Work: Permit Type:
Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool Electrical: New
Service — # of AMPS Addition/AIteration Change of Service Temporary Pole .__ Mechanical: Residential !%
Non -Residential G---' Replacement New (Duct Layout & Energy Calc. 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 1G Commercial Industrial Construction Type: #
of Stories: # of Dwelling Units: Parcel #: Owners
Name &
Address: Total Square
Footage: Flood Zone: (
FEMA form required for other than r) Attach Proof
of Ownership & Legal Description) Phone: Contractor
Name &
Address: IVIVt Lt.- Ci/ f14)71,11 E'\ 7 t7 J n [
ice 1/t1 C t 7 t IgG
I
t r``r,_'q rl -2-t i4ArState License Number: Phenc+& Fax:
N 0 7 C% L 2 G Z / G Contact Person: /VJ r Li is;- j A pN I Phone: g e J I Z 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. 1 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 aptdicabir. laws rcgniming construction and
zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESUTA IN YOt)R PAYIIJG TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER Olt. 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 piddic rrrorrls of this county,
and there may be additional permits required from other governmental entities such as water management districts, state agencies, or fedcr,i 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 Print Owner/
Agent's Name Signature of
Notary -State of Florida Date Owner/Agent
is _ Personally Known to Me or Produced ID
Nk 2-
14)-- V`l` Signature of Contractor/
Agent Date frill Contractor/Agent'
s N e 014 ci f'
426J
Date MY
COMMISSI
N
EXPIRES: November 12,
2006 Y`r V,r - `°
Bonded Thru
Budget
Notary Services Contractor/Agent is _
Personally Known to Me or Produced ID. -\n'
Q -\a A•U APPLICATION APPROVED BY:
Bldg: "Zoning: Utilities: Initial & Date) (Initial &
Date) Special Conditions: FD:
Initial & Date) (
Initial &
Date)
Seminole County Property Appraiser Get Information by Parcel Number Page 1 of 1
PARCEL DETAIL ZUS= j=Z= a < < Back (;
E 8TH ST
14- h
Seminuile Count) m p
v
o rrlv nrisr r
c trr cei
D
m
mL >
a
1101 K, Firs 11.
Nxuteu'd
4
771
7-hhS-7S-75SII6E SITH ST 2004
WORKING VALUE SUMMARY GENERAL
Value Method: Market Parcel
Id: 25-19-30-5AG-100E-0030 Tax District: S1-SANFORD Number of Buildings: 1 WARREN
WILLIE J & 00- Depreciated Bldg Value: $59,049 Owner:
CATHERINE J Exemptions: HOMESTEAD Depreciated EXFT Value: $0 Address:
806 WILLOW AVE Land Value (Market): $5,696 City,
State,ZipCode: SANFORD FL 32771 Land Value Ag: $0 Property
Address: 806 WILLOW AVE SANFORD 32771 Just/Market Value: $64,745 Subdivision
Name: SANFORD TOWN OF Assessed Value (SOH): $51,868 Dor:
01-SINGLE FAMILY Exempt Value: $25,000 Taxable
Value: $26,868 2003
VALUE SUMMARY SALES
Tax
Value(without SOH): $748 Deed
Date Book Page Amount Vac/Imp 2003
Tax Bill Amount: $540 WARRANTY
DEED 0111973 01000 1930 $20,200 Improved Savings
Due To SOH: $208 2003
Taxable Value: $25,901 Find
Comparable Sales within this Subdivision DOES
NOT INCLUDE NON -AD VALOREM ASSESSMENTS
LAND
Land
Unit Land LEGAL DESCRIPTION PLAT Land
Assess Method Frontage Depth Units
Price Value LEG LOT 3 BLK 10 TR F TOWN OF SANFORD PB FRONT
FOOT & 64
117 .000 100.00 $5,696 1
PG 56 DEPTH
BUILDING
INFORMATION Bid
Num Bid Type Year Bit Fixtures Gross SF Heated SF Ext Wall Bid Value Est. Cost New 1
SINGLE FAMILY 1973 6 1,670 1,258 CONC BLOCK $59,049 $68,068 Appendage
I Sqft OPEN PORCH FINISHED / 88 Appendage
I Sqft GARAGE FINISHED / 324 NOTE:
Assessed values shown are NOT certified values and therefore are subject to change before being finalized for ad valorem tax purposes.
If
you recently purchased a homesteaded property your next ear's property tax will be based on Just/Market value. http://
www.scpafl.org/plslweblre_web.seminole_county_title?parcel=2519305AG 100F0031... 2/19/2004
CITY OF SANFORD PERMIT APPLICATION
Permit # : o7 " loy0
Job Address: O 06 L") t J LD LJ 61 i/
Description of Work: f-1LJ
Historic District:
Date:
i
Zoning: Value of Work: $ r5700 Oil
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 Calc. 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 #: (Attach Proof of Ownership & Legal Description)
Owners Name & Address: w i I 1 1 Q L.) A t" r Q J 1 O Iti) tF} VOL
Phone:
Contractor Name & Address: r4r41w, I p i_2
11\ \% \ - ,/PD :b-
a j
Phone & Fax: 4107 -970 '%ODO 7O7/9p3 5/7- Contact Person:
Bonding Company:
Address:
Morteaee Lender:
Address:
Architect/Engineer:
Address:
State License Number: /,,/, F 0lP 7/.S
44- A l i y Phone:* 2 gZo 10o0
Phone:
Fax:
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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: 1 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 YOUK PAYrNG
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 requirem its of Florid ien Law, FS 713.
Signature of Owner/Agent Date Signature of Contractor/Agent Date
Print Owner/Agent's Name rin o tractor/, \ Agent's Na e
Signature of Notary -State of Florida Date l4 .ota A0 DateRAVE
MY COMMISSION # DD 164280
EXPIRES:: gNovember 12, 2006
Owner/Agent is _ Personally Known to Me or o tra8FJ Agent t8s Th -P q C°li( rt to Me or l
Produced ID Produced ID ycy_\ xj -C
APPLICATION APPROVED BY: Bldg:
Initial & Date)
Special Conditions:
Zoning: Utilities: FD:
Initial & Date) (Initial & Date) (Initial & Date)
CITY OF SANFORD PERMIT APPLICATION
Permit #: O(A - `C)A O
Job Address:
Description ci
Historic Distr
nni, 1 \\ l D
Permit Type: Building Electrical _Z11" Mechanical 11,_
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 Calc. 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 _Z_ Commercial Industrial Total Square Footage:
Construction Type: bL lL # of Stories: _ # of Dwelling Units: _ Flood Zone: (FEMA form required for other than X)
Parcel #: Q 1 5 - I Ci -3
11..\\
O "5.q°,.
Owners Name & Address: uJt
I - Q
e if lRoLo
Attach Prof Oofo ership & Legal Description)
Phone: I.
Contractor Name & Address:lp/I
g State License Number: CC G Q ko5(n
Phone &_Fax: -} o
t C
ai oC'-C ntact Person:.YP ry h 7 Phone:
A
Bondide C m a r' ! 1 A P% P%
Mortgage Lender:
Architk Engineer: _ Phone:
JAN 2004 Fax: Address: -
Applicatign.is Here y de o ja n t the work and installations as indicated. 1 certify that no work or installation has commenced prior to theissuanceofapermalliedto -meet standards of all law risdiction. I understand that a separatepermiimustbe-sec f !C L O PLUMBING, SIGNS, WELLS, RECEIVED, HEATERS, TANKS, and
AIR CONDITIONERS, etc. _ _:..
OWNER'S AFFIDAVIT: l 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 requirements of Florida Lien Law, FS 713.
nature ofOwne A t `
d
Si 3
g Date Sign cure of Contractor/Agent D to
Print Owner/Agent's Name PrintContractor/Agent's Name
0909 azure of Notary -State f Date nature of Notary-Sta of lori DateatureofNotary -State f FloridaFlor
Ow /Agent is _ Personally Known to Me or Contractor/Agent is Personally Known to Me or
Produced ID — Produced ID
ro ' l -I( APPLICATION APPROVED BY: Bldg:'. Zoning:
Initial & Dat )
Special Conditions:
initial & Date)
un u
j,N+Ve• LINDSAY MYERS
s Notary Public • State of Florida
My Commission Expires Dec 26, 2006
Commission # D0173915
Bonded By National Notary Assn.
Utilities: FD:
Initial & Date) (Initial & Date)
LIMITED POWER OF ATTORNEY
I hereby
ate
of
to sign his/her name on my behalf in order to apply fora At permit
for the work to be performed at:
Lot 3 Subdivision e—AS, ftjE S80 CUt-)
n
Address 906 OL NLZ . 1 -6 •
Type or print name of company and License # of Contractor
ignature of Licensed C actor
If applicable only'
Type or print name of owner
Signature of owner
STATE OF FLORIDA
ORANGE COUNTY
The foregoing instrument was acknowledged before me this day of _ rxoacx 0Dk,
by (name of person acknowledging). of
Notary] Public-Sfafe of Florida) LINDSAY
MYERS Notary
Public - State of Florida My
Commission Expires Dec 26, 2006 Print,
Personally
known OR produced identification LI/1'
Type
of identification produced !T h Cc, d
Seminole County Property Appraiser Get Information by Parcel Number Page 1 of 1
PARCEL DETAIL Ii 31 Back (j }
E STH ST
Sx uxiz as a t ui tllr
z
m r
tr
317,71
dl?7 S/hb E 9TH 5T 14
2004 WORKING VALUE SUMMARY
GENERAL Value Method: Market
Parcel Id: 25-19-30-5AG-100E-0030 Tax District: S1-SANFORD Number of Buildings: 1
WARREN WILLIE J & 00- Owner: Exemptions: HOMESTEAD
Depreciated Bldg Value: $54,704
CATHERINE J Depreciated EXFT Value: $0
Address: 806 WILLOW AVE Land Value (Market): $5,696
City,State,ZipCode: SANFORD FL 32771 Land Value Ag: $0
Property Address: 806 WILLOW AVE SANFORD 32771 Just/Market Value: $60,400
Subdivision Name: SANFORD TOWN OF Assessed Value (SOH): $52,123
Dor: 01-SINGLE FAMILY Exempt Value: $25,000
Taxable Value: $27,123
2003 VALUE SUMMARY
SALES Tax Value(without SOH): $748
Deed Date Book Page Amount Vac/Imp
2003 Tax Bill Amount: $540
WARRANTY DEED 01/1973 01000 1930 $20,200 Improved Savings Due To SOH: $208
2003 Taxable Value: $25,901
Find Comparable Sales within this Subdivision
DOES NOT INCLUDE NON -AD VALOREM
ASSESSMENTS
LAND LEGAL DESCRIPTION PLAT
Land Assess Method Frontage Depth Land Units Unit Price Land Value LEG LOT 3 BLK 10 TR F TOWN OF SANFORD PB 1 PG
FRONT FOOT & DEPTH 64 117 .000 100.00 $5,696 56
BUILDING INFORMATION
Bid Num Bid Type Year Bit Fixtures Gross SF Heated SF Ext Wall Bid Value Est. Cost New
1 SINGLE FAMILY 1973 6 1,670 1,258 CONC BLOCK $54,704 $63,059
Appendage / Sgft OPEN PORCH FINISHED / 88
Appendage / Sgft GARAGE FINISHED / 324
iNOTE: Assessed values shown are NOT certified values and therefore are subject to change before being finalized for ad valorem tax purposes.
Ifyou recently purchased a homesteaded property your next year's property tax will be based on Just/Market value. http://
www.scpafl.org/pls/web/re web.seminole_county_title?parcel=2519305AG100F0030&cpad=w... 1/13/2004
I rrctPARED W.
ADDR. DUI. fr
s i k,rd NOTICE OF COMMENCEMENT
State of Florida
Permit No. Tax Folio No. (PID)
County of Seminole
The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with
Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement.
DESCRIPTION OF PROPERTY: (Legal description of the property and street address)
806 WILLOW AVENUE, SANFORD, FLORIDA 32771
LEGAL LOT 3 BLOCK 10 TR F
TOWN OF SANFORD IIIIIRIIIIUIIII1111111gIII UU1111111111a1N111111g11
PLAT BOOK 1 PG 56
GENERAL DESCRIPTION OF IMPROVEMENT:
GENERAL HOME REPAIR IMPROVEMENTS
OWNER INFORMATION:
Name and address: WILLIE J. WARREN & CATHERINE J. WARREN
806 WILLOW AVENUE
SANFORD, FLORIDA 32771
NRRYMME MDRSE, CLERK OF CIRCUIT COURT
SENINOLE COUNTY
BK 05169 PG 0797
CLERK'S # 2004008162
R6I0RDED 01/16/P004 11156158 AN
RECONDING FEES 6.00
RMRDED BY 8 O'Kelley
t;LKIlfItU COP1
Interest in property: FEE SIMPLE MARYANNE MORSE
OLERK OF CIRCUIT COURT
NAME AND ADDRESS OF FEE SIMPLE TITLE HOLDER. (IF OTHER THAN OWNERPEMINLE N RI[
CONTRACTOR JAN 16 2004
Name and address: ATLAS GENERAL INC.
ZA250 BELLE AVENUE SUITE 101
WINTER SPRINGS, FLORIDA 32708
SURETY (Bonding Company)
Name and address
Amount of Bond - -
LENDER
Name and address: SEMINOLE COUNTY COMMUNITY DEVELOPMENT OFFICE
1101 EAST I IT STREET, SUITE 3301
SANFORD, FLORIDA 32771
Persons within the State of Florida designated by Owner upon whom notice or other documents may be served as provided
by Section 713.13(1)(a)7., Florida Statutes:
Name and address
In addition to himself, Owner designates of
to receive a copy of the Lienor's Notice as
provided in Section 713.13(1)(b), Florida Statutes.
Expiration Date of Notice of Commencement
The expiration date is lyear from date of recording unless a different
Swor to and subscribed befor me this 5th Day of
C
r4io'tary Public
Signature of Owner
January, 20004.
My Commission Expires: My 2. 2oo(,o
The foregoing instrument was acknowledged before me this 5th day of January, 2004 by Willie J. Warren an
Catherine J. Warren (name of person acknowledged), who is personally known to me or who as produce
FDI-# W to 5d - 896 - NO - 2 62 - D (type of identification) as identification and who did / did no to a and
oath> F DL-I' V I (050 - t 7- p - `-12 - (0 3 -
r
Y P&OFRCIAL NOTARY SEAL
LAcr\pmjeetslcommunity deMousing ActivitieslRehabilitafion02O3\notceofoommencemenAwilliewarrennoc.doc ;r, ANNIE WARD KNIGHT
COMMISSION NUMBER
DD113988
0 MYCOMMISSION EXPIRES
u
515 P.03it5
WORK -ORDER / QUOTE SHEETS'
on was com feted `" '
Semiq,ijiecountv Home Repair Program
Name: WILLIE WARREN
806 WILLOW AVE. 07 -- 2,RS.
State: FL Zt : 32771
ftrmized Description of Workem
Descriptlon
Install new roof system, ro1
structural a D'; r'r all wood damage, have roof Contractor or
engineer evaluate :tnd write S specification to remedlate the
2 roof system, Install deck, r; fa11 trusses. Install new metal roof system.
3 IeWFOQ'tha",Z4miunce U +....4 per' MSeare
4 FRepair aU —facia and —soffit, ern., °d damage two
post to re- -r- — 5
Inst$
if 5t) f(an hot water f&4ter, high energy star ratirm® f3
Install 8 door and harClware, handle Paint
watt, repair drywall, Irnst.:11 d . rywall, paint with behr satin palm, 9
Replace carpet Only
with vinly. ` replace 9
install GFCI, Install smoke cI " :ctor, upgrade electrical panel 250 ampand electricca system. 10
Ramove garage , Iz
4 ce 11
Paint exterior. pressure dead~ _baulk all` -- semi -{gloss paint, two Coat Eck and holes_ Paint with behr stag
2
ibic
SOam (
aM4 sink'and f g, L 3`fC 45cels, Ti
enemysiai"raFing TOW
1f
Checked • " - - continuo to To,rr )age pia ' '
N WMrir. ATLAS
GENERA: 1250
BELLE AVE 'S 101 WRITERSPRINGS, 32708
bF-M I NOLe COUNTY Goo -r.
407 665 7956 P.04/15
P-
24
1114 ............................
WOW URDER / QUOrk-MEETS
UAW1111nole! uounty Hom"iiate Name: `
ILUE WAMMM Ackreft.: -------
State:
ran- i Rem '
ww.4Mx9OL1wU Own of work Rehe
t) 15M bathWon 13 row,
inager-baff"OM: Irm With Crabbars. Insfall new f-_uceft, handicap Off llmndlcap access Mo,, sin r-
aP t0116ft. install tub, cabinet 14 k-,
t1le.
Nk GFCI's rec handicap door
3/0. Olywall, --PtaclO, Install wonder board, install eochaust fan. Install AC
system with aw, ductw(yorhigher, trane or carrier, rePair any k EUOw inBatts
attic h1:MA;atjOn Hoof to R"30_' 17 is 20
ftne
wanvn
Boo MHOW Avmaq
41100M, Flofift 21Addthe
U10winir
Re and9. repkWe
Re
etrussesvWthnewone&77.add OW
orsqu,,
ftM door antmnce
in vlV remove garage doorOndlWVWMMCMnftgbloc,* adpq Ce Wwfth(
mac M) -mWOOveandd Orgsh open Wafflnftg MW d0orPneft
type wo FROM" a W TeatallC3If
ClIP-OkeCOr7rr.
continue
to next rage ATLASGENERAL, INC 1250 BELLE
AVE STE 101
MMTER SPRINGS, FL 32708
0 .1"J e. WcL U c N
oG O I6uj Put
San o2c FW
d`
1
p
J-
CIL
yj
w;
ATLAS
PL =10.
CWMWAB or Yawn apadt
I
a
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v ..
Head
E
an=aspswi
1
1. W*n as regd}ed at each b"dauatfae anchor oa sl+os++, +.fps roan bearfn1eQaao21ntOpwQeenatte,
ocRidcAtlengthtoprosdde1f/4'empodrnentg °hbet. 3.
Caulk . Caulk
Ui tsetwem
wfredoss d
and
buck OWN
setim" as& UD
4-
If comet e/pwff vtar of wa,*t o+r. Orpth
s ft.+s nest larger whdo+r 1h chart. 41*w+. use anchor q ntity for v & -
1h A E1SiAl 300WMwrywMwadaas4sandd.,ign food, and rtsuet My gaoeDo* by atsm, 7. Letter doslgcotTOno on.ths tapean focaftan chart indiaa Mr..
e
U sol itad
OLWO
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Permit # :_ V`a
Job Address: ! ROOM
CITY OF SANFORD PERMIT APPLICATION
Date:
Description of Work: f lkCTIUC/ .
Historic District: Zoning: Value of Work: $ Z •90
Permit Type: Building Electrical _1:_ Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS 2-&V Addition/Alteration Change of Service _X__ 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 #: (Attach Proof of Ownership & Legal Description)
Owners Name & Address: I L LAIA/Ap kle IA'' Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
Phnne- State
License
Number:
Grt_ I 3 of ZY O f tact Person: L
i L 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. 1 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:
l 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 requiremen of Flori4alien Law, FS 7 y. Mo a/ Signature ofOwner/
Agent Date Signature o C ntractor/Agent Date Print Owner/Agent'
s Name Pr t Contractor/Agent' e Signature of Notary -
State of Florida Date a e df ry- Er%ftli GRAVE Date MY COMMISSION 9
DD 164260 EXPIRES: November 12,
2006 OF FLOPBonded ThruBudgetttt0tryOwner/Agent is _ Personally
Known to Me or Contractor/Agent is er nal Khoii Me or Produced ID Produced ID
5 5 ' 5a3- 103 -141 `0 APPLICATION APPROVED BY: Bldg:
Initial & Date) Special Conditions:
Zoning: Initial &
Date) Utilities:
FD:
Initial & Date) (
Initial & Date)