111 Sandpoint Ct RoofCITY OF SANFORD PERMIT APPLICATION
Permit # : — 14Tl-Y
Job Address: / l/ S4A-J Pdl
Description of Work:
Historic District:
Date: /^O C:Voeqj k
4 n.- (2tS Zoning:
Value of Work: S e Z) • ne-) 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 #: /
d '_0:2 0_ :, _ "c 7v (Attach Proof of Ownershi & Legal Description) Owners
Name & Address: Ki J L /
1 // Phone:
Contractor
Name & Address: ,IIA2f.L d .4R+ //,119tJ — /-a 11,n A;;,% 1 1_4 / 1t i!!i/
Aw --f, tozym e+`T-K.cW State License Number: /1l_ C-LY2 Lo (,e-- Phoue &Fax:
Contact Person: G' Phone: 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. AC tance
o it is verification thGt Dill notify the owner of the property of the requirement of Florida Lien Law, FS 7 3. Si e
of Owner/Agent Date S na of Contractor/Agent Date Print Owner/
Agent's Name Pri C tractor/Agent's NaJA Signature of
Notary -State ofsflorida Date Sig atur o Nota -Sty tate ofFloridaDateS1DEBBIE
BLANTON PAY COR4+".
L' Owner/Agentis _ Personally Known to Me or Contra or ' e -t•iy Personal3` Known -to' Nftgr yL _t,,
lfroduced ID /OVtC GL l _ P d uotY fib. 2007 FL Notary
Discount Assoc. Co. 01 o'•
P
CATION APPROVED BY: Bldg: om g: Utilities: FD: ua` (Initial &
Date) (Initial & Date) (Initial & Date) (Initial fi Date) Special Conditions:
F
Pe -snit rNumb'r
Parcel' Identiftcation N inber
Prepared by:. MAttwai_ /4-Llr•z.,
3773
RmW-rt to:
NOTICE OF COMMENCEMENT
State of l 11 ---
cottntE'
MARYANNE MORSE, CLERK OF CIRCUIT COURT
SEMINOLE COUNTY
BK 05512 PG 1417
CLE RK I S # 2004174 '90
RECORDED 11/12/2004 11:45120 AM
RECORDING FEES 10.00
RECORDED BY t holdgERTIFIED COPY
MAP.YANN MORSE
CLERK OF CI -..!!IT COURT
SEMI E OLJNT, FLRRIDA
BY
The undersigned hereby gives notice that irnprovcmcnt(s) will be made to certain: real prupe:rry, and in accc ice12 oO4
with Chapter 7 i 3, Florida Statutes, the following information is provided in this Notice of Commercement. -
Description of property (legal description £the roperty, and street address if available j
General description cif improvement(s)
3, Owner information
Name G NR Nl l•fiV 3 lelephoneNumr r
redress /rf S2 7;7 Fax Nurnber Ale ---)tits
1O _ Interest in Propery
Fee Simple Title Voider (if other than the owner shotivn above)
Mune Telephone Number
Addre>s Fax Number
x7
9
y.
1 C.
Cc tr-ac;or
Address
A4 2-3
Surety (if any)
Name
Address
Lender(ifany) O ye!'
Name
Address
Telephone Number e7 e 7
Fax Nuriber
Telephone Number
Fax N umber
Amount of bend $
Telephone Number
Fax Number
Persons within the State of f lorida designated by Owner upon whore notices or cuter documents may be
served as p, -tided by §713.13(I jta}7., F!oridi Statues.
Name Telephone Number
Address Fax Number
In addition so himself or herself, Owner designates the following to receive a copy of the Uenor's Notice as
provided in 6713. 3(1)(b), Florida Statutes.
Namc Telephone ;`lumber
Address Fax Number
F piration date of notice of commencement (.the eamiration date is one. y ear from the daze of recordirg
unless a different date is
r Date Signed Signature of Owner lNott: per §713.13(1)(a), ownar must
sign ...and no one else may he permi-acd to sign in his
or her stead." m^
this _, 9, day of 77) , 20 041 b}- he
is personally known to me OR Droducad as
identification. - Form
R-ics: 31-34 KATRINA
L. BLANKENBECKLOR Notary
Public - State of Florida My0x=
iAonETkeSAug28, 2037 Commission #
DD 245910 Bonded
By National NotaryAssn.