HomeMy WebLinkAbout1507 W 16 St 05-450 Roofer i
iso-7
Job Address:
Description of WON(:
Historic District: —
CITY 017SAlFORD P EIZ-11,11.1, A P V I, I UA I I ul"
J'—
t7-
atc: D.
73 ;i:
Zoning: Valtic of Work: S—
19 :92 44511,
rermitType: Buildinz 1-Jcctrical Mechanical
C11- 111,e of Service Tcmporl.ky Pole
Electrical: New Service — I/ of ANIPS Addition/Altcration
M&Ii-inical: Resi(lential Non'-'Rcsidential Replacement New (DUCL LZIYOUL r;ncrgy Clll..; Required)
Plurnbin?/ New Commercial: If offixtUres 11 O[W:Itcr ,Z-, Sewer Lines fl or Gas Lines
Plunibing/New Residenti.-II: 11 of W.Zitcr Closets
Occuparic
I
y Type: Residential Commercial -- Industrial 'I'otal Square Footare:
Construction Type: it of Sforics: il Or DwellinV Units: Flood Zolic: (17EPMA form required for otiter cluti X)
Plireel /h
Owners Name Address:
Attach Proor of Ownership 'Z L '111 DIC Cl I 60o)
I Z D -7 J
11 It o it C: q-o -7 - ._3 -z- ( - -7 -7
Nnine 1"Addr-cs%: 0 — e- Contractor i lZo 0 C
0 D A—'Q Fo- 1> El 7?;Z-nL
111101IC& Fax: 14t) 'I— _3.-30 — V) -3-3 -3. Cont.ict Ilerson: — I'llone: 4 JD
C' C C'
Bolldill. Collipam,
Addms:
Nlort,mgc Letidvi-:
ddl-Cs5:
Architect/rifigilleer:
I'llolle:
Address
Cd I 60rio ill(: Application is hereby made to obtain a permit to do tile work and installations as indicated. I ccr-,ify that no work or installation has con-In"(21C ) issuance of a permit and that -,ill work will be performed to meet standards of all laws regulating constniction in this jurisdiction': I understand that a separate
permit must be sccured for ELECTRICAL WO PJ' , P LUM 11 ING, S IGNS, WE LL-S, POO LS. F U RNACES. BO I LE M. 1-1 EATEI'S, TAN KS, and
AIR CONDITIONERS, etc.
ONVNER'S AFFIDAVIT: I ect-tify thm all offlic foregoing itiromtation is nccuritc and thatall work will bc done in complinfice with :111 rc.l.."llbaing
constniction and zoning. WARNING 1*0 OVINER: YOUk FAILUR.E TO RECORD A NOTICE OF COMMENCEMENTI'.1AY RESULT IN YOUR. 'PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO FFNANCING, CONSULT WITH YOUR LENDER OR AN
A'rl'ORNr-Y BEFORE RECOIU)ING YOUP\ NOTICE OF COMMENCr-w:iqT.
Ill addition to tile rcquircillclit!; of ilos pcililit. lll(:Ic Imly bc;I(Iflition:11 ictiow; ;Ipplic:tble to pl-(.)perty 111:1i lri:iy be found in thc public recortli of
Illis county,and there may beadditiotmi purnit!; requircd from other go-rilincoUll clititic.s wch u; w:14r nunac.cnictit di:3rict, sl3le or f6de.1-:11 agc-flcies'
Z
Ificatiqll tl iat will, ice o' Acceplat pC11114 is Veli 'flotify dic olthe propci-tyof'thc requirei
0
sil"Ilat of'
0
Print O\viyr1Ag2'.1: N 111131 Irin, ontractor A,,ent'!; Name
I . , I A
i!!I' turc of,
rids A-'YSi.. 4, Coll b(ai 'tat ol'Flori i K Wj"' 7r
My Commission DD3599M
Expires December 09. 2008
ent k IIer!;oII;jII\ Kritmii it) M.- or0%%3eAi
AITLICATION AI)PROVD) Byt
I I if i t in! & Da le (Inid:11 k. D.110
DEBBIE BLANTON
MY COKANI.2SION # DID 188491
EXPIRES: Februa 2k,,2007Iler' Known o I, C of-
RY- FL'Notary Discount Assoc. Co.
Inili:ll ,, Date) Initial k- D:!l!
NOTICE or, co,C\IjENCD\I EN Folio 1\10.
pCrIllit'140.
suitc of Florida
couilty,of Scalillolo
Cl widl
to G(;I'L
T r-'gliccl hcrrby giv(Z llOLlCc;-L1l;1Llicwidcsi. "idc(l ill Ull's !"'10LICC, of C0111111cliccinclit.
Cjj;jptcv 713, Flovid l Sulw=' tho followill'ir ilifori-nation
Ly- (1cfill dc scrjl)Lioli
I
of tll(; propuLY .-Ilid jtxcl: it' -.1%railab1c)
1. Dc5c )Lioll of propmi CERTIFIED rDP—V,—
91
clicral dG--;r'ri1%011 O.f
OWI,r-r lforlvl-'lLioll
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b. 111torcst ill J)1'01)CrLyI
G. NaInG alld -zlddrcss of 1'Cr, '-llnjflc utIcholdcl,
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xlrllrMARYANN—
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2-2 7-/--- numba
JL7 4 El (11b. pholic l)"ll1bCl I fill if of Q Iff if W [if 111116 Ill If 111
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2004177G96
11/1'IMM4 lli 1659 A
b. Tho"G "IllIbcr 11OLICC"
tj1C SLILC of (jc,iga"LC6 by OVI'llcf 111)0i'
pusolls widlill
providcd by SecLi011
V.1orld-,l SUILUtCS:
a. '111d addrc'
g. In addition to 11 "I"Gif Of 0' cic;Iglllitc'
of
0 , to rcccl-vc "' Copy Lllc Ll nor s NoCtcc 1; P Ovid' "I ill Scct'ou
cording lillic-so a diffr-rcll
aw yc"r fro'll ffic ChItc of. voCOL11111c,11ccillcilL (eac (;%pimtioll d
9. ExpiraLioll Cj-'jtr' O*flloticr'
dawis
2 0 by
bscribcd bcfoc(; 111C Uls%N'OrIl to (01' "A011-1:ll (I) at d "0
Uv,
CYNTHIA E. BENNETT
Lion
MY COMMISSION # DID 003571
EXPIRES: May 2,2005or, 1 roduccd W011-,I[I)l j(J1OV"l1 Bonded ThR lotary Public Underwriters
POWER OF ATTORNEY
Date:
Andrew J - (Andy)- Adcock ..do hereby authorize Ruben Birch
To pull the geroof permit for iQ -7 ) I & 4 T, ST" r-O
type of permit) (address)
P" Linda A Keeling
My Commission DD359999
Expires December 09, 2008
Stamp
PeDrsonally k ow to me or driver license # of State of Florida, County of
li? day of )2004.