HomeMy WebLinkAbout2004 Washington Ave 05-365 RoofPcritlit tt ns
Job Address:'1,
Cl'[*Y or SANFORD PERM[ I Al
7 atc:
Dcscription of Work: ILt" IL-VU r' t gr,, r, - —
Historic District: Zoning: Value of Work: S t
Permit Type: Btlildi[IF Electrical Mechanical Plumbing Fire Sprinklcr/Alarnl Pod1•^__
Electrical: New Service — It of AIvfPS Addiliott/Altcration Changc of Service Tcmpor;iry Polc
Mechanical• Residential _ Non `Residential Replacenacnt New (Duct Layout S I;ncrgy Cit1G, Required)
Plumbing/ New Conuncrci'll: It of Fixtures 11 of w:I(cr &c Sewer Lines 11 of Gas Line S
Plumbing/New Residential:11 of Wjiter Closets 1'lunlbin Repair— Residential or Commercial —_
Ocettpanc3' Type: Residential Commercial — Industrial Total Square Footage: _
Construction Tyoc: _ V of Stories: it of Dwelling 'Units: Flood `Lone: (FZ fA form required for otlier tltxn X)
Pnreel (l: l` C — _ + 0 (Attach Proorof Ownership & Legal Description)
Ownerrs,Na mc & Address: --
rA
n TNT- 2 C'(.J-----•'_---
T
Contractor N:unc C''Address, ^ -._...--•--._-.._....._
O Q Q2L NC-0 A J
Phone & Fax: Contnct Person:
IInnding C
Addms:
N'tortt':tt'C
Addl•ess:
Architect)
Address: •
Application is hereby made to obtain a permit to do the work and installations :is indicated. I cer,ify that no work or installation has commenced prior Iu the
issuance of a permit and that all work will be perfortned to meet standards of ail laws regulating constntction in this jurisdiction. Landerstantl that a separitc
permit must be secured for ELECTRICAL WORE, PLUMBING, SIGNS, NVELGS, I'OOIS, r•URNACES, BOILERS, HEATEILS, 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 witil all applicable la\v. rrtrd:sing
constntction and zoning. WARNING TO OWNER: YOUR FAILUl- E'f0 RECORD A NOTICE OF COMMENCE-MENT }.1AY R.C-SULT I:ICI POUR PAY[NG.
TWICE FOR IMPROVEMENTS TO YOUR PROI'EI:TY. IF YOU INTI3ND TO OBTAIN FINANCING, CONSULT WITH YOUR I.i'sNDSR OR AN
ATI'ORNEY Dr -FORE RT_COIU)ING YOUR NOTICE OFCOMIMENCEMENT.
NqE!! F: In addition to the rottuiremcall:; of this permit, Ihcre may be :ldditinnal i cstricliun ::,pplic:,bic to Ihi:; property lh:n m:ly be 1(xnitl in lhr, public rccordi of
this county, anti there may be additional permits reyuirctl from other governmcntal entities such as w: t r nLtnal ncnt districts, stab. al;cnrit.:;, ur fct ll ngencier.
Acceptance of per nil is veri(icalion drat 1 %,ii l rllot ify rile otvr.cr or tile propei;y of the rcquir
Sip; toreofowner/Agent Date Si
Ul.l tJ /l
f'
T —
I,I it vner/Agent's Nanr
ignaturc ol, Notar t. I o!' •lone
Y p PATRICIA W. AUSTIN
MY COMMISSION # DD 129074
EXPIRES: September 30, 2006
Other/Agent is ,i'+k" 11.111 ,,SondedThru Notary Public Underwriters
AI'I'LIC'ATION APPROVED BY: III(11 4a -b.__t! 4tD •" ring:
IInitial S:: t)atc)
specia! Conditions:
sAN-sttsr
rnclor Agctt('; Namc
I:au,rc itf o:ary•State o I-lorida Gate
DEBBIE BLANTON
k M yWill QM,# DD 188491
Produccf.::) _'IRES: February25, 2007
Ft. Nc!;;; Di7count Assoc, Co.
Initial .' Untcl (Initial f: Date) (Initial & Dstt
g
Pc,rinit No.
St-- tc aClTloricla
SEP8IN0l.E Q } i<zrt> CIRCUIT CttliDiT
BK 05511 FAG 0125
CLERK' S :0 2'004173790
GIRDED 11/1@/20GO
4
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County
or sell, 4101C il
pa'operty, al cl ill accordance w yL 1111provculcnt
will
benztdc Lo ccaLaII rea Tl1c under.rigllc(l llcl'cbi c:: aloLccLlait11 Claaptcr'/13,
1'
lo.vid:l SCatlltC:., file follo\Ylll illlon"liltioll l)rovidC(1 Ill Ulls .Notice, of CO111111CIlccallcllt. 1. . DescripLiou ofj)
l'ol)cl'LY: (legal cicscriptioll of Lllc l)roperty and sCrcct :cl(l7 V i f il7lila blc) 2. General dcscripLioll
ol:1111provcnlcilt: Owncr inforlllcltioll — p
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andaddress 5,I^-7
b. X1lterest ill
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iddress ofkcr, sl111p1C title loldCl' (l'l. other tlli'.l1 01V11Cr) MARYANNt ivl CLERK •
SENJTit LE
COUNTY,
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ConCracCor l Nalllc
and :uidress
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5. Surety -- a.
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ti'itllill tlac St ltc of F101icJa dcsil;n; tcd by Ow11cr Ul1ol1 "111o111 notices o1' otllcr doculllcnl way be served as provided by Sccdon
lorida SC',tL'UL'C,: a. ,.NaI11C a11C1
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B._ Xus ciclitioll
Lo llinlscil' or llcrscli; 0 llcr cicsiLllalcs to caj)y
of dlc S icnor's I\loticc as lla ovidcd x1z Scctiol 713.13(l)(),
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9. EX aratl011
CJatC 0 110tlCC Of Colll[11CllccilICIAL (LIlC (;Xj)iriltioll (IatC is l ycal' lt'Un1'l'lC CIIILc OJ' ICc CII/IIC 11111coS a "C1;C[1t datc is spcciriccl)
r ' Si ilaturC oi:
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or a Cirnlccl) ands `bscl ibccl bc,forc 111C tills ) rt' 1 Ai -
Personally x1lov.,11 —,,
Y— 0 ,q;, P,e`
N.cI I, MY COMMISSION #
DD 129074 EXPIRES: September 30,
2006 Bonded Thru Notary
Public Underwriters • /%p6} - l/'
POWER OF ATTORNEY
Date: / (- g' b 4
I, Andrew J.(Andy) Adcock do hereby authorize
1
Ruben Birch
To pull the Re r o o f permit for 7—o 014 '1,*(1 C;Tt) KJ
type of permit) (address
F-6Sf-o ,
Signa re
d
4'' ", Linda A Keeling
MY Commission
2
88
ExExpires Decemberr 0909. Z008 Stamp
CersonaDllykn
n t`o me or driver license # , of State of Florida, County of day
of P")o 3 - 2004.