HomeMy WebLinkAbout2540 Hartwell Ave 04-436 RoofPermit # : ( / q
Job Address:
Description of Work:
Historic District: Zoning:
CITY OF SANFORD PERMIT APPLICATION
Date: )A b_1
Value of Work: $ O up
Permit Type: Building DL 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 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: L—e S Z S ( ( a'() P\(LW . A N{
Z NN Phone:
Contractor Name & Address:
State License Number: CAL wS o%\Ab
Phone & Fax: a aD Contact Person: Phone:
Bonding Company:[
1
Address: E
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.
Acceptance of permit is verf c-ift th ill notifythe owner of the property of the requirements of Flor UeS713.
9
Signature of ner/Agent ate Signature of Contractor nt Date
Print Owner/Agent's Name ( Print Contractor/Agent Name \
Sig btary=State of'Fioinda Dat Si a re ary- to
fi< 2 4 /
At AN A -I-
PUSt.;;, Z124/040913488CJ. a
ai 913488 Ow
fiHhl''". ltat l: o Contr e 's @Xer gYr II K p v t tc N1e Produced
ID " Q APPLICATION
APPROVED BY: Bldg: Zoning: utilities: FD: Initial &
Date) (Initial & Date) (Initial & Date) (Initial & Date) Special
Conditions: A
v. a aa. ...n .a ena a m n .aa a. .a.•w•aa•n s ornor.
Permit Number
Parcel Identifcatlon Number MARYANNE MORSE, CLERK OF CIRCUIT COURT
SEMINOLE COUNTY
BK 05106 PG 1'968
Prepared by: ,; CLERK'S # 2003207864
RECORDED 11/20/2003 G1:65:59 PM
RECORDING FEES 6.00
RECORDED BY L McKinley
Return to:
CERTIFIED COPY
MARYANNE MORwSE
CLERK OF CIRCUIT COUR'R
t SEMI LE CI UN ILO.
NOTICE OF COMMENCEMENT
dym
State of
County of ,mac.niov 2 0 2003
The undersigned hereby gives notice that irrtprovernent(s) will be made to certain real property, and in accordanawithChapter713, Florida Statutes, the following information is provided In this Notice of Commencement.
1. Description of property (legal description of the property, and street address if available)
2. General description of ImK ovements)
f Q c
3
a
Owner Information
Name L2 pQ blot ty s Telephone NumberAddress
Fax Number
Interest in Property: Fee Simple Title Holder (if other than owner shown above) Name
Address Telephone Number
Fax Number
5. Contractor
Name 0--R,(L.o ck Nrl
Address (Po i,4,y %V%
6. Surety (if any)
Name
Address
7. Lender (if any)
Name
Address
Telephone Nurnbe ®\-a5
Fax Number "A n
Telephone Number
Fax Number
Amount of bond 3
Telephone Number
Fax Number
8. Persons within the State of Florida designated by Owner upon whom notices or other documents may beservedasprovidedby §713.13(1)(a)7., Florida Statutes.
Name
Telephone NumberAddress
Fax Number
9. In addition to himself or herself, Owner designates the following to receive a copy of the Lienor's Noticeprovidedin §713,13(1)(b), Florida Statutes.
Name r
Telephone NumberAddress
Fax Number
10. Expiration date of notice of commencement (the expiration date is one year from the date of recordin, unless a different date is specified):
Date Signed `` ........... _.........
Signature of Owner .o r §713.13(1)(g), "owner
must sign ,,.and on se may be permitted to sign itt
his or her stead.'
Sworn to and sLubscribed
before
me this c—.i_'_dayof20 ' by Q t ImoCIAwis _personally-
known tome OR produced a cA •ASIEGELUp. ZtUM flllBltC:
CC 913488 ; Signature
of Notary (notarial seal to a ar below) Form Revised: 12/
00 for 19 to 20