HomeMy WebLinkAbout2550 A Hartwell Ave 04-390 roof04-390 CITY
OF SANFORD PERMIT APPLICATION Permit #
Job
Address:Pt K Descrintinn
of Wark: Date:
Historic
District: Zoning: Value of Work: $ I
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 #:
Owners
Name & Address: Contractor
Name & Address: V-
t r,5 (- ,v 'E- . Phone &
Fax: Bonding
Company: Address:
Mortgage
Lender: _ Address:
Architect/
Engineer: Address:
Attach
Proof of Ownership & Legal Description) Pt /
ESL. Phone:
VL
State
License Number: 1
Contact Person: T N 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. 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 perm i ;veriftc ion th 1 notify the owner of the property of the requirements of Florida Lie Signature
of Owner/Agent Date Signatu of C ritractor/110< Date ` Print
Contractor/ ge Mk
ALAA EL 2MyCMA. otary- §
D
to Signature of Notary -St a No. 0 Wniner/A1
Y (
iomer4m I1PM-*P"Wri UOrfwLR Owner/Agent
is Personally Know---n to Nle or Produced ID '
1 APPLICATION'APPROVED
BY: Bldg: Zoning: Initial &jbateT (
Initial & Date) Special Conditions:
Contractor/Agent
is -j— Personally Known to Me or Produced ID
Utilities: FD:
Initial & Date) (
Initial & Date)
mui IQ ua It aai a Gal an n1 I9 ua n gal 11 Big 11 Igo 11 all 11 Igo 11091
NOTICE OF COMMENCEMENT
State of 1 C
County of
MARYANNE MORSE, CLERK OF CIRCUIT COURT
SEMINOLE COUNTY
Bit 05099 PG 1814
RECORDED 11/17/2003 08:33:25 AM
RECORDING FEES 6.00
RECORDED BY L Woodley
The undersigned hereby gives notice that improvement(s) 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.
1. Description of property: (legal description of property, and street address if available)
2. General description of improvement(s)
3. Owner Information
Name ,aSELEA Telephone Number
Address VO aV- :WZS n Fax Number k-k`,l
t-otyts cvo-Fl.°'a'»1'a 15` Interest in Property
4. Fee Simple Title Holder (if other than owner shown above)
Name Telephone Number
Address Fax Number
5. Contractor _
Name
Address P
VA
6. Surety (if any)
Name
Address
7. Lender (if any)
Name
Address
Telephone Number
Fax Number \AV-
tfZl IfIEI, copy
Telephone Number MARYANNE MOR6E
Fax Number
4NOV X111,2
Amount of bond $
Telephone Number
Fax Number
8. Persons within the State of Florida designated by Owner upon whom notices or other documents may be
served as provided by Section 713.13(a)7., Florida Statutes.
Name Telephone Number
Address Fax Number
9. In addition to himself or herself, Owner designates the following to receive a copy of the Lienor's Notice as
provided in Section 713.13(1)(b), Florida Statutes.
Name Telephone Number
Address Fax Number
10. Expiration date of notice of commencement (the expiration date is 1 year from the date of recording unless a
different date is specified):
I =' -
I / zz
Date Sign MYICIMM BqL ypq Signature of Owner [Not per ection 713.13(1)(g), is must
W CC9134W sign ...and no one else may WpermittelltiD Sion Ins s.pr her0$11 P---. ly Knows t 1 OQiljj, stead."]
Sworn to and subscribed before me- day of Uy . 20_/'
sil
personally produced I-- who is ersonall known to R
as identification. r
F 0: F
7509 PARK SPRINGS 'CR ( MOB I ICE);
U - ORLANDO
THIS FORM BECOMES A RECEIPT WHEN VALIDATED BY THE TAX COLLECTOR.