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HomeMy WebLinkAbout2310-2340 Windsor Lake CirO - tr3j CITY OF SANFORD PERMIT APPLICATION Application H : Submittal Date: R Job Address- 2310 23 40 W1_ SO ieCt,- Str.ro, Value of Work: Parcel fD: Zoning: Historic District: Description of Work: % STG L f' 3 "'"" l,, w" FOI-Ce- "S/ 5"uare Footage: Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool Sign Electrical: New Service - # of AMPS Addition/Alteration Change of Service Temporary Pole Mechanical: Residential )< 01 Non -Residential Replacement New (Duct Layout & Energy Cale. Required) Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines Plumbing/New Residential: # of Water Closets Occupancy Type: Residential Ak" Commercial Industrial Construction Type: # of Stories: # of Dwelling Units: _ of Gas Lines Plumbing Repair - Residential Commercial Occupancy Use Group(s): Flood Zone: (FEMA form required ) pp......................./.- eet 2S `y L"s Contractor: ' - %S"il,,.c2 PropertyOwner: rn Ce Address: 00 / Se- 1 eC2 Dr Address: SV o Sf-- feet) O ve,i v e/ m o Vs F .Z `7% 7 ac - r i?6 Pho 606 - 00`10 E-mail: Phone: te License Number: Bonding Company: Address: Arch itect/Engineer: Address: Plan Review Contact Person: Mortgage Lender: Address: Phone: Fax: Phone: Fax: E-mail: Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION, 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 a y be additional permits required from other governmental entities such as water management districts, state agencies, or federal agencies. Ace ptance of per it verification that l will notify the owner of the prop y of the it menu of Floar ien Law, 11 a ure er/Ag Date Sig re of-cont cj/Agent Date int Owner/Agent' Name _ Print Contractor/Agent's Name L)l'pKiL !) 3 13 0 Signature+of Notary St to of Florida Dat Signature of Notary t to of Florida Date JENNIFER N. CHICK NOTARY PUBLIC STATE OF KORIDA t is #eilQld,#?i2A+t ID XPIe.ES 21 712000 BONDED THRU 1-888-NOTARYI APPROVALS: ZONING: UTIL: FD: Special Conditions: Rev 07.07 Q r Jd• JENNIFER,N.,DICK S NOTARY PUBLIC 7,STATEOF FLORIDA Contractor a Pro Ate— FXPIRFC Y 7/n g IONDED THRU 1-888-NOTARYI- ENG: BLDG.- 39,© 9. d r NOTICE OF COMMENCEMENT Permit No.: Tax Folio No. State of Florida County of Seminole The undersigned hereby gives notice that improvement will be made to ertain real property, and in ,accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1. Descrintian_of 01 1.1 3. Owner ir& a. Name rA4C{ia / L of rr of improvement: e perty and street aftess if rc N 6-5 7Verc b. Interest in property ` c. Name and address of fee simple titleholder (if other than Owner) 4. Contractor a. Name and address U' S b. Phone number 5. Surety a. Name and address • 31 b. Phone number c. Amount of bond Lender a. Name and address Fax number Fax number ro r b. Phone number Fax number 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1xa)7., Florida Statutes: a. Name and address b. Phone number Fax number 8. In addition to himself or herself, Owner designates of 713.13(1)(b), Florida Statutes. to receive a copy of the Lienoes Notice as provided in Section a. Phone number Fax number 9. Expiration date of notice of commencement (the expiration date is 1 year fro date of ing un] a different date is specified) Signature of Owner Sworn to (or affirmed and subscri before me this a day of , 20 , by Personally Known OR Produced Identification Type of Identification Produced i ature of Notary Public, State of Florida Commission Expires: SHIANN PIEKARSKIILvIVC'OMKIISS104H 00402877 EXPMES: "arch28,2009 F ° ;Sonded'rhru Notary Public Underwriters l J LIMITED POWER OF ATTORNEY s I hereby authorize CA_ Of to sign his/her name on my behalf in order to apply for a permit for work to be performed at: Lot Subdivision Ze 2 Address_ 23 0 AijH A ow 1 1,Z Cy,r- S'k ,,, 94, 32--)73 C Type or print name of company Sign re of licensed cont ctor STATE OF FLORIDA o L 1i % License number A K A/ 4— PrintnameThe for going instrument was acknowledged before me this Z day of 20 By ne ' ` (name of person acknowledging) eaY4 Signature of Notary P' ! KATHLEEN A. HARRIS-LEVINE MY COMMISSION # DD261373 oa F EXPIRES: NOVEMBER 11, 2007 Nota co. Personally known or produced identification . ID # r OL-