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HomeMy WebLinkAbout401 Summerlin AvePermit # : os— l Job Address: s i V 1 SU yU1M t Description of Work: Historic District: CITY OF SANFORD PERMIT APPLICATION Date: P -J AA Zoning: Value of Work: $ ? SUO • O J 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 #: .� a /f ^ ' /'' (Attach Prr000fJof.Ownership & Legal Description) �,/ Owners Name & Address: EULIrI�� �1�JL�G�I VV �l%Gtfjy,- 'VI^3 A —, 5a�'Jl �� / A� Phone: Contractor Name& Address: rr• o -CT. �J� • a rI"L ` W oe-i f L"d, <- t a,( d�) . (�C'• State License Number: tf✓ l_ ©UO c� a O q C 7 L Phone & Fax(%``b. OL1-Z 49� Contact Person: bAC VG 3w�`Xi� Phone: 39GpG '6U4 �l � Bonding Company: Address: Mortgage Lender: Address: Architect/Engineer: Address: 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 NSULT 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 app this county, and there may be additional permits required from other governmental entities suc as Acceptance of s v iftcat n that I wi notify the owner of the property of the , _7/ Signa of Owner/Agent Date X >�� b�Z+ �v�(/CGI wner/Agent' ame 4Prin Si re of Nota -State of Florida Date DONNA D. SOUTHWICK NOTARY PUBLIC - STAI E OF FLORIDA COMMISSION # DD344712 Ow Agent is _ Personally Known EXH130 9/23/2008 Produced ID BONDED THRU 1-88- NOTARY APPLICATION APPROVED BY: Bldg: (Initial & Date) Special Conditions: Zoning: districts, of in the a+bW records of Signature of Contractor/Agent Dgte Print tractor/Agent's Name Sign re of Nota -State of Floridy,ONNA D. SC'IWICK NOTARY PUBLIC - OF FLORIOA COMMISSION #TDD344712 EXPIRES 9/23/2008 1 Contractor/Agent is _ZPernally ftMWT6FMd_I*'' _ Produced ID Utilities: FD: (Initial & Date) (Initial & Date) (Initial & Date) THIS INSTRUMENT PREPARED BY: NAME k7-vOf)tZLOTICE OF G Permit No A D D R yVL tit' c Ar S l State of Flonda County of e 0 The undersigned hereby gives notice that improvement will Chapter 713, Florida Statutes, the following information is 1. Description of property: (legal description of the p: 401 A—J L- 2. General description of improvement: 3. Owner information a. Name and address E (Cf 1* fir✓ j P r0.(L0 cC . 1z11 ;.-, Ort r'+4'4''"�„ig`�`c�; �'�zF.+i tty�, •'K� �` i NMNCEMENT COP`S N fi CERT1flf D ` tA ORSE CRY ANNE • Tax FolioW u I,,: r.I I,RCUIT COURT CLER �• QUnITY. , ..v.. SEMINOLE C+ ct-ER made to certain real property, and in accorii dLith tided in this Notice of Commencement. and street address if available) SA4 r-deWj i . X197'7 Sc^ I NLUCG -► (0( S• 144t5— b. 44G b. Interest in property c. Name and address of fee simple titleholder (if other Contractor a. Name and address PA c e%.I OPAk'V/?* I<7- - W 0f—j%(-X ST. t7VZi0rj b. • Phone number 99b 1 ?� "jA9 i< 5. Surety a. Name and address 31 7 b. Phone number _ c. Amount of bond Lender a. Name and address b. Phone number Persons within the State of Florida designated by Ov provided by Section 713.13(l)(a)7., Florida Statutes: a. Name and address b. Phone number 8. In addition to himself or herself, Owner designates to a 713.13(1)(b), Florida Statutes. a. Phone number Expiration date of notice of commencement (the date is specified) Sworn to (or affirmed) and subscribed before me this � ►�� Z�BE-�« o Pte, �.�n Personally Known ✓ OR Produced Identification Type of Identification Produced 11 ArA Siafore of No Public, State of Florida Commission. Expires: Owner) a? do . Fax number ''Krci CIV -j404_ FC • d.- o C Fax nwag, C4--'MW111 I: PAID." _ BK 05834 PG 1576 Fax nu*IMllINth FEES 10.00 upon whom not1Wjftj3hjf cb)c &t;s may be served as Fax number of a copy of the Lienor's Notice as provided in Section Fax number date is 1 year from the date of recordin unless a different /, o Si ature of Owner day of At1(otLs-f, 20 6 , by DONNA D. SOU'fH`NICK COMMISSION 4 DD344712 EXPIRES 98831/2008YI BONDED THRU