HomeMy WebLinkAbout105 W 18 St(� CITY OF SANFORD PERMIT APPLICATION
Permit # * (QC) �+ Date:
JoIlAddress: 3Z`l'l l
SI.
Description of Work: ee D i C.kjnn Ct U-0-i4cC__. �L-! (n lz-
Historic District: Zoning: Value of Work: S IL (6 b • �Z�
Permit Type: Building Electrical Mcchatucal 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 R)
Parcel q: (Attach Proof of Owner �'galiption)
Owners Name & Address:I0 ig� 3Z -l`1
Phone: 0- 3Z ei 1, Z
Contactor Name & Address: oC.t o r ry �OD C ! E d
hStatc License Pmbcr: L o Z� 5 0 ( _
Phone & Fax: 41—f
Bonding Company:
Address:
Mortgage Lender: _
Address:
Architect/Engineer:
Address:
4-13 *5Q h3�3 Contact Person:
Phone:
Fax:
I
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 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, mrd there may be additional permits required from other governmental entities such as w' r management districts, state agencjes; or federal agencies.
A
Acceptan of permit is verification that I will notify the owner of the property of the requ
attire of Ow /Agent Date
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PriR Owt r/Agent's arae
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.o ;,tore fNolary-S aW ori a Da '
DAFNEY FAYE ADCOCK
NOTARY PUBLIC, STATE OF FL RIDA
nMY ComrBeE*M6bjDfiCA� 0W1 ,
10 cd
ID
r� ,
APPLICATION APPROVLDtiY:li1ag:M� 1_ \^tom
(Initial & Dale)
Special Conditions:
fi to 0
Zoning: Utilities:
(Initial & Date)
I
Date
Bonded Thru Budget Notary Service
Contractor/Agent isgPersonally Known to Me or
Produced ID
l/o?63-<17D=VG—Z/7_C)
FD:
(Initial & Date) (Initial & Date)
1
NOTICE OF COMMENCEMENT
State of Florida County of Seminole
a Awe
eermit No. Tax Folio No. (PID)
The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with Chaptcr
S.4 vr' 713, Florida Statutes, the following information is provided in this Notice of Commencement:
DESCRIPTION OF PROPERTY (Legal description of the property and street address)
ItSS W, l b GTT, S 4v I �i 3Z 1`7 l
GENERAL DESCRIPTION OF IMPROVEMENT 21P, lt:�eb� I
OWNER INFORMATION
Name and address eJ Q p 6Z A 00
10 5 hJ ktlr 4. . • - r„> , Q t -3z -r1
Interest in property (Fee Simple, Partnership, etc.) _o t,,,, yam.
NAME AND ADDRESS OF FEE SIMPLE TITLE IiOLDER•(IF OTHER THAN OWNER)
CONTRACTOR
SURETY (Bonding Company)
Name and address
Amount of Bond
LENDER IWARYANNE MORSE
Name and address CL:Z1C OF CIRCUIT COURT
Persons within the State of Florida designated by Owner upon whom notice or other documents ma be se ed as provided
by Section 713.13(lxa)7., Florida Statutes: �� ���
Name and address
In addition to himself, Owner designates of
to receive a copy of the Lienor's Notice as
provided in Section 713.13(1)(6), Florida Statutes.
CK i ate of Notice of Commencement
t i�atio� 1F�c f ate o rdin_z unlece a different date is cnPrif,Prt 1
L s NOTAMY PUBLIC, STATE OF FLORIDA j�
MY CO m, Expires DEC. 2, 2008 /
�l' M, t1 00316609 ature of Owng�l 61
*,j Swo to a sub ibed b re me this Day of AV 1.9 700
a
r �», ° My Commission Expires: (�' Z it
Nota Public
zoos
. Cr
LL the foregoing instrument was acknowledged before me this 2 day of G-1, 1-9— by
s ca ^ 0 4k 0 ( eD (name of person acknowledge ho is personally known to
to a ate or who has uce 'j1, '1> . L. Zto 3 - t -I1 t) - t -i b 'Z11- U (type of identification) as identification
Wd who did / did not take an oath>
�0
��W Uri a
MCC
NG ROOF DRY -IN AND FLASHING INSPECTIONS
Company:IC �m r• (� License
`T
,Project Information
Owner. � ►y 0 ►' 0.- Permit #:
I6 Gj W • 8=e,;T
se-�-Po r> `1 3zft'l Subdivision:
address
3Z d — t-> C1 Z Lot #:
phone
I, h, 0 CK affiant, hereby affirm that I am the duly licensed
contractor of record for the above referenced permit, that all the foregoing information is true
and accurate, and that the dry -in, flashings at the above referenced address or lot has been
installed in accordance with the applicable codes and standards.
Contractor: al" (' 7 Z
signature
0 /
printed name
STATE OF FLORMA
COUNTY OF
This instrument was acknowledged before me is 2 day ofT by the
above referenced individual, C, (C— , who ackno dged that he/she is a
duly licensed contractor with 4 ` Az?t'E 09 �J Lo e. r-> A , and who acknowledged that
he/she was authorized to execute this document. He/she is e' _ r personally 1 vn to me or
produced
as
WITNESS my hand and seal this 2 day of _qLT 4 , 20
DAFNEY FAYE ADCOCK Notary
` t
°a
NOTARY PUBLIC, STATE OF FLORIDA
MY Comm. Expires DEC. 2, 2008
# 003766O9
COMM,
POWER OF ATTORNEY
Date:
I, Andrew T (Andy) Adcock do hereby authorize Ruben Birch
�
To pull the Reroof permit for X65 k), E9� �• ��'"1 a''Q q1' :3
(type of permit) (address)
Signature _
s�..!^ r.�yDAFNEY FAYE ADCOCK
NOTARY PUBLIC. STATE OF FLORIDA
MY Comm. Expires DEC. 2, 2008
COMM: # DD376609
ary Stamp
ersonall own to me or driver license , of State of Florida, County of
day of
..
t
POWER OF ATTORNEY
Date:
I, Andrew T (Andy) Adcock do hereby authorize Ruben Birch
�
To pull the Reroof permit for X65 k), E9� �• ��'"1 a''Q q1' :3
(type of permit) (address)
Signature _
s�..!^ r.�yDAFNEY FAYE ADCOCK
NOTARY PUBLIC. STATE OF FLORIDA
MY Comm. Expires DEC. 2, 2008
COMM: # DD376609
ary Stamp
ersonall own to me or driver license , of State of Florida, County of
day of