HomeMy WebLinkAbout106 Cobblestone WayPermit #
I
CITY OF SANFORD PERMIT APPLICATION
Job Address:
Description of Work:
Historic District:
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: ((2RO4of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: 5 3 11 3C) Sa
Owners Name & Address:
Contractor Name Address:
%tel � S�✓qs' � �--�t�
Phone & Fax:
Bonding Company:
6 <;1�6 (Attach Proof of Ownership & Legal Description)
Phone:
RG/
State Licen��eyNum11ber: L. L'C�CI s
Contact Person: itonl CV�1 5(4aP :
Address:
Mortgage Lender:
Address:
Architect/Engineer: r-APhone:
Address:
Fax:
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 pennit 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: 1 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 properly 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 ofp it is veriI- tion th t I will ify the owner of the property of the req
Q v> �SignatmeofOwner/Agent Pale
0 Ln �eSS
OQ Tint Owner/Agents Nam
_ o CcSi n cure o otary-St to o lorida Date
Lo V' .H .0
>'• 2 ;
U f.' Q sem-.7
M.- <
C7
V W Owner/Agent is Pe rsonally Known o to Me or
t- Produced ID
A CATION APPROVED BY: Bldg: Zoning:
Special Conditions:
Contractor/Agent is Personally Known to Me or
Produced ID
Utilities:
(Initial & Date) (Initial & Date) (Initial & Date)
A• L 5
O 1." � tV V
� �50
� j
q � p°
a��wy
FD:
(Initial & D
AFFIDAVIT
REGARDING ROOF DRY -IN AND FLASHING INSPECTIONS
l � �,06fCompany:(; n�
Ll�
�lno11a- J
EM.5casf /. 2-7n/
License #: 00 S:% V
Project Information
Owner: f` Y S rx Pif,SS Permit #:
name
1 �� c �< J✓JI5.!`��(/(1�C Subdivision:
address
fLaird,Fl` Lot #:
phone
,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 accord e with the applicable codes and standards.
Contractor: &t�
ksaaos Vru/n
printed name
STATE OF FLORIDA
COUNTY OF ,i�C
This instrument was acknowle ged before , this / day of , 20a by the
above referenced individual, rC�/ who acknowl d ed tha
g t he/she is a
duly licensed contractor with/ an w oowledged that
he/she was authorized to execute this document. He/ -,h either persona v I nswn o me or
produced
as valid identification.
WITNESS my hand and seal this day of
NOTARY PUBLIC -STATE OF FLORIDA
Kinyel Marearelli
Commission # DD451085
Expires: JULY 14, 2009
Bonded Thru Atlantic Bonding Co., Inc.
THIS INSTRUMENT PREPIRED BY:
NAME: 3r; t
A DP�ES: 11i �n /��� r 2 j SES RIVOLE CUuNry
". !� /l. (' A `��1 / ✓ tAa io.,snn.rKnL n 101cr.
OTICE F COMMENCEMENT
State of Florida
Permit No. Tax Folio No. (PID)
Building & Fire Inspections
1101 East 1 st Streei
Sanford, FL 32771
County of Seminole
The undersigned hereby gives notice that improvement 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.
N OF PROPER
of the'pipperty and street address)
GENERAL DESCRIPTION OF IMPROVEMENT
OWNER INFORMA
Name and address _
Interest in property (Fee
etc.)
CERTIFIED COPY
WiARYANNE iWtiP"15E
ADDRESS OF FEE SIMPLE TITLE HOLDER. (IF OTHER THAN OWNER)
°CONTRACTOR
Name and address
SURETY (Bonding Company)
Name and addres�s�
I/
Amount of Bond
i LENDER
Name and address�� ( G.-
UTY CLERK
MARYWE Imo, CLERK W CIRCUIT CMT
SENINULE COLWY
BK 058&4 IPtG 10791
RWIRDED CW18RINA 12a14a54 PN
REWR1iIN8 R- S 10.(K)
RE IMIE_D BY t holden
Persons within the State of Florida designated by Owner upon whom notice or other documents may be served as provided by Section
713.13(1)(a)7., Florida Statutes:
Name and address's _
Persons within the State of Florida Designated by Owner upon whom notice or other documents may be served as
provided by Section 713.13(1)(a)7.,Florida Statutes:
Name and address:
i
In addition to himself, Owner Designates of
To receive a copy of the Lienor's Notice as
Provided in Section 713.13(lh, �lcrida Statutes.
ll
Expiration Date of Notice of Commencement
(The expiration date is I year from date of recor
Brooke A. Eckert
Commission # D=IS3
Erpm Jane 1
Bonded Thru
to
Votary Public
a differentAate„is ftcified.)
of Owner
this t b ih ]Day of
My Commission Expires: (0 E (�
foregoin instrument was acknowledged before me this , day of , aa-bby
GaS P S� (Name of person acknowledged), who is persona y known to me or who has
produced; ; ,; r' } i5 i ,n C (Type of identification), as identification and who did/did not take
and oath.