Loading...
HomeMy WebLinkAbout116 E 17 St/' In t Permit # : J� Job Address: 11-r h CITY OF SANFORD PERMIT APPLICATION Date: Ig -1 I O S San -F6 rd . T=L_ 321'1 1 - Description of Work: re— — Y 0 C& Historic District: Zoning: Value of Work:.$LOl) 00 Permit Type: Building f 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: rQ_-1-06/ # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than Y) Parcel #: AQ Q i -{ — 30 _ S 09 — OG 00 — Q0 -10 (Attach Proof of Ownership & Legal Description) Owners Name & Address: G DYdD n 13ut-c he- ✓ I I W 1= • F1 th St Contractor /Name ,&r7 Address: IA -M CIL n -n L � \ Ck ( n Q co i LD i ri oTrn r- r/� my 1 �1 y101 1 1 N V T, �L J�tOta (�_ Mate License ,Y.nmber: C1�G V S 3V O Phone & rax: N 01— 8 3a- - 53`1 S y01 2j / — ' Contact Person: ��% n n [. Cern b e K- Phone: _ Sarn'e, Bonding Company: Address: Mortgage Lender: Address: Arc hitectlEnlrineer: Phone: Address: 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 OBTAINT 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 governmen ttes s was water management districts, state agencies, or federal agencies. Acceptance of pepfryl is verifica1,jk644&L1 *ill notify the owner of the propel(y of the of Ow iodAgent Date Print Gwrier/Aeent's Name 7 SCgnate of Nota o t r rfv'+lg�9NBEN:1VlJOHNS L"=MyTOMM6SIt91� pD.394025 XP'EXPIRE&,tFObt ' 8 2009 `_�ri,R� j r `mCeBdnded [hht ryots y pudic Urok wdters Owner/Agent is` /Produced ID 13 APPLICATION APPROVED BY: Bldg Zoning: (Initial 8 ate) Special Conditions: Date Print Co4hactor/Agent's Name '7-0 Q C' -7 a� Signatul of N of F AMBER N. JOHN O =* += Y COMMISSION # DD 394025 EXPIRES: February 8, 2009 'lAf Bonded ThruNotary P11 Underwrters Contractor/Age Produced ID Utilities: FD: (Initial & Date) (Initial & Date) (Initial & Date) M� 1111111 ilk 111!it191111liIII IlliitIlli01111111111off 11111111tH MARYANNE MURSEt CLERK OR CIRCUIT COURT Permit Nurnbbr SEMINULE CUUNTY Parcel tdent46tton Number — — — CDU—CVRCI.)583I FIG 0872 Prepared by: �%� b rf eacc� CLERK" S # 2005127556 RECURVED 07/068/2005 03:31106 RM RECURDINU FEES 10.00 �J RECURDED BY D Thoaas Return to: r, NOTICE OF COMMENCEMENT 'Cup,K State ofd Ur' (OZ SE '. Oun- of The undersigned hereby gives notice that improvement(s) will be made to certain real property. and in accordant with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. '. Description of property {legal- description of the property, and street address if available) r --t a� � I�a.rn iia � � .i-� � t ►-�-�-s 2. General description 5 � 1� (pc-� � 8 of Improvement(s) 3, Owner Information Name (0 prCjl0,'1 Telephone Number ^,ddress t ( Co 107 Fax Number �O ► \{�c.� 1"� ��� j ( Interest in Property: 4. Fee Simple Title Holder #if Other than owner shcr,�m above) Name Telephone Number Address Fax Number • 5. Ovntra r — — Name a -I `iG Telephone Number Address 6Y, e'-�/ Fax Number q 0j a1 j q (I I CX lo_►td o, T --L' a,Q S. Surety (if any) Name Telephonic: Number Address Fax Number Amount of bond g _ 7- Lender (if any) Name Telephone Number Address Fax Number B. Persons within, the State of Florida designated by Owner upon whom notices or other documents may t: served as provided by §713.13(1)(a)7- Florida Statutes. Name TeieAhone Number Address Fax ?Number :'- In addition to himself or herself Owner designates the following to receive a copy of the Lienor's Notice provided in §713.13(1)(b), Fioriba Statutes. Name Terephone Number Address Fax Number 10- Expiration data of notice of commencement (the expir i n date is o year from the date of recordin unless different date is specified): Date Signed Si ature of Owner Note: per §713.13(i)(g). "owner must sign—and no one else may be permitted to Sign; his o`` r her stead" Swom to and subssgribed b9fore me chis G �% day of _ cJ who is me OR f _produced: AMBER N. JOHNSON -- �rq''•• '•4•': -- .: *= MY COMMISSION # DD 394025 Signafur of Notary (rot: seal to appear below) EXPIRES: February 8, 2009 "•f p' f 4r Bonded Thru Notary Public Underwriters POWER OF ATTORNEY Date: o I hereby and appoint � ey-c—e- Y, of Fiv-,<�+ Ch 1 c e Pe yr ! ffi n G to be^ my lawful attorney in fact to act for me and apply to the \ �1 f sck n --U r C� Building Department for a C ®o � permit for work to be performed at a location described as: Section U Township Q'60 Ranges o9 Lot U (.) () Block O 0 Subdivision Address of Job 11 l.QC--� . 1—i SN- . OwneryUY ooYl (juTC%e� and to sign my name and do all things necessary to this appointment. Print Name of Certifie Signature of Certified The foregoing instrument was acknowledged before me this day of by who is personally know to me / who produced as identification and who did take oath. State of Florida County of a Notary Public AMBER N. JOHNSON MY COMMISSION # DD 394025 EXPIRES: February 8, 2009 OwM 7hru Notary Pudic Underwriters AFFIDAVIT REGARDING ROOF DRY -IN AND FLASHING INSPECTIONS Company: License #: AJC 670 44-tvcr,- AA1 ©2LAPbo 328 7-2- Project 2 Project Information Owner: R W _[C l4 -L`' (Z Permit #: name (l (� L` 17� S �✓f0� z?7l Subdivision: address Lot #: phone I, 1,4J i -)> Al e(2 c_4_­—(� , 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: signature printed name STATE OF FLO COUNTY OF This instrument was acknowledged before me this day of , 20 , by the above referenced individual, > C (, , who acknowledged that he/she is a duly licensed contractor with, and o acknowledged that he/she was authorized to execute this document. He/she is either e ally known to me or produced as valid identification. WITNESS my hand and seal this day ofnM,,., 2 Notary Public � DEBBIE BLANTON A "'' 1 i �o AAY GOMMISSION # DD 188491 ^� _ February 25, 2007 pec. Co. 1 -600 - 3 -NOTARY