HomeMy WebLinkAbout137 Meadons BlvdPermit #
Job Address:
Description of Work:
Historic District:
CITY OF SANFORD PERMIT APPLICATION r
Date: G I C�
Zoning: Value of Work:
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: ` it of Dwelling Units: Flood Zone: (FEMA form required for other than x)
Parcel #: (Attach ProjoOwnership Sj Legal Description)
Owners Name & Address: AIV-"
Phone:
Contractor Name & Address:
Phone & Fax:
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
State License Number: CC C- 0 J � I
Person: _ 8rr--, Phone: `3 CC' \CJS
u /
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, 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, an a may be additional pe its required from other governmental entities such as water management districts, state agencies, or federal agencies.
Acceptance i ' verifi do tha 1 notify the owner of the property of the reaui ments of Flo ' a'Li .LawS 7 . `
azure ner/ Date S gnature of Contractor/ ent Date
rind Owner/Agent's Name I P ' ontractor/ gent's Name
Signa UFFe of Notary -State off Chi Date
'y dP; MYCOMMIssionlD
of w EXAMS April 04 2005
Owner/Agent is _ Personally Known to Me or
Produced ID
,�
APPLICATION APPROVED BY: Bldojj) Zoning:.
[n n ate)
Special Conditions:
(Initial & Date)
slS5
Utilities:
DEBBIE BLANTON
MY COMMISSION # DD 188491
FD:
(Initial & Date) (Initial & Date)
'PPermit Number
B
Parcel Identification Number
Prepared By:
Return to: EDGAR QUINTIN, INC.
14824 WHITE MAGNOLIA CT.
ORLANDO, FL 32824
NOTICE OF COMMENCEMENT
I is tax cum OF CIRCUIT CMMT
SENIMLL cum.
BK 05713 P& 1771
CLERWIS *11 21-005074426
klt4tu &/@V21M 01421,214 PIA
REUNIMb FEES I&
Rwfto DV D !-hemas
�
State of j' _ T _ a
County of
The undersigned hereby gives notice that improvement(s) 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.
1. Description of property: (legal description of property, and street address if available)
w
2. General description of improvement(s)
3. Owner Inf oR
Name
Address ' vu -T ,�„ "L
4. Fee Simple Title Holder (if other than owner shown above)
Name
Address
5. Contractor
EDGAR QUINTIN, INC.
Name
14824 WHITE MAGNOLIA CT.
Address
ORLANDO, FL 32824
6. Surety (if any)
Name
Address
Telephone Number
Fax Number
interest In Property
Telephone Number
Fax Number
Telephone Number
Fax Number
Telephone Number
Fax Number
Amount of bond $
G�-�� PN��cMoc� �' R�oP• -.
Nor
c o��
S�M�N c�ERK
zx
7. Lender (if any)
Name Telephone Number
Address Fax Number
S. Persons within the State of Florida designated by Owner upon whom notices or other documents maybe
served as provided by Section 713.13(a)7., Florida Statutes.
Name Telephone Number
Address Fax Number
9. in addition to himself or herself, Owner designates the following to receive a copy of the Lienor's Notice as
provided in Section 713.13(1)(0), Florida Statutes. Telephone ber
Name
Address Fax N er
10. Expiration date of notice of commencement (the expiration d e is 1 a from
different date is specified):
Date Signe i ure f Owner te: pe
sign ...and no one else may b
stead."]
Swom fo and subscribed before me this day of
20lb-S by
9�r-Yz�r' SCJ ZA
unless a
IY4.13(1)(g), "owner must
to sign in his or her
who is personally known to me OR produced
as identification.
Signature of no aNenl appear below)
Form Revised: 3198 k� ' MY Commission ODOf g
V11 04 2005
F
AFFIDAVIT
REGARDING ROOF DRY -IN AND FLASHING INSPECTIONS
Company: r Qu i r
i � � • License #: CCL 0
Project Information
Owner: �� (� 3-r- Dc J t J
name
3 c LJ
address
4 a i- UD i
phone
Permit #: 6 _ J 5- J
Subdivision:
Lot #:
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:
CK)_41
signature
�Cl\lV- i v—*—^
printed name
STATE OF FLORIDA
COUNTY OF
This instrument was acknowledged before me this S day of , 20 ZS by the
above referenced individual, , who acknowle ged that he/she is a
duly licensed contractor with i ✓ I�v t ,; , and who acknowledged that
he/she was authorized to execute this document. He/she is either personally known to me or
produced � as valid identification.
WITNESS my hand and seal this day of
.,.1'vn:rvatUN # DD 188491
Ey'p a""_" : .brua
1-800-3-NOT,gP.Y ry25,2007
.. ._....,. �.. Assoc. Co.
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