HomeMy WebLinkAbout228 Odham DrV51
CITY OF SANFORP PERMIT APPLICATION
f� /
Permit #: 0 1551 V rr Date: a c
Job Address: 92% har 1 \�)Y
Description of Work:... �0,0-Q_ 3 `VC3C\jx
Historic District: Zoning: Value of Work: S 55 (�
Permit Type: Building Electrical Mechanical `r Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary Pole _
Mechanical: Residential J/Non-Residential ReplacementNew (Duct Layout & Energy Cal c. 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 V/ Commercial Industrial Total Square Footage I a
Construction Type # of Stories: I # of Dwelling Units: Flood Zone (FEMA form required for other than N.
Parcel #:
O«ners Name & Address:
Contractor Name & Address:
Phone & Fax
Bonding Company
Address:
Mortgage Lender.
SOS O N--3 6Q "— U � Sb (Attach Proof of Ownership & Legal Desc
Phone:
State License Number Lk i (
1= Contact Person �t�i� 1 )i �� a Phone: qoq -,C
56—y� es
Address:
Architect/Engineer. 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)f 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 aplidable to this property 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.
Accept e of p mit ` erification th i otify the owner of the property of the requirements cf Fl�Lien , FS 7C �-a�-� S.00
Signa ure of O Tier/Agent Date Signature o tractor/ ent txllre
vo -11� 7: V
Print O 's Name Pri Contr gent's Name
a Date tgn f Notar)LState of Florida Date
aaY
"u. Notary ublic State of Florida �/ P Notary Public State of Florida
Jose Luis Duarte `'.
M Commission DD387345' Jose Luis Duarte
Y M Commission DD387345
�pF niOwf 6411!222 Personally Known to Me or Contractor/Agent is _ Personally - o, o Y
c Produced [D of F` txpires 0111812009
APPLICATION APPROVED BY: Bldg: Zoning: Utilities: FD:
initial & D t (Initial & Date) (Initial & Date) (Initial & Date)
Special Conditions:
May 10 05 10:34a HRS 4076449113 P.2
i niJ pvJ t KUNIENT PREPARED BY: NN // �T '/
MARYANNE NO LLE4 1RCUIT [> WT
NAME Evavn Dilla S041NOLE CUIJ I
ADDR. 830 S. Ronald Reagan Blvd Ste 102 PK 05693 'S 0817
CLZRKI S 4t 20()50645430
I on wood cj— a 32750 `11M)RDE"D 04/19 mS 04,01,34 pk
RMRDINB FEB 10.Oo
REMROED
NOTICE OF COMMENCEMENv t oodley
I'
TAX FOLIO NO.
PERMIT NO.
STATE OF FLORIDA
COUNTY JOF SEMINOLE
The UNDERSIGNED hereby gives notice that improvement will be made to certain and r
Property. and in accordance with Chapter 713, Florida Statutes, the following information
Provided in this Notice of Commencement.
DESCRIPTION OF PROPERTY (Legal description and street address)
General Description of Improvement
OWNER INFORMATION
Name and Address
Interest in Property (Fee Simple, Partnership, etc.)
NAME AND ADDRESS OF FEE SIMPLE TITLEHOLDER (if other than owner)
CONTRACTORa
SURETY (Bonding Crnnpany)
Name and Address
Amount of Bond
LENDER
Name and Address.
and Address)
M
OF CIRCUIT COURT
Persons within the State of Florida designated by o ��qt
be served as provided by Section 713.13(1), (a) 7., Florida Statuh�m notice or other documrn 1 (� 201A6
(Name and Address)
In addition to himseif, Owner designates
or _
to receive a copy of Lienors Notict-pZdcd in Section
713.13(2), (b), Florida Statutes.
Expiration Date of Notice of Commencement
(The ex f recording unless a different date is
s:y :.yr,: narcm uD /
« .Exp res r+icL200g� 1
Print Name
Sworn to and subscribed before me this ` day
day of
Notary PubUc
My Commission Expires \ \
The foregoing instrument was acknowledged before me this \
day of �11,wrc
10
— by
� b VA4U- �(name cfperson aclmowledgcd), who
mown to me or who has produced
identification and who did (did not) take an oath. (h'pe of ident
7
�� 0. LZMA
gna tune of Owner
np57
-00001,
Personally
ration) as