HomeMy WebLinkAbout311 Dogwood LnCITY OF SANFORD PERMIT APPLICATION
Permit #: O's 2 0 Z� Date:
Job Address:
'311 D �oo/J S'fI H-F�� /—L- i '7 3
Description of Work: ic-
Historic District: Zoning: Value of Work: S
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinld-er/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 It 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 1)
Parcel #
(Attach Proof of Ownership & Legal Description)
Owners Name & Address:
S�n,F�tio c 2 a 'x'1.3 Phone: ��e —.3,
Contractor Name &Address:
/lam ,rsGCiZ:i fJGJ cl ��j xJGod V j flJS>t:7 :��d F'
)-) ^2 I /State License Number: C C C 0 �.� 1S d
Phone & Fax:1
?)
Contact Person0 : L7 ARAC)'V'0 Phone: 11O 7 ` 3 /..L/- 0 -Y -
Bonding Company:
Address:
Mortgage Lender:
Address:
Arch itect/Engincer:
Phone:
Fax:
Address:
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 constriction in this jurisdiction. I understand that a separate
permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACE'S, BOILERS, HEATERS, TANKS, and
AIR CONDITIONERS, etc.
OWNER'S AFFIDAVI"I': 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 RESUCI' IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITII YOUR LENDER Olt 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 governmental entities such as water management districts, state agencies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713.
mature •f Owner/Aggnt Date Signature of Contractor/Agent Date
Owner/Agent is _
✓Produced ID
APPLICATION APPROVED BY:
Special Conditions:
' f riot Co ctor/ gctis Napic.
n Van De Hey
Mori Date e of N ary- a c of Florida. & ttgmmission DD249386
�pw Shannon Van De Hey Expires September 14, 2007
My Commission DD249386 C►�
� Id; Expires September 14, ?C9g�tractor/Agent is " Personally Known to Me or
ak v Known to Me or —
Produced ID
Zoning:
(Initial & Date)
Utilities:
FD:
(Initial & Date) (Initial & Date)
PERMIT AUTHORIZATIOA
04/03
I r-2. QLe pCAL hereby authorize
(License Holder/Please Print)
0.40111 to obtain a permit in my behalf
(Authorized Person — Please Print)
under my License # C 'C�C D `Z 2 -SO ` for the job described below:
TYPE PERMIT
Building
Electrical
Plumbing
HVAC /
Roofing ✓/
Pool
Other
State of Florida
County of BVI OLkS L
Affirmed and subscribed
Wh4\is pi#s6naIIy
me this
DESCRIPTION
Owner _,5;44-' X-&- & 400 w0 12 -
Site
Site Address Yll %r®c wew)0
.54'�'levti/.✓ / -
Tax Parcel #
,(ii�en e -M der Signature)
Date
1-7> day of U 20 Dpi by
to m or who has produced (type of ID) as identification.
3t to of Florida Print, Type or Stamp Name f N tary
Notarial Seal
F ADCOCK
fp OF FLORIDA
DEC, 2, 2008
.a: ;0376609
E4DAFNEY F YA E DA COCKARY PUBLIC, STATP OF FLORIDAComm. ExPlroo DEC, g, awe
COMM, # D0370M
"WynrvrI
GAR:D
RO F DRY -IN AND FLASHING INSPECTIONS
Company: 6 License #: Co -7Z-� O
Project Information
Owner: Permit#:
name
e c-,6 w-oolJ Subdivision:
address
1/07 -3>y -v5;3-/ Lot#:
phone
I,
JeQ , 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
C111.1 qA—C;O— 6
printek name
STATE OFF A
COUNTY OF
This instrument was
before
above referenced individual, -'-J+-),.
duly licensed contractor with
he/she was authorized to execute this
produced
WITNESS my hand and seal this
"�. DAFNEY FAYE ADCOCK
' * NOTARY PUBLIC, STATE OF FLORIDA
% MY Comm. Expires DEC. 2,20M
COMM, # D03766O9 �
day of v >� , 20 , by the
, who acknowledged that he/she is a
C-1 Lo,.,, ho acknowledged that
He/she is rt er ersona11 wn to me or
as valid identification.
day 20 d
- O(J)k-, 4�_�
Notary P blic
0
LU
Q
CL
w
s.
NOTICE OF COMMENCEMENT
State of Florida County of Seminole
Permit No. Tax Folio No. (PID)
Tlie undersigned hereby gives notice that improvement will be made to certain real property, and in accordance %vith Chapter
CERTIFi[_D COPY
F�
713, Florida Statutes, the following information is provided in this Notice of Commencement.
Y
Nl€_
YX*,I NE i"IORSE
ESCRIPTION OF PROPERTY (Legal description of the property and street address) ; '� Of
C Rl•�
Z .
u E C ORI[
J
�
C
DEPUTY CLE
' GENERAL DESCRIPTION OF IMPROVEMENT 0O F
6204
OWNER INFORMATION ��
%- %!,� moi''✓
Name and address
no w ' ci�2
Interest in property (Fee Simple, Partnership, etc.)
NAME AND ADDRESS OF FEE SIMPLE TITLE HOLDER•(IF OTHER THAN OWNER)
CONTRACTOR
Name and address
SURETY (Bonding Company) A1,4
Name and address
Amount of Bond
LENDER
Name and address
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
of
In addition to himself, Owner designates
- to receive a copy of the Lienor's Notice as � ,r
provided in Section 713.13(1)(b), Florida Statutes. mp{ -g
*44*#»*#44***»*#*»*****»#*»*******»*»*»**»*****»»###44######4»*##***»*#44****************#** � �.n �
Expiration Date of Notice of Commencement �J
px
from data of recording unlecc a different dare is cnerifirri t
(Thcc',igRaf fs a� migy <'
My Commission DD249386 �✓�— — T1 :w'
Expires September 14, 2007 :Si a e of OwnerV Ch
t�n
VJ
rn a , bsc 'ped befor ,me this _ f ___Day f ro W& i 00.,
�D ::
to I..
My Commission Expires: ,..,
—Nota ubiicy ' "+1 1b
/ r o49-,iLwho
LC by —°
f re oin cnt was ac lodged before mub
e this
G, / (name of person acknois�personally known to
(type of identification) as identification
meor who has produced
and who did / did not take an 0atht> y