HomeMy WebLinkAbout110 Newport Sq (2)f 1
CITY OF SANFORD PERMIT APPLICATION
Permit #: -��/�1 Date:
Job Address:
Description of Work:
Historic District:
Zoning:
Value of Work:
0
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service - # of AMPS
Mechanical: Residential Non -Residential _
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets _
Occupancy Type: Residential Commercial
Construction Type: # of Stories:
Parcel #:
Addition/Alteration
Change of Service Temporary Pole
- Replacement
New (Duct Layout & Energy Calc. Required)
# of Water & Sewer Lines
# of Gas Lines
Plumbing Repair - Residential or Commercial
Industrial
Total Square Footage:
# of Dwelling Units:
Flood Zone: (FEMA form required for other than X)
Owners Na''me//& Address:
/ /C --,Nor i i /, ,,
(Attach Proof of Ownership & Le2al Description)
Phone: QI — -3Z 3 0� 6-6 %
r�
Contractor Name
& Address: r`t / 17— '�-_kl oto /l j6e�,J,10 —1-9 e
g r/✓ State License Number:
Phone & Fax: -O 7 F3- 63-
7 9,- Contact Person: 0,t -o' puc-
Bonding Company:
Address:
Mortgage Lender: _
Address:
Architect/Engineer:
Address:
Phone:
Fax:
K07 -F-5 9CG SC.
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, 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 FS 13.
Signature of Owner/Agent Date ,Signature of ontractdr/A, ent Date
�
Print Owner/Agent's Name PrpW-4�on jkactor�4gent's Name
Signature of Notary -State of Florida
Owner/Agent is _
Produced ID
Personally Known to Me or
Date re ofNotary-State of Florida
DEB !E B ANTON
4Y COl4, 41SSiON # DD 188491
EXPIRES: February 25, 2007
ntra Y/Agent is _ '&FSOIga yuKtnowa pi
APPLICATION APPROVED BY: Bl 1 �''/ Zoning:
nil.°�tial & Date)
Special Conditions:
Utilities:
(Initial & Date) (Initial & Date)
FD:
Date
18) 0
(Initial & Date)
[Workmans CCmP i 1Q1 East i" Street
�chocked: I .
— -- ----i r Sanford, FI 32771
JF, MINO LE COUNTY Phone: 407.665.7050
FIORIVA'S NATURAL u,oicr. Fax: 407.665.7466
SEMINOLE COUNTY RESIDENTIAL PERMIT APPLICATION
Job Street Address: i mR u a pate:
Cit :N , 7, C I
Parcel ID: 4 <i 4 x., n ...� _ Zlp: 3�. 7/
Less: a6
ISt2i
n -e: 2:
Holder Name:
sh Proof of Owns
el ID: ( e__<
Book: ��
Valuation of
Total Square
Total HVAC/
Will trees be
:ank 1 I V1`elt
!Y'eche.nica!
Fiumbfnc�
RoofinZ -
Low Voltao;
Low Vrlta�t
Gess
State
K
;•� _�X. ri tiyes, complete an Arbor Permit
utilities .�.�----w _.
Pubitc Water I F'uhli E ewer
titilStY Latgerciude t}ti!%y Letter From Adlriare AFrt�
SUBCONTRACTORSc.
h�arnr, Liense # Req/Cert —
---- J 1_..__ Card Hctder's Na
SEPARATE PERMITS ARE REQUiREt7 FCR ELECTI iCAL P'�l/M3iNG, HE.MTlhO, VENTILi�TIN(i OR i 1R GpNT117iptltNG. TI4iS
NERN11T 6EC'OMF..S NULL AND VOM IF WORK OR CONSTRUCTIONAU Ifi NpT COMMFNCEG WITHIN u iKONTHE, Op I
IF CONSTRUCTION GR WORK I6 SUSPENDED OR ASANfJONED 17OR A rERIOD OF 6 MONTHS AT AI4Y TIME AFTER WORK is
COMMENCEL,
t hereby certify thrt 1 htive read and examined thin application and know tyle game to be true and, correct. All Provialons of Ie'rra
and ordinances governing this type, of work will be compiled with whWher specified herein or not, the granti
not presume to cons authority or vlolts, ng of c penntt dose
�ermenenco or tonrfruction. a or cancel the provlslore of any other state or local low regulating construction or the
The valuat/on for this permit w/116® calculated us/ng the SBCC! Building Valuation Data using thrt Gond ategory.
By my signature l ackncw[Q!�2e this fact and waive an rfq is to app®al said valuation and or permit feesc
I hereby cartify that at the time of the application and issuance of the above permit, all net;ssary
Workmen's Compensation Insurance required by the State of Florida has been obtained to effect the
proper protection of those workers under my_ employ.
SlgnAt%Cont oto �Date:
r: A,,�� � Date:
Limited Power of Attomey
Date: /° D
I hereby name and appoint George Augstell of
The Home Improvement Co, Inc. to be my lawful attorney
in fact to act for me and apply to for
a 1�S- --� �` % G / permit for work to be performed
at a location described as: Section Township Range
C� Lot 0 Block
Subdivision
(Owner of Property and Address
and sign my name and do all things necessary to this appointment.
M.C. Loch CGC 1505853
'ype of Printn me of Certified Con ractor ano License #)
of Certified Contractor)
Acknowledged:
Sworn to anq subscribed before this
_ Day of A.D.
Notary Public, State of Florida
(Seal)
SYLVETTE'ORTIZ-WITTMER
My Comm .Exp. 8/27/!05.,
No. GD 0053152-
[ 1 Personalty Known I.D.
APR -15!2005 15:23 From:
4079776025 To: S,40783,;7076 P.2'2
NOTICE OF COMMENCEMENT
This doCiarnent pn;parcd by; N:cme;
Address:,,
STATE OF 1~LORWA COUNTY OF SEMINOLE TAX FOLIO it (Complete .Parcel TD 0)
The undersigned hereby informs all concerned that improvements will be made to Certain real property, and is accordance with
Chapter 713, Florida Statics, the following information is provided in this Notice of Commencement. {
(DESCRIPTION Of PROPERTY (I,cpl description of the property and street address)-
�
(D . % -eco �� g" `iI - '-
GENERAL, (DESCRIPTION OF IMPROVEMENT:
i"1�1V11& 4 ADDRESS . J—
�27
OWNERS INTEREST IN PROPERTY (Fce Simple, PartncrsWp, ctc,)
NAME A" ADDRESS OF FEE SIMPLE TITLE HOLDER (ff other than owner)
CONTRAC7CQRNAARIZ &ADDRESS:
C6 C,u c'srf S' 5 S� c9 �v c� C7 / � 7,
SURETY (Pending Company
) NA1V!'iw & ADDRESS -
Amount of 'Sond:
Persons within the slate of Florida designated by owner upon whom notice or other documents may be saved as provided by Section
7l3,13(1)(a)7„ Florida Stmucs,
Name and Address
In addition to himself owner designates the following person to receive a copy of the Lieaor's Notice; as provided in Section
713.13(1)(b), Florida Stattrtes;
Name and Address:
Expiration bate of Notice of Commencement
(no expiration date is 1 year from date of recording unless a differeadhte is specified)
Si of r �i
Printed Name of towner
STATE OF 2 6 ,� COUNTY OF -t—
The for goiq i�st�t was acknowledged tlu i .-rday of =
who personally kno "tt me or has produced
nolnialedgod-tiutt iOd-ic signed the instrument voluntarily for iho put
`til" NORSE, CLE (IF i+lt'WIT L -WR>!
CLEW (i1= SEMMLE C,` 'nk
Bit t:F56�. 8
FILE MUM
R RDED W03&1005 08.-04.-5 AN
REMIRDIM FEES 10.0
RMRDED AY t holder►
R,li A gjl 8iI it fir+ N !ii �l l� fits i� ttlt 11 tae 0 Bit at lull R
Signature
(type of identification) as identification and
,d in it. ,
of Florida
Print "T, or Stamp Commissioned Name of Notary Public
ri�YPltri, George T.egAeU
Expues NOY 16. am
,'rE �...••�r; Beed `Tl�
M -kc Eos Cow bis