HomeMy WebLinkAbout417 W 6 St (3)CITY OF SANFORD PERMIT APPLICATION
Permit # : (c, Date: S
Job Address: 4/'7 Gy &0/
Description of Work:
Historic District: Zoning: Value of Work: $ !F-�'cno
Permit Type: Building Electrical
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:
Mechanical Plumbing Fire Sprinkler/Alarm Pool
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)
Parcel #: (Attach Proof of Ownership & Legal Description)
_wners-,Name & Address: 0LZ2e N /W fITSU'0,4 2.og
5 .}M Phone: 154o'7- 5,t 2 -
Contractor
Contractor Name & Address:
Ze),c ;;?t)o4 :; �'csZa `%C, /::F— :F 2- 7 3,!!0 State License Number: e'GG- 0S*7
Phone & Fax: '44'7— !9 ; /n4ef5 _S Contact Person:r �pi//sd Colic Phone:.60`%
Bonding Company:
Address:
Mortgage Lender:
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 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 istqrification tNt
ignatt elf-_• caner/Age
Pt: wn'er/.A ent_s.Na e_
ign re o Nory-
,�N,11
W
Ower/Agent is
Produced ID
APPLICATION APPROVED BY: Bldg:
Special Conditions:
I will notffy theAne�r,of the property of the
GDate
Date
LORI D. TUCKER
MY COMMISSION # DD 406941
Ia& April 2, 2009
no fed eery Public Underwriters
(Initial & Date)
Zoning:
Lien Law, FS 713.
Agent
Print
SigEamre o_f&oI,,?—_,-St9re of Florida Date
LORI D. TUCKER
'•: �':= MY COMMISSION # DD 406941
Contractor/Agent is T Personally r EXPIRES: APdI2, 2009
I/ Produced ID `I'.� ' Pm Notary Publk Underwriters
Utilities:
FD:
(Initial & Date) (Initial & Date) (Initial & Date)
1
M I MUS -12-
AFFIDAVIT
REGARDING ROOF DRY -IN AND FLASHING INSPECTIONS
Company gr�r�� lliz`,�� %,,,� License #: C.�G ��-7
�f Project Information
Owner: IMOCIS7y
name
address
phone
Permit #: 0 � - 3 (C) )--
Subdivision:
Lot #:
1, ��6& 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.
Contra or��
'i signature
printed name
STATE OF FLO M A
COUNTY OF J
This instrument was acknowledged before me this day of 120 , by the
above referenced individual, , who acknowlec ed that he/she is a
duly licensed contractor with , 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 _1.20
b1ie....�_-...
r 'A" ANTON
DD 188491
�M ry25, 2007
1-8003-NOTA',7V Dunt Assoc. Co.
14V
Permit Number
Parcel Identification Number
Prepared by: 1j &p IAyv C c_<�-
Return tory- Jz;,/�-,.0
NOTICE OF COMMENCEMENT
State of / Al
County of _Ctoxt IA, -.PZ e.
MARYANNE MORSE, CLERK OF CIRCUIT COURT
SE.M I NOLE COUNTY
Bid 05839 FSG 1767
CLERK'S 4 2005131021
RECORDED 08/43/2045 12:04:43 FSM
RECORDING FEES 14000
RECORDED BY G Harford
MARYWINE MORSE
CLERK OF CIRCUIT COUP,
COLEYCOUNTY, ELO1.II
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.
Description of property (legal description of the property, and street address if available)
2. General description of improvement(s)
Pie lu0E-
3. Owner information
Name 441 OR -A/ 0/ 7'JVJ?A/ZA
Address Al/ +7 W, C " -T.
Telephone Number 4/ 0 7
Fax Number
Interest in Property:
4. Fee Simple Title Holder (if other than owner shows above)
Name Telephone Number
Address Fax Number
ontractor _
ree Ake - df
dress re R /L) ion 4 jC T� 19-
Surety (if any)
Name
Address
7. Lender (if any
Name
Address
J/;z7 FIG G
Telephone Numbers l
Fax Number
Telephone Number
Fax Number
Amount of bond $ _
Telephone Number
Fax Number
8. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served
as provided by 713,13(1)(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 713.13(1)(b), Florida Statutes.
Name Telephone Number
Address Fax Number
10. Expiration date of notice of commencement (if expiration date is one year from the date of recording unless
different date is specified): Date Signed Signature of Owner (Note: per 713.13(1)(g),. "owner
must sign ... and no one else may be permitted to sign in
his or her stead."
Sworn to and subscribed before me this _ _ day of d 120 by
I , -Aden rwk _-,,L)haYa, who ' II
known to me OR
Signature of Notary
23-20 (9/04)
producedas identification.
is persona y
PiPk T!PV ., TERRA APPLING
_Notary Public - State of Florida
•
*-z6kDWMW0nEVkWJUl29,2008
Commission # DD 342309
Bonded By National Nota
n, W
ryAssn.