HomeMy WebLinkAbout504 E 8 St (2)Permit # :
CITY OF SANFORD PERMIT APPLICATION
Jf
ice,
Date:
9714Job Address:, '�D� C. 8ST, .54-N r-0�, FF-(- % 71
Description of Work: S14J)4Lc g6QeOP- 27 SQ S
Historic District: Zoning: Value of Work: $_ f-�D
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:
�tJbTi4 �Z.�
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 #:.Z S 10 HC7 ' C/706 -C)CI3 U / � (Attach Proof of Ownership & Legal Description)
Lf-'
Owners Name & Address: 1u1• A- ->?' Y,4,,k1cr /"! CCAZGe= �--/
1,6q, FL + --5Z/ --KS— Phone:—V4,'c.S%V
Contractor Name &Address: 9 D A AI n r` r tr n
State License umber: e` •Qi6(CAD ATf>A It'
-Phone & Fax: GENGUA�C7�ntact PersonDCHREZ HZ)Pp,)�Ph®on�e:371D7 7�p • V&49 -,599Z
Bonding Company:
/
ddress:
Mortgage Lender: .
Address:
Architect/Engineer:
Address:
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, and there may be additional permits required from other governmental entities such as water management districts, state agencies, or federal. agencies
Acceptance of permit 7en'fitio�,'Illltfify owner of the property of the requirements of Florida Lien Law, FS 713.
✓✓✓ Signature of Owner/Ag Date Signature of Con ctor/Agent Date
�iti-,gm /-/ // y
wner/Agent's Name
�
MateWflonda
Signature of Notary -State of Ft illyPubli
My comm. exp. filar. 9, 2009
�( Gtlr m. No. DD 386607
Owner/Agent is l \ Personally Known to -M
Produced ID
APPLICATION APPROVED BY: Bldg. Zoning:
Special Conditions:
Print on or/A is Mme
�L.
Signature, 'o(,Notxy- -StW or--Whka�ut r `t Date
* ;,(1' < OWI6,HS10141? DD 164280
l:XPIRES: Novemberrl2, 2006
Thru Budget Notary Swoces
Contractor/Agent ispersonally Known to Me or
Produced ID
(Initial & Date (Initial & Date)
Utilities:
*03
(Initial & Date) (Initial & Date)
PN ermit Number
Parcel Identification Number •/iso -5�G• dlo� • �oSo
Prepared by:
Richard Morris
1260 Saratoga Ln
Geneva, Fl. 32732
Return to:
D R & G, Inc,
1260 Saratoga Ln
Geneva, FI. 32732
NOTICE OF COMMENCEMENT
11119139 fig 1f=N WE"is go M a In" Mona= !o w WE
NOTARIZE
MARYME KJRWI CLEM OF CIRLUIT CWRF
501NOLE G{fi..WY
RK 05796 FIC 1249
CLERK'F#2005111873
RK01RDED 01106/M
11:24:07 AN
REOIRDINS FFU 10.00
RkUItiM-1 BY t holden
CERTIFIED COPY
MARYANNE MORSE
CLER OF (RCUIT COURT
nr...l. f
BY -
State of F-1 () r i Circ u Y CLERK
K
County of Wit. ��l ! i No L E'
U ��
The undersigned hereby gives notice that improvement(s) will be made to certaln ( 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 the property, and street address if available)
SHNFeR�/L~E'C W y� of 1..0'1`5I3c k 9Ti� Toc�N DF' SANFo�eD
2. General description of improvements)
Sl4iA/,Q« re roof
3. Owner information
Name /64i54 C.c.t/LLI-lAf&Tfi.VE _7 MCC4f-4E/ Telephone Number -V60 571'3�y%
Address 7y,Sp w1c.T"sfgNle9-- vdlF- Fax Number
Llq-romA. FG, 3-27-25 Interest in Property:
4. Fee Simple Title Holder (if other than owner shown above)
Name Telephone Number
Address Fax Number
5. Contractor
Name D R A.nd G, Incorporated Telephone Number 407 327 5636
Address 1260 Saratoga Ln Fax Number 407 349 1398
6. Surety (if any) Geneva, F I , 32732 p
Name Telephone Number
Address Fax Number
Amount of bond $
1--?- Lender (if any)
Name
Address
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 (the expiration date is one year from the date of recording
unless a different date is specified):
Date Signed!!' Signature of caner [Note; p 713.13(1)(8), "owner
must sign ...and no one else may be permitted to sign in
his or her stead."
Swom to and subscribed before me this Jt -r' day of
G> l fJ--me 0 a—At .
who is _personally known to nt6OR /
111 as identification.
Signature
A-50-5 by
seal to appear neiow)
PAMELA M. WILLIAMS
Notary Public, State of Florida
Form Revised: 3198 My comm, exp. Mar. 9, 2009
Comm. No. DD 386607
,♦
AFFIDAVIT
REGARDING ROOF DRY -IN AND FLASHING INSPECTIONS
Company: �- f License #:'Q -Sc:,
Project Information
Owner:
Permit #:
name
:y C Subdivision:
address
-,Sr) �\ - Lot #
phone
S
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
printed name
STATE OF FLORIDA
COUNTY OF
This instrument was acknowledged before me this ac day of by the
above referenced individual, who acknowl ged that he/she is a
duly licensed contractor with _ owledged that
he/she was authorized to execute this document. He/she is eit ersonallyknov� to me or
produced as valid identification.
WITNESS my hand and seal this day of — , 2065
Notary Public
�atPR=POe�% FLORENCE A.0-GRAk,
*MY COMMISSION # DD 164261:
EXPIRES: November 12, 2006
Srr _ �e.`O °nude Th..r u Bud;et'L,t3 ry iee�•
Gr r