HomeMy WebLinkAbout719 E 8 StPermit #: 0 M
Job Address: ���
Description of Work: (G
Historic District:/lJ J Zoning:
CITY OF SANFORD PERMIT APPLICATION
` Date:
U
6'a
Value of Work: S
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/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 # 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 x)
Parcel #:
(Attach Proof of Ownership & Legal Description)
Contractor Name &
Phone & Fax: ,4 Contact Person: Phone:
Bonding Company:
Address:
Mortgage Lender:
Address: ,� J
Architect/Engineer: ,v 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 is verification that I will notify the owner of the property of the requirements of Frida Lien Law, FS 713.
o
Signature of Owner/Agent
Print Owner/Agent's Name
Date
Signature of Notary -State of Florida Date
Owner/Agent is _
Produced ID
Personally Known to Me or
APPLICATION APPROVED BY: BI 'Zoning:
(Init Date
Special Conditions:
Signa%o7nfractor/Agent Date
�� A
Prin ontractor/ gent's Name
- /?/r�-/DSS
Signature of Notary -State of Florida Date
ConFE
aNgeN is �rPo�S�t%�11 v�So Me or
1_800-3-N0T,,,17Y
(Initial & Date)
yF3: February 25, 2007,.'
F' No`"Y Discount q� Ft
o.
(Initial & Date nitial & Date)
Workmans Comp
1101 East 151 Street
Checked: ` Sanford, FI 32771
SEMINOLE COUNTY Phone: 407.665.7050
11.0RIDA's NATURAL CI101CF Fax: 407.665.7486
SEMINOLE COUNTY RESIDENTIAL PERMIT APPLICATION
Job Street Address: I I�, 5f4 k St Date:
Cit S Zi .z
Parcel ID: L o I.
Directions to Job Site: o v`c, -1--� , e �-�- ON cc 41- �- /0 cv,-S
Owner Name: rv-\ ; &kr-c, I ---3
Address: 1 o r 4--��-1 c -
Cit /StIzi Cin wrr ,� c77
Phone o (o 21— (P Z'3 Fax: 9oZ G l e / 3
Contact Person: I Int c .-J Day Phone: qo 7 ' -017
Contractor:
Address:
Cit /StIzi
Phone: Fax:
Lic. Holder Name: State Re ./Cert#:
'Attach Proof of Ownership: Tax Record from Seminole Co. Property Appraiser's Office Tax Receipt or Deed etc.
Parcel ID: Lo -t- -I-ie- O �r P wl= J✓dJ r%,- �a -. S,,- I"- -J,
Plat Book: I Page(s):
Subdivision Name:
DESCRIPTION OF WORK
Valuation of Work (Estimate): $ .S` 6,,-6 -�
Total S uire Footage:
Total HVAC/Livino S ace Square Footage:
Will trees be removed? Yes No If yes, complete an Arbor Permit
Utilities
Se tic Tank Well Public Water Public Sewer
L -Existing Well Utility Letter Include Utility Letter From Aperopriate Agency
SUBCONTRACTORS
Business Name License # Reg/Cert Card Holder's Name
Electrical
Mechanical
Plumbing
Roofing
Low Voltage
Low Voltage
Gas
Irrigation
Other
NOTICE
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS
PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 6 MONTHS, OR
IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 6 MONTHS AT ANY TIME AFTER WORK IS
COMMENCED.
I hereby certify that I have read and examined this application and know the same to be true and correct. All Provisions of laws
and ordinances governing this type of work will be complied with whether specified herein or not, the granting of a permit does
not presume to give authority or violate or cancel the provisions of any other state or local law regulating construction or the
permanence or construction.
The valuation for this permit will be calculated using the SBCCI Building Valuation Data using the Good category.
By my signature, I acknowledge this fact and waive any rights to appeal said valuation and or permit fees
I hereby certify that at the time of the application and issuance of the above permit, all necessary
Workmen's Compensation Insurance required by the State of Florida has been obtained to effect the
proper protection of those workers under my employ.
Signature of Contractor: Date:
Signature of Owner: Date:
—2 �—/ — 0 5
`THIS I14STRU NT PREP E_ D BY:
NAME: i1c, /� v
ADDRESS:
SE1�II tiULE CU(1NT2'
� -- � � FLORIDA'S \ATl!!Rnl CHOIi'E
NOTICE OF COMMENCEMENT
State of Florida
Permit No. Tax Folio No. (PID)
Building & Fire Inspectioi
1101 East 1 st Stre
Sanford, FL 327;
County of Seminole
The undersigned hereby gives notice that improvement 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 O
description of the pfoperty and stre t(�address)
10GENERAL DESC�PTI N OIRVT
! COPY
nApp.SET
OWNER INFORMATION
Name and address
4
Interest in property (Fee Simple, Partnership, etc.
RY
NAME AND ADDRESS OF FEE SIMPLE TITLE HOLDER. (IF OTHER THAN OWNER)
IHI Irl ut 111119
`i 5 2005
CONTRACTOR MARYANNE MORSE, CLERK OF CIRCUIT COURT
Name and address°` ,f f , SENtNULE Cl1UNTY
cFl/�
/V, HFC 05811 PG I:*9�
SURETY (Bonding Company) RELHI}Fll 0'1/15/2005 01.26.01 PH
Name and address REi.� RUING FEES 1t�, t0
` RELUNDED by D Thoaas
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 /C-/, i C ka R.. /? 0/ l evtf
Persons within the State of Florida Designated by Owner
provided by Section 713.13(1)(a)7.,Florida Statutes:
Name and address:
whom notice or other documents may be served as
In addition to himself, Owner Designates of
To receive a copy of the Lienor's Notice as.
Provided in Section 713.13(1)(b), Florida Statutes.
Expiration Date of Notice of Commencement
(The expiration date is 1 year from date of recording unless a different date is specified.)
Sworn to and subscribed before me this 1
Co
Notary Pub '
The fore oing instrument was a owledged bef
I (Name of person acicr
produced (Type c
and oath.
)ay of T�j
JANET E. LEE
MY COMMISSION # DD 38455h
EXPIRES January 6.2005
nded 4<N ary Publicnderwrit ry
LLLl
Iwledged), who is peisonall4knoWn personalto me or who has
identification), as identification and who did/did not take