HomeMy WebLinkAbout811 Escambia DrPermit # : �S _ 3 I (0 3
Job Address:
Description of Work: [Z(—
Historic
Z( Historic District:
Zoning
CITY OF SANFORD PERMIT APPLICATION
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Piz
Date:
Value of Work: S
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alan Pool
Electrical' New Service — It 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 #:
Own •rs Name & Address:
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Contt.ictm• Name & Address: _
Phone & Fax: L
Bonding Company: .
Address:
Mortgage Lender: _
Address:
Arclutect/Engincer:
Address:
(Attach Proof of Owncrslq'p & Legal escription)
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Z'� Phone: — z — l D 3G
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State License umber: "� ( �C 0 Z Zai O
(I �j Contact Person: �y 1Vjt7 0 Phone: 01 7J ZZS O
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, IIEATERS, 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 complianlce 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 F.OR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITII 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 requireme of P da Lien Law, F 3.
xdate Signa e f ontract /Agent ate
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Print
vDAFNEY F&YE ADCOCK
NOTARY PUB , STATE OF FLORIDA
MY Com . Expires DEC. 2, 2008
Fit is rs�,wLtui to M or
diced ID Vr _
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APPLICATION APPROVED BY: BldpL�,a%1 Zoning: Initial & Date)
L (Initial &Date)
Special Conditions:
Date
Utilities: FD:
(Initial & Date) (Initial & Date)
(� tatc of Florida
Permit No.
NOTICE OF COMMENCEMENT
Tax Folio No. (PID)
County of Seminole
7lie 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.
DESCRIPTI9N OF PROPERTY (Le al dcscri tion of tjt c property and street address)
GENERAL DESCRIPTION OF IMPROVEMENT
OWNER INFORMATION
Name and address
Interest in property (Fee Simple, Partnership, etc.)
NAME AND ADDRESS OF FEE SIMPLE TITLE HOLDER -(IF OTHER THAN OWNER)
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CONTRACTOR
Name and addMss _ � q p �r r --D (�', �0 d
SURETY (Bonding Company)
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 se ` ed as
by Section 713.13(IXa)7., Florida Statutes:
Name and address
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CERTIFIED COPY.
AYANNE MORSE
FLb DA
ITY.•CLERK
In addition to, himself, Owner designates of 28 200 ►
to receive a copy of the Lienor's Notice as
provided in Section 713.13(1)(b), Florida Statutes.
q pirat®14f L Fby£aAbW1 f recording_ unlet-, a diffemnt dare is cnrrifirrt.l
NOTARY PUBLIC, STATE OF FLORIDA
MY Cbttlth. Expires DEC. 2, 2008
" \ Signature of Owner
So to a I su c 'bed be ejme this Day of o
My Commission Expires:
N'tac Pu Iic q
`Zo0
The ;ren going�i� enyjvas acknowledged before me this day of V 1. , �9 by
� A� 6 W Q^�� (name of pe on acknowledged), who is personally known to
me or who has produceda( `r1>,1[ (type of identification) as identification
and who did I did not take an oath>
4
POWER OF ATTORNEY
Date:
I, Andrew 1 (AndY) Adcock do hereby authorize Ruben Birch I
To pull the R e r o o f permit for g I ,DFZ
a �� 1
(type of permit) (addr ss)
Sizdature
DAFNEY FAYE ADCOCK
(11)
NOTARY PUBLIC, STATE OF FLORIDA
MY Comm. Expires DEC. 2, 2008
COMM. # D0376609
Stamp
Personally n to me or driver license # , of State of Florida, County of
�v day of '�,y ►� •�— --
Zno
AFFIDAVIT
REGARDING ROOF DRY -IN AND FLASHING INSPECTIONS
Company: License #:
o
Project Information
Owner:-�/ l°t—� CSD �J &-o,_ Permit #:
name
1,-0 ::JP_ Subdivision:
/� address
Cj��ql—,�l
a - Z Lot #:
phone
i
I, o K�_, affiant, hereby affirm that I am the duly licensed
contractor of record f r 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:
n ZdZa,,-
signature
(`►� 1�'1� �o
print d name
STATE OF FLO
COUNTY OF Pesti L d
This instrument was acknowled ed before m this 7,]_ day of J , 20,9S by the
above referenced individual, Gh C o C4Z , who acknowledged that he/she is a
duly licensed contractor with A LP 17-- t c> o acknowledged that
he/she was authorized to execute this document. He/ he is pfitGer personally kno to me or
produced as vale
WITNESS my hand and seal this day of 1200
R
Nota Pt
WD F
A NEY FAYE ADCOCK
NOTARY PUBLIC, STATE OF FLORIDA
MY Comm. Expires DEC. 2, 2008
COMM, 0 DD378609