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Permit # : O v
CITY OF SANFORD PERMIT APPLICATION
Date:
Job Address: 'aJV KVJGZuLL L3W-LVt;, _
Description of Work---,�Q� _.
Historic District: Zoning: Value of Work: $ , 1W. 00
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: It of Fixtures # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets Plumbing Repair— Residential or Commercial
Occupancy Type: Residential v"' Commercial Industrial Total Square Footage:J 70 0 4
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than ?
Parcel t#: -31-11 — 3 )-54-17C)0— 0.15E) (Attach Proof of Ownership & Legal Description)
Owners Name & Address: &36 — ! *.? -
Wa L7�UiL:� C.� `f Phone:
C*P71,
�- Aontractor Name & Address: RP a, — �t-� 3 T fy-s
_`
1 � 11-`('t0 Q 7 32-7-SAp � 'State
License Number: C—CZ G o G
Phone & Fax: 1 10� 2 l S 0 �3 0 l Coqtact Person: f �( 1 �" � Z— A l� i hone: �O GSQ
Bonding Company:
Address:
Mortgage Leader:
Address:
Architect/Eugineer: 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 t0maybetional permits r om other governmental entities such as water management districts, state agencies, or federal agencies.
Acceptance ofn that I o ' of the property of the requirements oARP4't-l'
tgnature of Owner/Agent Date Si dti' Date
-b Ueb��
PrintOwner/Agent's N���� Print Contractor/Age Nary
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YP V;' 'Jit
of
rider ?.' e of Notary -State of Florida to
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Owner/Agent is ` Personally Known to Me or �ohimhor/Agent is Pe orally Known to Me or
_ Produced ID <� uced ID P1�
APPLICATION APPROVED BY: Bldg: 1 r Zoning:
(Initial & Date
Special Conditions:
(Initial & Date)
Utilities:
FD:
(Initial & Date) (Initial & Date)
AFFIDAVIT
REGARDING ROOF DRY -IN AND FLASHING INSPECTIONS
Company: 2�q-M I5 C629 5f '6b - 19C- License #: OF 0s; e5
Project Information
Owner: iCp"J .L.� Permit #:
name
BSO Pi5,4// 4 �.
address
phone
Lot #: (D\,o
I, f 1-7�- -� 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
Z
printed name
STATE OF FLORIDA
COUNTY OF
This instrument was acknowlNged efore e this J day of , 2(4� , by the
above referenced individual, Q- �9 S , who acknowl 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 U w7�p- �-1b- 3loa L0 as valid identification.
WITNESS my hand and seal this .
day of
Notary Public
V�p,RY PUe;i FLORENCE A. DE GRAVE
c* MY COMMISSION # DD 164280
EXPIRES: November 12, 2006
`O Bonded Thr- Buft1, Notzr/ 8�rvices
FROM :UCEDASCHOOLOF ORLANDO
us,ufl��.:�•iq. 2005E 2'GiPM
$�iZY and ��I ern n -
Amy Htaiaex
1u&peu6iiA AdmhAstratnr
AAA MIX SERVICES
218 LM; Obi$ BLVD
Caawlberry, p'L 32707
4074M.34"
File Numbmt caOOM
Will Gall No..
FAX NO. :4072734923
Aug. 12 2005 08:41RM P1
—i8t we Abot Ns Une For Racvnding WW,._:_. _
arra my Deed
TlziS Wat'Mnty Deed. made [leis 5th day of :tiny, 3008 Dakween Judy T Phillips, U1, a simple tarn whose post office
tiddsoaa is 853 VAGLL CLAW CT, Lake Mary, FL 32746, granter, and Rimrdn Loom and Lim Leen, husband And vrlfe
Wtsose post oft en addres$ i9 850 ROSALU D RIM Sna ord, FL 32771, grantee.
cwhenawr rand hfttin &Wo ftwms "Imn=- and "gffflVW" ladaala a 6 p4r6as to &3 iooavxu&'at turd Ehe tlasrg. Ispat rvrcuntadvo6, and mig ns of
individv2r6, WW dW BUtMSaM atld u A$W Of GO t tffld6ns, hUSTS wd VUSOM)
Wit"esleth, that said gramu,, for and in eall3idarailan of 1ho Sum, of TEN AND N01100 DOU-ALS (S 10.00) Aod ocher
good omd valuable consideratloas to said gramor is bated ,paid by said graotee, tine receipt wilnreef is hereby acknowledrxl,
has gradled, bargained, and sold w tele said ZrjMWe:, and ipantce's htim 4a1d, as5i ns forever, the followMg described land,
zinaan:, lying and beim its Seminole County, FWrida to.wlto
Lots 2S And * Nook 17, San Lasta Ud Section, accordin; to the alas 4hereof, as record in Plat
$00114, Pant: 30 40, Of the Public Records of 64minele CoU4ty, FL.
Pared LSentiSoitioo Num6m; flap Lanta 2nd Soothe,
Togetbar wlltl all thy: tLnewnts, tweditattteals 8rtd appxmaaces rhorcto belonging of in urlywi;te apptrtaift.
To Have and to Hold, the some in fec sharpie forevtrr,
And the Wtftw bereby novena tts will said gr=tee that the -MA[Qr is lawttitlty sdZ06 Of said ]awl in fee simple; that the
grantor has goad right anal lawful avtharity to self aril COnVOy Said land: that the grantor hemby fbily wavants the title to s:0
land and WIR defend rino same: lEzinae pre lawful claims of All parsons whomsoeVan and that said lvd is free of all
encumbra r4s, except taxes accn "Z snbt:squelat 10 December 31, 2004.
J #o WItlle" Where r grantor l.1as h=un'u set g1rautW f $laud alnd seal the day and year first above writt®a.
Signed, sealed and delivered in vur prryence:
6&i
Wit"Sa Name:
Wft5z.gs Name
RecPiv,ia Tins Ali&, 3, 4: MM DeubleTbmea
FROM : UCCDHOCI IOOLOF ORLH4DO FAX 140. :-40727::3-4023 firay. 12 2005 coo: -4:]Nl
State of Flrnnda
aunty of Seminole
The fMgoing insn=unt was ack4owkdged bely e, rnL^ this 5th day of July, 2QM by Judge T Phillips, M, who i_j is
M-winally I.riown or (X] hes Droduced a drjvtr a Iioense es idcntiftoadon.
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