HomeMy WebLinkAbout2412 S Palmetto Ave (2)CITY OF SANFORD PERAM APPLICATION
Permit No.: 2 l(JV / Date:
Job Address: 24f /2 fo,w7 % ofte g- &ge _ • _ _TZ 7'7%*
Permit Type: Building Electrical Mechanical Plumbing Fire Alarm/Sprinkler
Description of Work:
Additional Information for Electrical & Plumbing Permits
Electrical: Addition/Alteration _Change of Service Temporary Pole New AND Service (# of AMPS )
Plumbing/Residential: Addition/Alteration New Construction (One Closet Plus 'Additional)
Plumbing/Commercial: Number of Fixtures Number of Water & Sewer Drainage Lines Number of Gas Lines
0
Occupancy Type: _Residential /Commercial _ Industrial Total Sq Ftg:.!2 FWo Value of Work: S
Type of Construction: Flood Zone: NumPY of!!(Sh Number of Dwelling Units:
ft
Parcel No.:"=& 30- s't/- Coco -OS 30 ,(o S'3 . PB 3 PGttach Proof of Ownership & Legal Description)
Owner/,
Contractor/Address/Phone: f — /,eM T;! 0. ek 224
Contact Person:
Title Holder (If other than Owner):
Address:
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer
Address:
State License Number:
Phone & Fax Number: Z-32Z -Ae*-?
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 i erification that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713.
i
M).cTAGoF-LINI;
of Owner/Agent Date Signature of Con or/Agent to/'
RAY _
Yo; fIf/i7( LI te5,.o
inr t'Owner/Agent's Name IT Print Contractor/Agent's Name
Signature of No -State of Florida Date H Signature of Notary -State of Florida Me
tiyP••., Melissa Cameron
Commission # DD079918
3
v a so
ce Expires Dec. 20, 2005
iQii1 Atlantic Bonding o., Inc. •
Owner/Agent is Personally Known to Me or Contractor/Agent is O<-Personally Known to Me or
Produced ID Produced ID
APPLICATION APPROVED BY: 0 t I 1 Date: I12's', 2
Special Conditions:
CEO IFIED- COM
MARYANNE MORSE
CLERK OF CIRCUIT -0004OTICE OF CMNCEWNT Permit
No. qFmIliOLE CQVKV- ELOR@Ill Tax Folio No.3y.iy-3o-Sy/.oeeo-0130 State
of Florida County
of Seminol M nul 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. we
C'r t 1.
Description of property: (legal description of the property and street address if available 3 •,mo. 2.
General description of improvement: R 6 roe.C' loos a Qk d 6a `k aH dlF.,o,.+' Pb viGL, 3.
Owner information a.
Name and address a , e'
f /.2 South e e e•!9rie s•.1,1—. F.b ' s ?i b.
Interest in property c.
Name and address of fee simple titleholder (if other than Owner) 4.
Contractor 0
a.
Name and address aka Roe-F;alx --owner-wi 0/yt Yuf s. SR 77oiC %
br-c..D/Q- 5atc ore F Q 32773 b.
Phone number Fax numb 5.
Surety N IN a.
Name and address 9QIiNn
a..*,'.CLERK W CIRCUIT COIRT b.
Phone number Fax numlifir( C.
Amount of bond CLERKS a 6.
Lender KMRMOl/28 eW M37928 AN a.
Name and address 1.
WWROIN9
FE S Loo Y
N Noldon s
b.
Phone number Fax number 7.
Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided
by Section 713.13(1)(a)7., Florida Statutes; a.
Name and address >:.,afes so• ' mr /s'74C 7r--v &OrGC D8 TF/, '?
27;3 b.
Phone number Fax number 118.
In addition to himself or herself, Owner designates of to
receive a copy of the Lienor's Notice as provided in Section 713.
13(1)(b), Florida Statutes. a.
Phone number Fax number 9.
Expiration date of notice of commencement (the expiration date is 1 yepr from the date of c g unless a different date
is specified) X
Signat
re O me e-- /y,ZtwfSworn
to (or affirmed) and subscribed before me this Iq day of Z AyIf U , 20 OZ , by Personally
Known OR Produced Identification Type
of Identification Produced williaN'' {
a s, sR Z
Signature
of N ry Public, State of Florida Commission
Expires: WILLIAM
YATES. SR. My
Comm Exp. W2/04 No.
CC 940537 11
P"—Wy Kwm 1 I Cow I.Q TN18
INSTRUMENYWRF.PA `• NAME
1/;/%Q'H lV rs.S APDR. ,
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