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CITY OF SANFORD PERMIT APPLICATION
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"Permit # : v"' � v
Dater c� g 0 �p
Job Address: D ( 04' vn ul , e r C>
Description of Work: —�o o �'"9
0,�} 4 }= i` r,� y Y',' otal Square Footage 30 b 4 J 2. ,,`,
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Historic District: Zoning:
Value of Work: S_ • 0 d
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
Construction Type: # of Stories:
# of Dwelling Units: Flood Zone: (FEMA form required)
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Owners Name & Address: ��
lot C"_ k.-, 1 �( -'_ f(i
�C) Phone:
& Address:
Cl— tti.- •-1- D V, C>
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Phone & Fax:
Bonding Company:)
Address:
Mortgage Lender: .
Address:
Architect/Engineer:
Address:
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State License Number: C✓ d7?_ Z S th 1
Contact Person: C. -o C Phone:
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 wat management districts, state agencies, or ral agencies.
Acceptance of permit is verification that I will notify the owner of the property of the require of FI ida Lien Law 71
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Print
S%, DAFNEY FAY ADCOCK
NOTARY PUBLIC ATE OF FLORIDA
MY Comm; Ires. DEC. 2, 2008
q DD376609
,gr/Agent is Personally Known to 1
Produced ID
APPROVALS: ZONING: UTIL:
Special Conditions:
Rev 03/2006
D to
Siguaf'ud of
Signature of Notary -State of Florida Date
or Contractor/Agent is _ Personally Known to Me or
Produced ID.
FD:
ENG:
BLDG:
OF COMMENUMEN'
State of Florida -ounty of Seminole
Permit No. Tax Folio No. (PID)
The undersigned hereby gives notice that improvement will be made to certain real prof. y, and in accordance :ith Chapter
-
713, Florida Statutes, the following information is provided in thii Notice of Comm( net ant
DESCRIPTION/ F PROPERTY (Legal descri fth property and street ads.. s)
.J
GENERAL DESCRIPTION OF IMPROVEMENT -k2 P7
OWNER INFORMATION
Name and address rl 5 -VC- —1'f7
C�)
Interest in property (Fee (Fee Simple, Partnership. etc-) 6 b-, L&_
NAME AND ADDRESS OF FEE SIMPLE TITLE HOLDER -(IF OTHFRT. 'iNOIATNER)_
CONTRACTOR
Name anpddress
C>c_ocAL_— _ooF_j
80D
SURETY (Bonding Company)
Name and address lvlfl97MY" CIRCUIT CUURT
T—
Amount of Bond SEMINULL UJUNI
BK W38S Pel 1623; (Ipq)
CLERK'S # 2006138493
LENDER 0,'1fiV'_ _y1
Name and address _i_!_06A Ve,09:04 P14
RW,010*0 BY T Kjg�j,.
Persons within the State of Florida designated by Owner upon whom notice or other d -aments may be serve( as provided
by Section 713.113(1)(a)7., Florida Statutes:
Name and "address
In addition to, himself Owner designates of
to, receiv,,-- a, py of the Lienor's r Mice as
provided in Section 713.13(1)(b), Florida Statutes. CERTIFIED COPY
"MAVMNE, MORSE
F,xpnp n De,lt t
CLERK OF CIRCUIT COURT
oftee o en
(ie plf�titip
of cordin2 unless a diffetrnt date ',z
r CNAA ITAO "FF L(DOak( SEMINOLE COUNTY, LORIDA
MY Carnm, ex RIDA
7 17 �lr" DEC, 2, 2008
0937, 'Je-d
c9mm, 0 6609
ignl�e o 0DEPOT CL 'R
S-IvQrnito aInd s0scribe h1fore me this Day of 0
I t t AUG 28 2006
I J1,
7-
my Commission Expire-
ot,qvv Public
The fore t Ct was acknowled ed before me this day of
(name I e
me or who has produced_,. (type �id
'go
(vg ins rume
of person acknowl�
and who did /Aid I � not take a;i,.oaih>