HomeMy WebLinkAbout1938 S Lake Ave (2)Permit #: LAO �t
Job Address:
CITY OF SANFORD PERMIT APPLICATION
Date:
Description of Work: - 'N D
Historic District: Zoning: Value of Work: S Ito -C7-
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
5/t- 7 '
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 Fixlures
# of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closcts
Plumbing Rcpair—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 #:
Owners Name & ddress: _
Contractor Name & Address:
Phone & Fax: 0
Bonding Company:
Address:
Mortgage Lender:
Address:
Archilect/Tngineer:
Address:
(Attach Proof of Ownership & Legal Descripti
Z-7-7 1 Phone:y # -% 3 {d9 [�) O
O Y rJ
/Slate License Nur ber: L Q ZZ S O
Contact Person: '4'Ott Ddb Phone: qon
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 ora 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, ctc.
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 rcxtridions 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 districtA tate agencies, or federal a cncic&
Acceptance of permit is verification that I will notify the owner of the property of therei
a of Owncr/ t ale (D D Ola1.1".a
ILC \k4v
Print O n Ill's e
1 w _ . A to I8 In,
APPLICATION APPROVED BY: Bldg:
Special Conditions:
FAYt ADCOCK
(Initial & Date)
Zoning:
Licn Law, fi4 ] 3.
Name
Signature of Notary -Stale of Florida Date
Contractor/Agent is _ Personally Known to Me or
Produced ID
Utilities:
(Initial & Date) (Initial & Date)
FD:
(Initial & Date)
AFFIDAVIT
REGARDING ROOF DRY -IN AND FLASHING INSPECTIONS
Company: Y—CO �p �p License #:
Project Information
Owner: (o (v Permit #: _
name
ry >Subdivision:
address
Lot M
r phone
I 4-p -o c.o affiant, hereby affirm that I am the duly licensed
contractor of record 0 the gbove 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
printcl name
STATE OF FLO A ,
COUNTY OF Parti d LQ i
1
This instrument was acknowledged before met is �5 day of - 20V 1 , (Aby the
above referenced individual, C� who acknowledged thIie is a
duly licensed contractor with o, and who acknowledge8 that
he/she was authorized to execute this documen . He/she is eit all to me or
produced as valid idents cation.
WITNESS m hand and seal this day of v.J V- , 20J ( -
y _-�-- --�- X71
DAFNEY FAYE ADCOCK
Notary
�
• NOTARY PUBUC. STATE OF FLORIDA
MY Comm. Expires DEC. 2, 2008
COMM. 8 .DD37660g
• w N
,I 111$x%
LD411'ED POWER OF ATTORNEY
Date:
I he: eby name and appoint
of A C>C p e,�< - Pb O 1�:-i l to be my lawful attomey
in f.tct to act for me and apply to for
a 2e _ �D O permit for work to be performed
at a location described as: Section Township _ Range
Lot Block Subdivision
SOLv\ K -,7
(Address of Job)
J (�
S -T i'.{Ct D (9 5 J6 . Uk f-, 4-1,�ern -VI'D(Jwner of Property and Address) qt, 37%'1
and to sign my name and do al things necessary to this appointment.
_ 4� A-0co e4l, C CC,OZ� So
(Type or _ name o gertified Contractor and License #)
/Signadnee of ed Contractor)
Acknowledged:
Sworn to an s> scribed before: me this
Day of \JU.—,tie_ A.D. a oo
JL ,...'►" DAFNEY FAYE ADCOCK
` NOTARY PUBLIC. STATE OF FLORIDA
MY Comm. axplres DEC. 2.2008
COMM. M D0076809
an. ares: 2
AtV %0 `F<UCUL '/�
�� NOTICE OF COMMENCEMENT
State of Florida County of Seminole
b Pctmit No. Tax Folio No. (PID)
71ic undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with (::taptcr
713, Florida Statutes, the following information is provided in this Notice of Commencement.
DESCRIPTION OF PROPERTY (Legal descri tion of the roRY and street —Irl— —Irl—
)
P P f�ss
OWNER INFORMATION
Name and address
NAME AND ADDRESS OF FEE SIMPLE TITLE I1OLDER•(IF OTHER THAN OWNER)
• 1
CONTRACTOR
Name and addicss to e -441e-441 O% -r
ETY tJ
SUR(Bonding Company)
Name and address
Amount of Bond
LENDER
Name and address
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Persons within the State of Florida designated by Owner upon whom notice or other documents may be served as pro. ided
by Section 713.13(lXa)7., Florida Statutes:
Name and address
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In addition to himself, Owner designates of
to receive a copy of the Licnor's Notice a:,
provided in Section 713.13(I)(b), Florida Statutes.
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Expiration Date of Notice of Commencement
date is 1 vcar from date of recordinvunlcco a dif%n:nt date is mv-nifirvi
'
�°fit";ti DAF EY FAYE DCOCK Y
,........ 4
NOTA PUBLIC, GTA OF PLOgIDA
MY C M. Explreo EC, 2,208 Signa of cr
' MM, 0 D 78808 f aov
„h V
Swo Day of� }9
tTr
The
me or hho has produced
and who did / did not take an oath>
My Commission Expires: (%
--
beforeme this day ofZU , 4A b
—r-'*.*> (name of person acknowledged), personally��Icpa:ion to
f
(type of identiicatio