HomeMy WebLinkAbout400 N Entrance RdJ!'N-26•-:076 06:46 FROM -SIGN KING
Ferret#: 0(0—
Job Address:
�• Description of Worll:
historic District: zoning:
+4076304T$4 T -36T P.002/002 F-602
CTTY OF SANFORD PERMIT APPLICATION
Date: IUIJ 2 8 2006
RECEIVED
Value of Work:
Permit Type: Boildutg K Electrical Mechanical Plumbing Fire Sprinkler/AI"m Pool
Electrical: New Servicer - fl of AMPS AdditioNA)terabon Change of Service Temporary Pole
MecbaWcal: Residential Non -Residential Replueerocnt Ncw (Duct Layout & Energy Cule. Rcquircd)
Plumbing/ New Commercial # of Fixtures N of Water & Sewer Lincs N of Gas Lincs
PlumbiDoew Residen(iol: It of Water Closets Plumbing Repair - Residential or Comrnercia)
Occupancy Type: Rcsidmlial Commercial Industrial Total Square Footage:
Construction Type: Sof Stories: # of Dwelling Units: Flood Zone: (FCMA form required for oilier shop x)
rarcel is; -___
Owners Name
Contractor Name & Address:
(Anacb Proof orowoersNp & Legal Description)
�/ Start License Number: /X 11 X 9-1
Ybone & Fax:A. �o� gin' %llll3 �' �//%7 ��Q ���Footnet Penna: / r Lti� Rd e eo/�PI� Phoma:
Buadiog Company.
Address:
Mortgage Leader: .
Addre.s:
. A chltctVEycl=r:
LL /I
VA
Phmle'. yd?—NS/ -05J2
Fax: y67 - 9&—/19?
Application is bercby mode to obtain a permit to do the work uad instuUulioas us indicated. 1 certify tbat oo work of insailation 110..1 commeoced prim to the
issuance of a permit tad that all work will be performed to races $1801%rds oral) lows regulallog cousmution in Ibis jurisdiction. I uoder.tuod tbat u separate
permit must ie secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEA11-11S, TANKS, and
AIR CONDTr1ONERS, cie.
OWN19R'S AFFIDAV11•: I certify that all of ilia fartgoiog idformmion is accurate and tbot all work will be dont
waotructioo and zoning. WARNING TO OWNER YOUR FAILURE TO RECORD A NOTICE OF CON IN E
TWICL• FOR IMPROVEMENTS TO YOUR PROPERTY, IF YOU KIM TO OBTAIN FINANCING, CC
ATTORNEY BEFORE, RECORDING YOUR NOTICE OF COMMENCEMENT.
NOTICE: In oddibou to the requinemeols of tbih, permit, tberu may ba attditioonl rostrit:tions PI is btu to this p
this county, and dire may be additional permit requind from other govt:mmealal colid ssib oe ter.manugr
Acceptauco orp"mii is verinceilon that 7 will uoiiN the owoer of the property of ib rcquirem t o Florida Li
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Print Owncr Agcot's eine t Coors ge
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Sign CC otury-Stine of Floridu Dote ntre f ry•
lilpcc with all applicable luws ntgtdoliog
MAY RESULT IN YOUR PAYING
r rM YOUR UNDER OR AN
but lady be found in the public retortlS of
trick, state agencies, or federal ageacies.
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Fionda Dote
IVELISSE NAIJ1Rip
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owner/Agent is o n oubk - State of Ffllrlds ControcloflAeent ie Penooall)R � ttst�pPp
Yrodueed ID Explin ow20, 2 _ Produced m
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t / APPLICATION APPROVE - »+••imam
(lailiul Dute) a Dote) (Initial & Dole) (Initio) A Dole)
SPccial Conditioner:
=-.4
Permit #:
Job Address: 160- 466 AJ.
Description of Work: )
,CITY OF SANFORD PERMIT APPLICATION
Date:
V^
Historic District: yy Zoning: Value of Work: S OX '17-1'
Permit Type: Building K 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 Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: (Attach Proof of Ownership & Legal Description)
Owners Name & Address: flrivo _!2e 1610
AQ 140 jPhoae:
Contractor Name & Address: t r /V. m/� State License Nuber: �d19, /
N
Phone & Fax: - 4/ '// gontact Person: / ►M 1 ae I Pit - l Phone:
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/En�jneer: E• Phone: /1
Address:�Sy5 L�n1 4 f1 ii -4 08- errV /" l L5216'7 Fax: Il'7—��Lo'
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' ompli cc with all applicable laws regulating
construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF CO EME MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CO SULT ITH 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 I is ble to this o that may be found in the public records of
this county, and there may be additional permits required from other goveromental entiti such as ter.manag en districts, state agencies, or federal agencies.
Acceptance of permit is verification that I will notify the owner of the property of th requirem t o Florida L' w, FS 713.
_ 4 � i�-Q
' Signature of Owner/Agent Date Si ature of n to t Date
Print Owner/Agent's Name "I Contra gent's Nam
cfi
Signature of Notary -State of Florida Date Signature f tary-State of Flonda Date
ntq uNV awPN a0lpld p
Owner/Agent is _ Personally Known to Me or Contractor/Agent is I- Personally; me POWs
_ Produced ID _ Produced ID �� oe�ra V,7S�Jd
L9LS9Z000NW� '�'��
APPLICATION APPROVED BY: Bldg: Zoning: Utilities:tl7W... r �
(Initial & Date) (Initial & Date) (Initial & Date) ••• (Initial & Date)
Special Conditions:
Permit If
Job Address: lfwV
Description of Work: (�✓ i/� t
Historic District: A110 Zoning:
of
Permit Type: Building Electrical v
Electrical: New Service — # of AMPS
Mechanical: Residential Non -Residential
CITY OF SANFORD PERMIT APPLICATION
Date.
G/zZ/o
Total Square Footage,�-t A--44 _
Value of Work: S bi/d0
Mechanical Plumbin Fire Sprinkler/Alarm Pool
_ Addition/Alteration Change of Service Temporary Pole
Replacement New (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas bines
Plumbing/New Residential: # of Water Closets Plumbing Repair — Residential or Commercial
Occupancy Type: Residential Commercial Z Industrial
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required
Owners Name & Address: _
Contractor Nam4 & Address:
Phone & Fax: - 7ZZ
Bonding Company:
Address: f -
Mortgage Lender:
Address:
Architect/Engincer:
Address:
Phone:
I4�1_
7 / T tate License Number: A�,_ Ar —
Contact Person: Phone:
J
Phone: a—
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: 1 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 M 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.
NOTI E: 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 govemmental 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 r quirements ori a ie L 713.
2 O(�
Signature of Owner/Agent Date /ature of on /Agent Date
Print Owner/Agent's Name Print Contractor/Agent's Nar
� • 2Z•�6
Signature of Notary -State of Florida Date ignature gt%;State JWI�aJOHN80N Date
MY COMMISSION I DD 285822
EXPIRES: March 23, 2008
1�'oa nv Bonded TW Nogg Notazp Banker
Owner/Agent is _ Personally Known to Me or
_ Produced ID
APPROVALS: ZONING:
Special Conditions:
Rev 03/2006
UTIL: FD:
Contractor/Agent is t/�ersonally Known to Me or
Produced ID
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THIS INS 'RIM EPA E B
Name: 1, ((,�� i
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Building Fire Inspection
1101 East First Street
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Address: ' ► ► _
CMUMLCHOICELE
Sanford; Florida - 3MT
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State of Eforlda
County of Seminole
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NOTICE OF COMMENCENENT
Parcel ID Number (PID)
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The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with c'
Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. ,D
DESCRIPTION OF PROPERTY (Legal description of the property and street address) /00• 00 N oyt'(yc,,t t . BE
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OWNER INFORMATION CLERK 05ICIRCUIT "')RT in
Na•�}�1e and address: E+
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CONTRACTOR
Name and address: :rhQ
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Persons within the State
as provided by Section 7
Name and address: S
to himself, Owner
Section 713.
Florida Designated by Owner upon whom notice or other documents may
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Expiration Date of Notice of Commencement
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(The expiration date Is 1 year from date of recording unless a different date Is specified.) m
STATE OF FLORIDA 12.
COUNTY OF SEMINOLE 1 r'
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The foregoing Instrum nIt was acknowledged before me this 12 day of _ �l� nP . 2G 6 (n rn
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by who Is personally known to me o
Name of peniaW making statement o
OR who has produced Identification type of identification produced
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•sdAP COM6111on Explin ow20.soloist IOW
9onded By fWpoftal qpa
EDENS&AVANT
June 12, 2006
Seminole County
City of Sandford
RE: BrandSource Appliance Gallery
100 -400 North Entrance Road Suite #10
Sandford, FL 32771
To Whom It May Concern:
I hereby authorize The Sign King or their representative to sign for and obtain any
building and electrical permits and inspections required by state and local laws
necessary to remove, install, modify and/or erect signs for BrandSource Appliance
Gallery at the above location.
S4'A le�_
Judy nder
Regional Prop rty Manager
Edens & Avant Investments LP
As Agent for: E&A Southeast LP
State of FLORIDA
County of SEMINOLE
Judy Kender who is personally known to me, and -did not take an oath acknowledged
the foregoing instrument before me this 12.day of June 2006.
Signikurjeloif Notary Public P1do-ONdRaft
My Commission expires:
Comm om 0 OOQ0=
(Stamp)
498 Palm Springs Drive Suite 100 1 Altamonte Springs, FL 32701 1 phone 407.261.9111 1 fax 407.261.9112 I www.edensandavant.com
,tft-. ADDI 1AAIr l: x111 I ADV
ORLANDO
KISSIMMEE
407-830-7443 -79M 407-944-4520
FAX. 407-830-4754 TOLL FREE 877-540-8395
726 N. HWY. 17-92 9 WME E-mail: signkingfl@aol.com
LONGWOOD, FL 32750 WEB: www.thesignking.com
RACEWAY MOUNTED CHANNEL LETTERS
with Light Emitting Diodes
FRONT VIEW
NOTE:
THIS STRUCTURE HAS BEEN
DESIGNED IN ACCORDANCE WITH THE
REQUIREMENTS OF SEC. 1609 OF THE
FLORIDA BUILDING CODE 2004
IMPORTANCE FACTOR = 1.0
EXPOSURE CATAGORY = B
WIND SPEED = 110 MPH
DESIGN WIND PRESSURE = 37 PSF
NOTE: FOR OUTDOOR APPLICATIONS
INSTALL SEALING RING (SRPT)
WHERE THE PASSTHRU ENTERS
THE LETTER.
AN AMPLE AMOUNT OF GE SILICONE II
SEALANT IS TO BE APPLIED
TO PREVENT WATER FROM
ENTERING THE BUILDING.
ULUnderwriters
Laboratories, Inca
LISTED
E199844
SIDE VIE%
1/8TH THK. A
MATERIAL
Jarr
c
Florida
REAR VIEW
TYPICAL RACEWAY -MOUNTED
CHANNEL LETTER INSTALLATION
1/2 DIA. STAINLESS STL.
METAL THREADED ROD, 4FT. O.C.
RACEWAY OR 1/2 DIA. EXPANSION BOLTS
SLE
Y:\LIGHTED SIGNS\APPLIANCE GALLERY\CHANNEL LETTERS.pit 6/2/2006 5:55:20 PM Scale: 1:15.11 Height: 35.576 Length: 241.798 in
FRONT SIGN 18 IN. X 240 IN. (20 FT.)
IBRANDji
James David Wells, Jr., P.E.
1345 Unity Court
Casselberry, FL 32707
Florida Professional Engineer No. 53616
FEB. -12' 98 (THU) 21:02 A. B. SHOPPING CENTER TEL:205-969-1000 P.023
Tracts L a nd 12 SEMIN04E TOWNE CENTER REPLAT, according to the plat thereof as
recorded in Plat Hook 47, pages 8. 9 and 10. Public Records of Seminole Count
Flory,
ida.
LESS AND EXCEPT THE FOLLOWING FROM THE ABOVE LEGAL DESCRIPTION:
A portion of Tract 1 described within the following legal description, to wit:
Commence at the South quarter corner of said Section 29 for a point. of reference;
thence run North 00. 15' 36• Kest, along the crest line of the Soucheasc quarter of said
Section 29, a distance of 2098.60 feet; thence run North 89" 44' 24■ East, 155.93 feet
to a point lying on the Westerly line of said Trace 1 and the point of beginning;
thence run along the cooman lines of said Tract 2 and Tract 1 of said plat the
foll.ow+ing` couraee: South 68• 00' 00" East, 15.26 face; thence min Norah 520 00' 00"
East, 89.99 feet; thence run South Be* 00' 00" Wit, 10.74 feet; thence n,** l7orth SB•
00. 00" Rest, 39.86 feet; thence run North 69. 53' 08" East. 2S3.79 feet; thence run
North CO- 06' 52" Hest. 37.17 feet; thence run North 89" S3' 08" East, 35.07 feet, to
ly"iay on the Southerly line of Trace 6 of said plat; thence, departing said
c .oa linea between said Tract 2 and Tract 1, run along the c0ma:on lines between sand
Tract 2 and Tract 6 the following courses: -North 89• -S3' 08" East, 316.23 feet•; to the
point of acme of a curve concave Southwesterly; Lh^ence rt -n Southeasterly along
said curve. having a radius lenath of 36j.4o feet, a C__t_1 o:.gl2 Gi 31' 4oJ 45°, an
arc Length of 139.33 feet, a chord length of 137.56 feet., and a chord bearing of scuan
74' 16' 30' East, to a point on the aforesaid camaoa lines of Tract 2 and Tract l;
thence departing said coon lines of Tract 2 and Tract 6, rlsn along the said cocumort
lints of Tract 2 and Tract i the following courses: South 27. oo' 00" Nest, 321B
_e
feet; .thence run South 63° Co' 00" East, 38.51 feet; thence run North 87" 00' 004 East,
155-42 feet; thence run South 00. 17' 42" East, 461.51 feet; ° ,
00" West, 379.75 feet;. thence run South 780 36' 34" Hest, 85.Sa feet the SO departing
said coa==n lines -of 'Xacc 2 and Tract 1, continue South 780 36' 34" 'West, 0.80 feet;
thence ton North 63• 00' 00' Nest, 79.76 feet; thence run North 27• 00, 00% Fast, SS.50
feet to a point On the aforesaid common lines of Tract 2 and Tract 1; thence run along
the said eoamsOm lines of Tract 2 and Tract 1 the following courses: North 630.00' 00"
Hest, 359.54 feet; thence run North 27. 00' 00" Ease, 92-34 feet; thence run Horth 18"'
00' 00" Nest, 386.75 feet to the point of beginning.
EXHIBIT "B"
- --- -
PARCELS I AND 11 ABOVE BEING THE SAME LAND AS DESCRIBED BY THE
FOLLOWING COMBINED METES AND BOUNDS LEGAL DESCRIPTION:
A tract of land lying in Section 29, Township 19 South, Range 30 East, described as follows:
Commence at a point in the Northwesterly corner of Tract 5, Seminole Towne Center Replat,
according to the Plat thereof as recorded in Plat Book 47, Pages 8 through 10, Public Records of
Seminole County, Florida, said point lying on a non -tangent curve concave Southeasterly for the
Point ofBeginning; thence run Northeasterly, along the Easterly right-of-way line of Oregon Avenue
and said curve, having a radius length of 1382.39 feet, a central angle of 02'49'08", an arc length
of 68.01 feet a chord length 68.00 feet, and a chord bearing ofN23 °08'43"E; thence, departing said
Easterly right-of-way line and said curve, run S66 °03'21 "E, 55.00 feet; thence run N25 °04'23"E,
25.00 feet; thence run N66 °03'21 "W, 15.00 feet; thence run N26 °2525"E, 40.00 feet; thence run
N66"03'21 "W, 40.00 feet to a point lying on said Easterly right-of-way line of Oregon Avenue and
said non -tangent curve, concave Southeasterly; thence run Northeasterly along said Easterly right-of-
way line and said curve, having a radius length of 1382.39 feet, a central angle of 12'57'12", an arc
length of 312.53 feet, a chord length of 311.87 feet, and a chord bearing ofN33 43'32"E to the point
of tangency; thence run N40" 12'08"E, along said Easterly right -of- way line, 257.82 feet; thence,
departing said Easterly right-of-way line, run S49"49'07"E, 461.68 feet to a point on the westerly
line of.Tract 12, said Seminole Towne Center Replat; thence run S01 "28'21 "E, along said Westerly
line, 147.58 feet; thence run S39"16'40"W, along said Westerly line of Tract 12 and the Westerly
line of Tract 18, a distance of 226.39 feet to the Northerly line of Tract 1, said Seminole Towne
Center Replat; thence run S87"46140"W, along the Northerly line of said Tract I and said Tract 5,
a distance of 284.78 feet; thence run S02"17'32"E along the East line of said Tract 5 for a distance
of 51.72 feet to a point on a non -tangent curve concave Southeasterly; thence run along said East line
Southwesterly along said curve having a radius length of 155.00 feet, a central angle of 26"1835",
an arc length of 71.18 feet, a chord length of 70.55 feet and a chord bearing of S32"40'24"W; thence
run S87"46'40"W along non -radial Iine 53.77 feet to the point of curvature of a curve concave
Northerly; thence run Westerly along said curve having a radius length of 94.76 feet, a central angle
of 16"19'39", an arc length of 27.00 feet, a chord length of 26.91 feet and a chord bearing of
N84"03'31 "W to the point of compound curvature of a curve concave Northeasterly; thence run
Northwesterly along said curve having a radius length of 147.67 feet, a central angle of 26"07'10",
an arc Iength of 67.32 feet, a chord length of 66.74 feet and a chord beanng ofN62050'07"W to the
point of tangency; thence run N49 °46'32"W, 85.01 feet to the point of curvature of a curve concave
Southwesterly; thence run Northwesterly along said curve having a radius length of 49.33 feet a
central angle of 24"06'49", an arc length of 20.76 feet, a chord length of 20.61 feet and a chord
bearing of N61 "49'56"W to the point of tangency; thence run N73 053'21 "W, 85.13 feet to a point
on a curve concave Easterly and the West line of said Tract 5; thence run Northerly along said West
line and said curve having a radius length of 1382.39 feet, a central angle of 02 "02'07", an arc length
of 49.24 feet, a chord length of 49.24 feet and a chord bearing of N20"42'56"E to the Point of
Beginning.
The above described land being 7.455 acres, more or less.
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TOWNE CENTER PLAZA
SANFORD, FLORIDA
SEPTEMBER 19, 2003
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NORTH ENTRANCE ROAD
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EDENS&AVANT
June 12, 2006
Seminole County
City of Sandford
RE: BrandSource Appliance Gallery
100 -400 North Entrance Road Suite #10
Sandford, FL 32771-
To
277?
To Whom It May Concern:
I hereby authorize The Sign King or their representative to sign for and obtain any
building and electrical permits and inspections required by state and local laws
necessary to remove, install, modify and/or erect signs for BrandSource Appliance
Gallery at the above location.
Judy rider
Regional Property Manager
Edens & Avant Investments LP
As Agent for: E&A Southeast LP
State of FLORIDA
County of SEMINOLE
Judy Kender who is personally known to me and did not take an oath acknowledged
the foregoing instrument before me this 12 day of June 2006.
SignAutprlof Notary Public
My Commission expires:
PUM - oft of Fait
ConMd8WN # 00601006
dW 9y 11 On al Node A=L
(Stamp)
498 Palm Springs Drive Suite 100 1 Altamonte Springs, FL -32701 I phone 407.261.9111 1 fax 407.261.9112 I www.eden5andavant.com
JUN -00-2006 11:01 FROM -SIGN KING +4076304754 INJMop WfolaiMSNft7 lgilljIUJ
THIS INEPA E t Building 3 Fire Inspection
Name: 1101 East First Street
Address: ) . ' Sanford; Florida • 32771-
S>;Mnv02E C07
State of Fjodda rUMa'SNAMPAL CHOK County of Seminole
NOTICE OF COMMENCEMENT
Parcel ID Number (PID)
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.
DESCRIPTION OF PROPERTY (Legal description of the property and street address) /00• ffyQ N crgt" _ &.4c�
Su.'r to tt7 So,,•�a,d f FL 37,-7-71
OWNER INFORMATION /
No a and address: 9*4 $eu'i'i�ta<t� Xorst i T�. A"if�t.C.0 490/ Alai q St. "Wia Sba
i SC 0/
CONTRACTOR
Name and address:
D/ZQt.�
Persons within the Stat
as provided by Section
Name and address:
to himself, Owner
Section TI&
Florida Designated by Owner upon whom notice or other documents may be served
To receive a copy of the Ltenor's
Expiration Date of Notice of Commencement
(Tho !Uiration date Is 1 year from date of recording unfte a different date Is sooelfled.)
STATE OF FLORIDA
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CITV OF SANFORD PERFtIT APPLICATION
Permit #:- (7� — a (92 / Date.
Job Address: e!& rirt oi,y
Description of Work: Re P)thCC- E'7Cr 5'i rniolr S IEW 4,e !!.c4/4 Total Square Footage
Historic District: Zoning: Value of Work: S 130,0
_Z
Permit Type: Building Electrical Mechanical Plumbing K 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 1� �'�
Plumbing/New Residential: # of Water Closets Plumbing Repair - Residential or Commercial P t:lICIA+ fid.
Occupancy Type: Residential _J?1_ Commercial Industrial
Construction Type: 1— # of Stories: --t— # of Dwelling Units: Flood Zone: (FEMA form required )
Owners Name & Address: .lie K rK0.
Phone: `,,*7- ?OZ - /Za
Contractor Name & Address: RQ IPArta Le Of F'--0. TM_ e—
U3 ess'ex P it ne)1 'Wn m- State License Number: C./ Lf G
Phone & Fax: W 7—*f a+ 1/ O Coutact Person: -*;" AIA & ee Phone: 4,07—M. - ll k/
Bonding Company:
Address:
Mortgage Leader:
Address:
Arcbitect/Engincer:
Address:
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: 1 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 iA 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 applic
this county, and there may be additional permits required from other governmental entities such as
Acceptance of permit is verification that I will notify the owner of the property of the
Signature of Owner/Agent Date
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is _ Personally Known to Me or
Produced ID
APPROVALS: ZONING: UTIL: FD:
Special Conditions:
Rev 03/2006
property that may be found in the public records of
agement districts, state agencies, or federal agencies.
Lw, FS 713.
Date
ant's Name
Signature of Notary -State of Florida
DEBBIE BLANTON
W COMMISSION # DD 16MI
EXPIRES: February 25.2007
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