HomeMy WebLinkAbout523 San Lanta Cir (3)Permit # : ®( _ Q r)
Job Address: 5Z� �
Description of Work: ke'_
Historic District:
Zoning:
CITY OF SANFORD PERMIT- APPLICATION
Square Footage
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm tool
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:C (Flood Zone: /) (FEMA form required )
Owners Name & Address: 04 a kys k�4 {�1.. �Z 3 c J �Y l l� �%� O t IQ Soo `—f 0 ✓ c>
Phone & Fax:
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
Phone:
Fax:
C)SSv
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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. 1 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 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 anagement districts, state agencies, or federal agencies.
Acceptance of permit is verification th I will notify the owner of the roperty of the requir f F r Lien Law, eFI .
of
Name
Date Signature of Notary -Stale of Florida
DAFNEY FAYE ADC4act dA Owner/Agent is _Personally Kn1041"
NOTARY PUBLIC, STATE OF FLORID,pr u d ID sProduct ID MY Comm. Explrsa DEC. 2; 2ppg—
COMM, FLAY
APPROVALS: ZONING: ENG:
Special Conditions:
Rev 03/2006
Date
Personally Known to Me or
BLDG:
60
• r
i � 3-Z-111
State of Florida
Permit No.
NOTICE OF COM [ENCEMENf
,ounty of Seminole
Tax Folio No. (PID) .
llle undersigned hereby gives notice that improvement will be made to certain real pro-, :y, and in accordance ith Chapter
713, Florida Statutes, the following information is provided in this Notice of Commencem --nt.
DESCRIPTION OF PROPERTY (Legal description of the property and street adds ,:-s)
I
L
�Zoo� I
GENERAL DESCRIPTION OF IMPROVEMENT
'
OWNER INFORMATION
Name and address • - •-
Z 3 �L e—r.—C C� ,� iz ,.
Interest in property (Fee Simple, Partnership, etc.) O 61 A e—,,-
NAME
✓NAME AND ADDRESS OF FEE SIMPLE TTTLE AOLDER.(IF OTHER T.' %N OWNER)
CONTRACTOR '
Name and address
400
'SCO u 0 o F— NCO
a ✓ y Z —1 —I
I '
,Y ..,. 1
SURETY (Bonding Company) j CERTIFIED lgOPT.r
Name and address
Z;,,'..,.MjARYNF
IAmount of Bond I S,LENDERName and address
Persons within the State of Florida designated by Owner upon whom notice or other d •currents maybe seiver. as provided':? it
by Section 713.13(l)(a)7., Florida Statutes:
Name and address
•++**r+**+++*****s***i****t+s*+****ts**a+s****+***+#+*f****+a*s-:•s+s*++*r++++s*++••+*+++++++
In addition to himself, Owner designates I of
to receive a c --py of the Lienor's T' .>tice as
provided in Section 713.13(l)(b), Florida Statutes. I
ss**s**s*sr***r++*s**»***++**+************s********ass*******r*.•�************r++ ++r*+r+++r
Expiration Date of Notice of Commencement
e expiration date is I Year from date of recording unlerm a differrnt date is z •: C-ifieri
DAFNKY FAYE ADCOCKJ
.r ! NOTARY PUBLIC, ATAf6 OF kLp1t000 91`pAure of Owner
MY Comm, xpirpoa go.
bsOM d�biQdlt pthis Day of a00 L -O I
My Commission Expires
Notary
The foregoin insttument was ac ow] gyd ed before me this9pemrs
day of V ,-films =Iy�now; t) eL rt t _ (N. (name on aclmowbi ,ed), who is n
me or who has produced (type : _' identifica n
and who did / did not take an oath>
so
SeM1N!ktN
PLORIDAS NATURAL Clic
Limited Power of Attorney
Date: -1 Z u o to
hereby name and appoint
of A C -)LO CA 6- -1200 V- I ,.j &
(Name)
to be my lawful
(Company Name)
attorney in fact to act for mend ply to Seminole County Building and
Fire Division for.a -P-- O o r permit for
(Type of Permit)
work to be performed at the location described as:
Parcel ID*:
Address of job: �'Z � 'S a-ri L-�-+�� C� ✓ S a � D —TL 3Z-71
Property Owner: A L JKAt �`�
and to sign my name and do all things necessary to this appointment.
yAr� Co �•K 42D F NJ Po 4rW 0"1 40 co ul _ CCC -0 Zz S o I
s Company
of
Acknowledged:
Sworn to and subscribed before me this day of LA.D. C> 00
Notary Public
:' COMM DAFNEY FAYE ADCOCK
�/ ti� NOTARY PUBLIC, STATE OF FLORIDA�
(Seal) t .,, � My xN' DO376soi IDB
My Commission expires on:
Building and Fire Inspection Division
DCA03 - DEC - 133
PERMIT
ye' -.0
SEMINOLE COUNTY
FLORIDA'S NATURAL CHOICE
INSPECTION FOR FLASHING
& RE -ROOF DRV -IN BV
AFFIDAVIT
******• The intent of the roof dry in affidavit was to assist in the high volume of re roof
inspections for repair of the hurricane damage.
The affidavit does not take the place of the required dry in inspection, but can be used in
conjunction with the inspection. The primary purpose of the in progress inspection is to protect
the existing house contents, and interior finish from potential damage due to rain.
The contractor is required to call the inspection on the day it will be ready, and the inspector will
make an in progress inspection of the dry in, and accept the affidavit for the portion of the roof
already covered.
This affidavit can only be used for re -roof and is not applicable to new construction or tile roofs.
# DATE Z �I
JOB ADDRESS `_-)a�_'? �tQ� �,i ,�C 0 1,,J_ V Ste` 0,/ C---.)
LOT / SUBDIVISION
COMPANY
LICENSE #
I
Zia l
I, I-V1\Q---\ \/A- 19 C c) CAL , affiant, hereby affirm that 1 am
the duly licensed contractor of record for the above referenced permit, that all
of the foregoing information is true and accurate, and that the dry -in, flashings
at the above referenced address / lot has been installed in accordance with all
applicable codes and standards.
Aav)�_' �L Ccs /a'_z__1 b(ee
Contractor: Print nature & Date 61 i
Owner: Print
Signature & Date
1101 EAST FIRST STREET SANFORD FL 32771-1468 TELEPHONE (407) 665-7050 FAX (407) 665-7461