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HomeMy WebLinkAbout137 Clear Lake Cir%' CITY OF SANFORD PERMIT APPLICATION Permit # : �v-1 Iq J �s r Date: 2-1-2--1 _ 12-06-) Job Address: 13 1 C i� i �a � � r c. e sa �n r�� c� arc, F)2 -I -I Description of Work: Historic District: Zoning: Permit Type: Building Electrical Electrical: New Service — # of AMPS Mechanical. Residential Non -Residential Plumbing/ New Commercial: # of Fixtures _ Value of Work: Mechanical Plumbing Fire Sprinkler/Alarm Pool _ Addition/Alteration Change of Service Temporary Pore_ Replacement New (Duct Layout & Energy Calc. Required) _ # of Water & Sewer Lines # of Gas Lines Plumbing/New Residential: # of Water Closets Plumbing Repair — Residential or Commercial Occupancy Type: Residential Y Commercial Industrial Total Square Footage: 2Z Construction Type: # of Stories: _L_ # of Dwelling Units: Flood Zone: (FEMA form required for other than X) Parcel #: 07— 2 b `3 y ✓ 15 b 1 " 0 o oc - ul (Attach Proof of Ownership & Legal Description) Owners ,%� Name & Address: I' ( )7 LA Y nWL Contractor Name & Address: _ 19-d- Phone: U 1--t U Y j CA LP )nn V �D `Z2O t C 1 L State License Number: L I_( lX I J Phone & Fax: M 1 FS G l Z I Contact Person: s U S� C Phone: Bonding Company: Address: Mortgage Lender: Address: Architect/Engineer: Phone: Address: _ 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 water management districts, state agencies, or federal agencies. Acceptance of permit is verification that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713. 'Os • ,o Signature of Own /Agent Date Signature of Contractor/Agent Date a r2 ,g4 it 7Y16 inn a S 1 �' t� Print Owner/Agent's Name Print Contractor/Agent's Name 0,R t1?') 2�Z�l Zob1 }� rrt K � � -_ 1 ru o Signature of Notary -State of Florida Date Signature of Notary -State of Florida Date 01,(D O 3y K W 3 y �. N v C O rno.a No ; Owner/Agent is _ Personally Known to Me or p - m Produced ID R C> APPROVED BY: Bldg: Zoning: (Initial & Date) Special Conditions: Contractor/Agent is � Personally Known to Me or Produced ID m v LL c0 o <�i �o00 m C G Cn 0 N 4 TE , E £ O N ' d z U'J Utilities: FD: yj wrS (Initial & Date) (Initial & Date) (Initial & Date) alv. sR $S9 Power Of Attorney Date: -2 I herby name and appoint G l 1 son -T� t Co n� Advantage Roofing Inc. To be my lawful attorney in fact to act for me and apply to the lJAI s�i� D -(d for a roofing permit for work to be performed at a location described as: Parcel ID#: Z `2©- 3 - 501 " 0 a " C-) D ?) 0 Legal Description: �,CQI (� i" l-�i d P n o rt v 111 G s P H 3 P'3 z S 3C -U Address of Job: S C" ft r d''[. 3 Z Owner of Property and Address: � OSS' w cl r u And to sign my name and do all necessary to this appointment. Contractors Name: Typed: Thomas Ringler. Advantage Roofing, Inc. State License#: CCC052477 Signature of Certified Contractor: Acknowledged before me this Z-1 day of R'- , 10 By Thomas Ringler ID Or Personally know to Me Notary Signature:`( N!� `OLC'�LP seal My Commission Expires: i211 U bQ� A" "sr. Notary, Public State of Florida M Barbara Mackey. A. € My Commission OD381'674 r� Expires 12/26&200 , Fmorad Br. S . _F� t ( C) M j ftwm *a. Lp ct o 5 FcA r -rT1 Gt c. un 0 (Z I u nc(o f;;t 32 n 4 �1 atma of CA Candy of -Y), I jjnj<� 3),o qD _'5- /-C) D 0 I fill III III if 1 111all11lot if 991 If III If 119119i9 11111111111 fill MARYANNE MORSE, CLERK OF CIRCUIT COURT SEMINOLE COUNTY 89 06606 pq 1239; Qpq) CLERK'S # 2007031437 REWHOED 04/01/2001 10:01:42 AM W111941111r. 441S 10.00 REC00tl BY L McKinley TM urAmood hwoW gMma r4dw #0 krVovenmt(s) wM be mads to cartgo red property, and In somdams wNh Chapbr713, Sorkin Statutes, dw follovArig kftmmMm Is pmvklod In this Medco of Commom.m. i. DaKwlp*m of�T prop on of property, and atroet address, It wallable) ,vtA Lcq�'ot I 7TC1co ua�--C.v I (I cA,-, ZE I Gowrd dos, p0ondbywrovenurd(s) . RcpzooF sninc & omm k ) A*kww 13-1 C k C G 4. Poo UN00 -) Nsttte Address n,T-09-C eoo-Finq Aftm Ue q 0.5 �?A I tf I aC Lin . s. &N*(W 416, 0 3 Q -1 CO -M Herrn Ad&vn 7. 11.4"Wormm RIM oftm TolophowtoMmebw Fum"mm k"fed in Property TdwhwW Mmdw Fax Number Tasomm ftmtw -1-n 01 C1 -7 2 - Fax Wm6w Td*wmwrkw ftst afflaw AmouIt of bond Td*mwmuom ftx oxidw & Persons, w" do ftft of FWft dsdpvftd by Oww upas whore rAWm or othw domAwb may be swvW as, pm%IcW by &KtIm 71&1:Xa)7., Florida &abA3& 01mbe TOq*wm*nbw Ad*m Fax HumW 9. MadMorilolft" orhwuffOmwdodrMwthe fWkwingiovwdwa*Mof#wU&we@Nodmas, provided In Sedim 71&13(1)(b), Florida Sftft& mms Tolophom Nmtw Ad* an Fax NutWkw Aft*10sawdais oflod" of commmormt om sxpmmm &% is I ywftf"ft dab oftoo&,ftg wtum a dpfMent dow Is spocried): 7— —7 016 ftrw Groalmolowper ftoftm"m%worlsom 90..AW ro m*VW OW to PnMftd Its 0p b 16 or her ley of persorav im " M-1 6 m ON xj prodaosd 1/ L, ash L41 WMIRED OR 11 R- MORSE WPM -OF CIRCUIT COURT N, E TY FLORIDA DEPUTY CLERK JAR 0 1