HomeMy WebLinkAbout1611 Merthie DrApplication #:
Job Address: k3
CITY OF SANFORD PERMIT APPLICATION
Submittal Date: ? ` dpi \ V2
Value of Work: S 41) k U
Parcel ID: � l � Z"�.Z 1 •-CUG OD Zoning: Historic District:
`n_�_� �vob
Description of Work: 6r� /Gri �� Square Footage:
P.
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............................
. .............. U.....................................................Sr.::.c� G _
Permit Type: Building [iY Electrical ❑ Mechanical ❑ Plumbing ❑ Fire Sprinkler/Alarm ❑ • ooi •❑ Sign
Electrical: New Service — # of AMPS
Addition/Alteration ❑ Change of Service ❑ Temporary Pole ❑
Mechanical: Residential ❑ Non -Residential O 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 0 Commercial ❑
Occupancy Type: Residential ❑ Commercial C Industrial ❑
Construction Type:
............................
Property Owner:
Phone:
Bonding Company:
Address:
Arch itect/Engineer:
Address:
# of Stories: (_ # of Dwelling Units:
E-mail:
Plan Review Contact Person:
.L ........ A ...............
Occupancy Use Group(s):
Flood Zone (FEMA form required)
...... ....... ....... ... .................
ontractor:
Ad rens•
O �
:e7 2t7e /��,
Phone: State License Number: C.if �c'-6 I �rp'
Mortgage Lender:
Address:
Phone: Fax:
Phone:
Fax:
E-mail:
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
ATR 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 v 'fication that I will notify owner of the property of the nts of id3ineFS 713.
7
Si of Owner/Agent Date Sign re of ontractor/A nt Date T
hf�oh .�- c rX ��r 4�
Print Agent's Name Prim on to gent's Name
Si re of Notary -State o Florida Date Signature of t IF
BEAN—
2O,'ftY PueGf` Notary Pi.iblic State of Florida MY COMMISSION DD629096
Jam -s Rivera EXPIRES: February 25, 2011
e My Cun;mission DD550213 �iaoo-a Ntar
00 -3 -NOTARY FI. Noy D scount Assoc. Co.
9�oF vQ? Expires 05/09 10
er/A enCis _ ersonally Known to Me or Contractor/Agent is _ Personally Known to Me or
Produced ID Produced ID
APPROVALS: ZONING: UTIL: FD:
Special Conditions:
Rev 02/2007
ENG:
BLDG:
Permit Number
Parcel Identification Number c) ` s°
i
Prepared by:
Return to: ' �J
NOTICE OF COMMENCEMENT
State of •lC4:3-4
County of;��,�`
I loll 1111611 ill II 16l It 1110 oil ii 11111111 II III it 11111 ill 11111
MARYANNE MORSE, CLERK OF CIRCUIT COURT
SEMINOLE COUNTY
BK 06640 Pg 1124; Qpg1
CLERK'S # 2007046757
RECORDED 03/29/2007 01IISW PM
RECORDING FEES 10.00
RECORDED BY H DeVore
CERTIFIED COPY
MARYANNE AbRSE
CLERKOF- R, f COURT
SEMINO U Y, FLORIDA
BY
DEP
The undersigned hereby gives notice that improvement(s) 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.
1. ,Qescription of propert (legal description of the property, and street a dr ss if available) o�
2. 06neral des4tion of improvement(s) ' , d
3. Owner WiformatiV1 , D
Name z'� Telephone Number
Address �� Fax Number
Interest in Property:
r � � C•
4. Fee Simple Ti le Holder (if other than owner shows above)
Name Telephone Number
Address Fax Number
5. Contractor
( Name %>t'y'�Pc Telephone Number
Address % c "� Fax Number
tom- _?' L,
6. Surety (if any)
Name
Address
7. Lender (if any
Name
Address
Telephone Number
Fax Number
Amount of bond $ _
Telephone Number
Fax Number
8. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served
as provided by 713,13(1)(a)7, Florida Statutes.
Name Telephone Number
Address Fax Number
9. In addition to himself or herself, Owner designates the following to receive a copy of the Lienor's Notice as
provided in 713.13(1)(b), Florida Statutes.
Name Telephone. Number
Address Fax Number
10. Expiration date of notice of commencement (if expiration date is one year from the date of recording unless
different date is specified):
Date Signed Signature �of Owner. (Note: per 713.13(1)(g), "owner
must sign ... and no one else may be permitted to sign in
his or her stead."
Sworn to and subscribed b
Z-1 V4 /a;,-
me this 0'-/ day of
known to me OR produced
Signatur Notary
23-20 (9/04)
as identification.
,20 07 by
who is personally
SEAL
,PgY Rp@
Notary Public State of Florida
— o tvly c or rnssion D0550213
9 ., Exp res 0510912010