HomeMy WebLinkAbout2626 Palmetto Ave''^^ / CITY OF SANFORD PERMIT APPLICATION
Permit # : V ! / (aol << , Date:2�-7
Job Address: ,521, � L _ (� IV �C'.-i 'z� L. .2t t �l i -u F� r-/
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Description of Work: C '"'> - ' r.. " ''A_ '- RAZotal Square Footage U
Historic District: Zoning: Value o ork: S
Permit Type: Building 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
Construction Type:._ # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required )
Owners Name &Address: r71 47 . `1 �P c"Y1
1 ' Phone: ( > % .3 X23 _
Contractor Name & Address ( 1 �F S /i "I(�
-;2Q f (o " 1 % l +7 v Yq t S-�/ r�_ P ) _ell : State License Number: C C._ ) 3 -1
Pho e & FaJa� �� FL / 073 y (� �C� 7 J-��i ""`�1.3 �ContactPerson: 1 Y L i Joi �Phonq 4(x`7) %.S 8' `JAL. ZY
Bonding Company:
Address:
Mortgage Lender: "
Address:
Architect/Engineer
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: 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 i ' verifica ' hat I iv a owner of the property of the r u r ents of Florida,Lien Law, FS 71 .
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Sign a of Owner/ gent Date of ontractor/Agent Date ` j/o2 (�7
Prim er/ a t'3'Palmfe _�-.-. o acto ent's N e
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�ignature-tae of Flo a Date Signature of Notary -State of Florida Date
•••••• LIAM 8. SIMPSON _
4000 g4;• NOTARY PUBLIC - STATE Of FLOICA
: COMMISSION # DD467M MY COMMISSION # DD629096
�Yp pp���� Qst,�,,pp/I''��yy��pp a` EXPIRES: February 25, 2011
tis iiSnpYSrlt7�vtYtfr)41@'(rr Contractor erwiKW*KaffiwxUOft
_'Ptdduced ID BONQFD THRU t-888-NOTARYI _ Prod ti
APPROVALS: ZONING:
Special Conditions:
Rev 03/2006
UTIL: FD:
ENG: BLDG:
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THIS INSTRUMENT PREPARE BY: Building & Fire InspectiorfY�"'
Name: 1101 East First Street„
Address: .� �.�� l�z2 �', c�;�r. J�/J: Sanford, Florida 32771.x! {=
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State of Florida T_,.. w-. County of Seminolq
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NOTICE OF COMMENCEMENT rT';
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Parcel ID Number (PID) [l> l U ,3� '.� C7�� Ci L! C%C J •, i
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The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with
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Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. -11 Q;, -.,
DESCRIPTION OF PROPERTY (Legal description of the property and street address)
,.i'' �Q,FZr nF C\K• �V Iry �-
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GENERAL DESgRIPTION OF IMPROVEMENT 1 S M\NO �y 0
M
NER INFORMATION /
1 f. 1
Name and address: (9W"�,L. m . �- 15.. /�'a��i7 sf" (_:.�11Ur � I? k0 /I l l «�.;v� .5
CONTRACTOR_ 6
Name and address: ° cr'�e `� ��;, ; ,ti's c-�Jn�-r �� <
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(-, (r � r sZ C S`r � ,1 I" (�4 J z��� c� _ 1, , 7 � 7: •3 R
Persons within the State of Florida Designated by Owner upon whom notice or other documents may be served C0
as provided by Section 713.13(1)(b), Florida Statutes. r;
Name and address:
In addition to himself, Owner Designatesj, z ��-2. CL
Of to
c.l .moo r� n Lk C- Sr -'t 0 -)To receive a copy of the Lienor's Notice as Provided in 41.
Sectio 713.13(1)(b), Florida Statutes.
Expiration Date of Notice of Commencement
(The expiration date is 1 year from date of recording unless a different date is specified.) .n
rsi
STATE OF FLORIDA
COUNTY OF SEMINOLE CD
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Sign re of Owner //CD
The foregoing instrument was acknowledged before me this / day of -z22? /�` 0�
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by ! C < ! ' Who is personally known to me
NarWe of person making statement
OR who has produced identification type of identification produced e
r. epi '••.,
WOW #-& SIMPSON
l NOTARY PUBLIC - STATE OF FLORA
COMMISSION # DD46M4
'•., orr.'• EXPIRES 8/29/2009
BONDED THRU 1 -888 -NOTARY?