HomeMy WebLinkAbout624 Grovewood Ave® ®
CITY OF SANFORD PERMIT APPLICATION O f
Permit # . v Date.
Job Address: V -k W C)c-)6 � -
Description of Work: S P
Historic District: Zoning: J Value of Work: $ ,
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 Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: 1-0J� y— 0 -50 5-- 60 6
Owners Name & Address: -eau \ WO lO Y &A
Name & Address: ��J�%y Y-\ ��
g 31 _ rQ li ca ek
Phone & Fax:
Bonding Company:
Address:
Mortgage Lender: .
Address:
Architect/Engineer:
Address:
0—
Contact
Contact Person:
(Attach Proof of Ownership & Legal Description)
Phone:
State License Number:
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 permit is verification that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713.
ss a7 1/91 a co
S ture of Owner/Agent Date Si re f Contract Agent Date
r"L M o
Pri t O ner/Agent' arae ttmry Guy Turner Print Contractor/Agent's Name
o.,coramission #DD208048 (� Y 1 UJQJ
to
Signature of otary-St of Florid ; *_ EXPir(WWay Ol, 2007 Signature of Notary -S — ate
%�9• • �P; Bonded Thru DE!BlE BLANTON
°F Atlantic Bonding Co., Ino.
Lall
COMMISSION 188491 l
� ruary t 200
Owner/Agent is _ Personally Known to Me or Contractor/Agent i t u Assoc Co,
Produced ID _ Produced ID
APPLICATION APPROVED BY: Bldg:
Special Conditions:
Zoning: Utilities: FD:
(Initial & Date) (Initial & Date) (Initial & Date) (Initial & Date)
�-1 /, 0v
POWER OF ATTORNEY
Date: (- o - v�
I hereby name and appoint David or Judy Mercer of First Choice Permit Service
to be m. lawfultt ey in act to act for me and apply to the
San I
Building epartment for a permit
for work to be performed at a location d cribed as:
Section Township
Subdivision
Range Lot Block
e
(Address of Job)
FRU l m o r�� a U
(Owner of Property and Address)
and to sign my name and do all things necessary to this appointment.
Kevin Ryman CCC1325505
Type or Print N#me of Certified. Contractor and Contractor's License Number
ignature of Ceftified Contractor
The foregoing instrument was acknowledged me_ is p day of GI ✓1 20 d�
byYl 04 ` n why is personally k I own to me/who produced
as identification and who did not take oath.
State of Florida
County of Osceola
V1. 7�� Seal
Notary Public, Florida
F(407)
ROBERT M LANITRIP
MY COMMISSION# DD599213
EXPIRES: Sept. 26,2010
99.9-8153 Florida Notary Service.com
Permit No. _
State of Florida
County
NOTICE OF COMMENCEMENT
-
M e -Y ce.r
Tax Folio No.
M411YANN' ' MODS
CLERK OF. C"'CUIT CQt!
mai NILNTY, FLO'
r1_F_PK
The undersigned hereby gives notice that improvement will be made to certain real property, ain—accordance
Chapter 713, Florida Statutes, the following information is provided in this Notice of CommencementJR,
1. Description of property: (legal description of the property and street address if available)
CA-) 00 c C -,L
2. General description of improvement: 2 rour
3. Owner information 0
a. Name and address ' Q
�\-.10 o U c�
b. Interest in property
/ c. Name and address of fee simple titleholder (if other than Owner)
4. Contractor
a. Name and addressv
(u>n.dMc. i
b. Phone number 1-fy I c�� j 6) D.S Fax numb r
5. Surety
p N
a. Name and address
MM'M"'t WVM- iL EM. W CIRWIT WJRT
b. Phone number Fax nun pIF ""`""
c. Amount of bond 8K 06546 Rn 15981t1pq1
6. Lender CLERK' S 0 29*7003670
a. Name and address RF DS 011Nf i 10.34.0 VA
J;k7MD116 FMR Ifs So
b. Phone number Fax nunBY T K14ke
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as
provided by Section 713.13(1)(a)7., Florida Statutes:
a. Name and address
b. Phone number
8. In addition to himself or herself, Owner designates
Fax number
of
to receive a copy of the Lienor's Notice as provided in Section
713.13(1)(b), Florida Statutes.
a. Phone number Fax number
9. Expiration date of notice of commencement (the expiration date is 1 year from the date of recording unless a different
date is specified)
Drivers License #FL-
. j`I Signature of Owner
Swoz to (or affirmed and subscribed before me this �� day of-rJOA*L , 20 by
MUS li�0
Personally Known OR Produced Identification
Type of Identixication Produced FL t J Q
Henry Guy `furrier
Signature of Notary �c, Stat f lorida =o Y P"C- ; Commission #DD208048
Commission Expire . =•.:Q- Expires: May 01, 2007
;�oFwoeO
Bonded nru
}atlantic Bonding Co., Inc.