HomeMy WebLinkAbout170 Bolivia CtNOV O'S 2011 CITY OF SANFORD
k BUILDING & FIRE PREVENTION
BY: _ PERMIT APPLICATION
Application No: Documented Construction Value: $ H , 12 S., 00
Job Address: I-�Q 'SDI int i -A C+. SQ07,M , FL3"" Historic District: Yes ❑ No ❑
Parcel ID: Zoning:
Description of Work:
Plan Review Contact I
Phone: LArsl • 7PI 1• t ULtLi Fax: Ur -!52-Z- O4*1
E-mail: Curl z5fi11Q neurtian
Property Owner Information 1rYb1CCYA(AC . 6 o�
Name I &STrI tws CyltSSlon �orews
Street: 1�0 'S�x�\��,rx Cir•
City, State Zip: sa(y6rA , fi- 39-4.3-1
Phone:
Resident of property? :
Contractor Information
Name ?m Ve Ck1 CO3L (�D/1('� �'flOrl i -' Phone:
yi
Street: '9ga!571 Qkr 5U � Fax: L n Jq - C>qH
City, State Zip: Ochi l d n State License No.: 01A C O 9 1301 3
Name:
Architect/Engineer Information
Phone:
Street: Fax:
City, St, Zip:
Bonding Company:
Address:
Building Permit O
Square Footage:
E-mail:
Mortgage Lender:
Address:
PERMIT INFORMATION
Construction Type:
No. of Dwelling Units: Flood Zone:
Electrical O
New Service — No. of AMPS:
Mechanical f (Duct layout required for new systems)
No. of Stories:
Plumbing 0
New Construction - No. of Fixtures:
Fire Sprinkler/Alarm 0 No. of heads:
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 perfonned 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. A NOTICE
OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
FIRST INSPECTION. 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.
The City of Sanford requires payment of a plan review fee. A copy of the executed contract is required in order
to calculate a plan review charge. If the executed contract is not submitted, we reserve the right to calculate the
plan review fee based on past permit activity levels. Should calculated charges exceed the documented
construction value when the executed contract is submitted, credit will be applied to your permit fees when the
pen -nit is released.
Signature of Owner/Agent Date
T� -,has X.At-they
Print Owner/Agents Tame
zel /L
Signature of Notary-Statc of Florida Date
Owner/Agent is /Personally Known to Me or
Produced ID Type of I D
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
Rev 11.08
UTILITIES:
FIRE:
r
11
Signature of Contractor/Agent Date
-Ty\smas (l�;c�
Print Contractor/Agent's Name
Signature of Notary -State of Florida Date
WASTE WATER:
BUILDING:
CHRISTINA E. NEWMAN
MY COMMISSION Y DD 804130
A€
EXPIRES: July 8 2012
]own
Bonded Thru Notary Pu* Underwriters
Con
to Me or
Produced ID
Type of ID
WASTE WATER:
BUILDING:
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: �� ' {
I hereby name and appoint: 'Kl u C►lS(,rVIUz-:j
an agent of: M --
(Name of Company)
l�
to be my lawful attorney-in-fact to act for me to apply for, receipt for, sign for and do all things
necessary to this appointment for (check only one option):
W All permits and applications submitted by this contractor.
0 The specific permit and application for work located at:
(Street Address)
Expiration Date for This Limited Power of Attorney:
License Holder Name: :TtOn''.s 4cy--1
State License Number: (`,1�OZCiaQ3
Signature of License Holder.
STATE OF FLORIDA
COUNTY OF r)Mn4�2
The foregoing instrument was acknowledged before me this _day of k)c,:,,
200__Ak , by who ism personally known
to me or o who has produced
identification and who did (did not) take an oath.
Signature
z GREGORY MEISENBUR6
Wffy PUBLIC
STATE OF FLORIDA Print or type name
Comm# DD0936897
Expires W/29/203
(Rev. 3/27/07)
Notary Public - State of
Commission No.
My Commission Expires:
as
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. A NOTICE
OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
FIRST INSPECTION. 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.
The City of Sanford requires payment of a plan review fee. A copy of the executed contract is required in order
to calculate a plan review charge. If the executed contract is not submitted, we reserve the right to calculate the
plan review fee based on past permit activity levels. Should calculated charges exceed the documented
construction value when the executed contract is submitted, credit will be applied to your permit fees when the
permit is released.
(��L //-
Signature of Owner/Agent Date Signature ofContractor/Agent Date
`-Al f A. Bi'�fk�r Ii1r1Y1aS fl��t�n
Print Owner/Agent's Name Print Contractor/Agent's Name p
gigrpfure of Notary -State of Florida Date Qnluum of Notary -State of Florida Date
7y;., ~ CHRISTINA E. NEWMAN
-
MY COMMISSION I DD 804130
EXPIRES: Jury 8, 2012
Bonded TAru Notary Pu* Underwriters
Owner/Agent is Personally Known to Me or Contractor/Agent is Personally Known to Me or
Produced ID Type of ID Produced ID Type of ID
APPROVALS: ZONING: UTILITIES: WASTE WATER:
ENGINEERING: FIRE:
COMMENTS:
Rev 11.08
BUILDING: