HomeMy WebLinkAbout211 Bradshaw Dr (2)* �Ov
\F D u'� CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No:&_C
� c��, y�.5 Documented Construction Value: $ 1,2Q0.00 /
Job Address: (9 �� C�f'C��.� )i i v pp_ Historic District: Yes ❑ No L4'
Parcel ID: S55- IQ -30 - SQA - OF—L-0 - 0130 Zoning:
Description of Work: ? 4+ +a,_Q Q WkLt R J im 0 Q Ic-4g IL
Plan Review Contact Person: r- 5+6?►Ce,_A Title:
Phone: L101- SOA-I'Mo(io -Fax: E-mail:
Property Owner Inforrnation
Name ,,� ► QA" e-\ a Phone: 7Uo Y
Street: c°� \ \ n S �_'p C6 Resident of property?
City, State Zip: u4, _&\9 3a % 7 I
DD_ Contractor Information
Name Phone:
Street: Fax:
City, State Zip: State License No.:
Architect/Engineer Information
Name: Phone:
Street: Fax:
City, St, Zip: E-mail:
Bonding Company: Mortgage Lender:
Address: Address:
Building Permit 13
Square Footage: Construction Type: No. of Stories:
No. of Dwelling Units: Flood Zone:
Electrical O Plumbing D
New Service - No. of AMPS: New Construction -No. of Fixtures:
Mechanical O (Duct layout required for new systems) Fire Sprinkler/Alarm D No. of heads:
work or installation has commenced prior to the issuance of a permit and that all work will be performed to
mrrtr Cranri;lrric nt viii inwr reor:i^ ncr r.^r ::r :r::^n :F :::::r :^:^::^^ •: —•:•••..: _ .......
must be secured for electrical work, plumbing, signs, wells, pools, furnaces, boilers, heaters, tanks, and
air conditioners, etc.
1)WNli:lt'.S A 1+1411)A V i'i'- i rrrtifv that viii of thr fnrranina infnrmnrinn is nrrnratr. anrt That viii wnrir wiii
be done in compliance with aU applicable laws regulating construction and zoning.
TA /lft7<71UL'D. VirlirD L' A Ti iTDL' Till DL'i/`l1D71 A lUllT7ir`tG' OF!`irlIkIAAny+liT!'L'liACl►TT
RESULT IN YOUR PAYING TWICE FOR MIPROVEMENTS TO YOUR PROPERTY. A NOTICE
OF rOM_ W.NVV1WXF.NT_ NUIQT RF. RF.rORDVD AND Pfi.CTVD ON TH_F .if1R CiTF. RF.FORF THF
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COM[r*MNCEMENT.
N(YFICK- Inaddition to the renrtirementc ot'thic nerinit them may he widitional rectrirtionc annlir.ahle to thic
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.
ArrPntanrP of nPrmit_ is vPrifiratinn that i will notify the nwnPr of the nrnnPrty of the rPnivirPn1Pntc ofFlnrlria
Lien Law, FS 713. .
l he ( :itv of tiant)rd reRtiitpS payment of P plan review tom, A nonv of the exer(ltel rontrart is rentiire.d in nrrier
to calculate a plan review charge. If the executed contract is not submitted, we reserve the right to calculate the
Dlan review tee based on hast Aermit activity levels. Should calculated charees exceed the documented
construction value when the executed contract is submitted, credit will be applied to your permit fees when the
permit is released.
x �A� / , it
Signature of owner/Agent Dau
\-X� i �(9 7A� JL-Vp/J
Print owner/Agent's Name
°of, Notary Public State of Florida
Victoria K King
or;W9 My Commission DD788820
Expires 05/14/2012
Owner/Arent is Prcnnally Kn r
Produced ID Type of ID
�JnA I -L! J� I Al 41 t I11
SVkftiiFo?'COr4n*W/Agefit- u
Print Contractor/Age 's Nantc
Signature oll'Nottry-StR6 of ori Dau
tp'� °�t� Notary Public State of FloridaVictoria K King
OF VWMY Commission DD788820
Expires 05/14/2012
rnnt"mrtor/Anen t. Knrnvn to M
Produced ID Type of ID
APPROVALS: ZONING: 0 0 1),-(0 ' I- UTILITIES: WASTE WATER:
ENGINEERING:
FIRE: BUILDING:
COMMENTS: ON �,r ;W �re/�_ In vPn -- 4"
Rev 11.08
�
9
......... . .ted .............
I ST"T
Rmatme
0211
Pk'Noirpppppwwmiow
-mm
ouw tm F7 at
s6
im 11118
i
am" o" rocs of wow ran sr os I ei000 ors 0.1• an
o u ff 12
nm i i
f yo
2
�1a►mlaT er,eoll
LOT a
.AL al• IXACI(
,ocov
,m ,I« ,6, aTY CF SANFORD • 8 IIDING PIAN REVIEW
""CANNING AND ENT SERVICES
I APPROVED
' DATE 2 J c-"'/
UIT�I
o
MACm K i
I 11M room as 0,► m X
Coup LM MCC as Wr
Ql \ v—
WPM to LM
0.2' am
Dem i
LOT I i
OLOOK C
i BOUNDARY SURWYY
IR
to rwroi mala m MICHAEL EARL DUKES
MU MnaLNa
'u'00 VM t°' WS"aaGWAW LOT 13, BLOCK E.
OEM enc I'I2 ollm e0OG0c COUNTRY CLUB MANOR UNIT 3
�ouu uta we PLAT BOOK 12. PAGES 75 AND 76.
iasm
am a SEWINOLE COUNTY, FLORIDA
wdmw O st m"aN
• um 01001 an RAT
UK amass are+ao ST 2
"alt oftm lomm 410
110 a c"I M2r 1 N2V2
m<ta 19 RM 11111/11 400
MP I1111l rma nm/ 410 r
040) monies Ito afolom rYT f
a 1RR taw IOEOI if N tar Y
TOT M AM E
WT IIIOOA masa act
NOT t'Np.6M Vlq OOIAY[ a0
s 0/ 2
nuw waam warn Aa
Wo N mO$0 uallms to
h ODO OIAII INC WaN PIOR a
IAM a NTNOIT Wao
O IR x2110 a
WAD ,'�l0•
L
• - &IWlM 41W OOI= am"" no
. - IWL a
x . 15""1"8": WT N COO=
® - I�10m 1/J' sroI Ioo W 1
0 - COOK M82E 016T/L 1.; 0, o - 444
. MW v WAI Ut: t21 00011110.
e2mL NEO-�IId►�
RI watA� 0)1 -BOE 4
� x0111 0) &MIS .
� - rm O1 COOt0etom IOL . Nbll a1
,av2t� O0 m
ONIIN, ec W
MImIIi
Ip1�q /ry
I( alts O' AIAIONIL OOiM1Otl
24 rW,14 ee: III e200
O - rt2 W4= 3/I' as 40 A e
B- CEWAM 11/O ON POC No O
• - ah 1/2' ar Im m um
4 - K= rd E 27 swm
sm on AS an"f7O
- OCNI im 1rf/ am
_010 10 u arm
*AID 1/I/tle
"a uMv a carwo To 00 MFJW roll "a
Ias 2,0 L nusrM area 4 VrE OA10 a0
mita MO OM{L IQT Oe mO1 a 4
W= "III► at IOILWA ONImOMI.
IO M r0.I020002MW10/11M.T LAW Iaw YOf M M )A PART 14 VMI a1M.Y. MID
Oe2fi 017na1 M� Ism 45"AC® TW lana O
MG 0D/Ml L2O2 M 0 MC e2o0m
.aO am 219"
R1ETI1
LOT a
.AL al• IXACI(
,ocov
,m ,I« ,6, aTY CF SANFORD • 8 IIDING PIAN REVIEW
""CANNING AND ENT SERVICES
I APPROVED
' DATE 2 J c-"'/
UIT�I
o
MACm K i
I 11M room as 0,► m X
Coup LM MCC as Wr
Ql \ v—
WPM to LM
0.2' am
Dem i
LOT I i
OLOOK C
i BOUNDARY SURWYY
IR
to rwroi mala m MICHAEL EARL DUKES
MU MnaLNa
'u'00 VM t°' WS"aaGWAW LOT 13, BLOCK E.
OEM enc I'I2 ollm e0OG0c COUNTRY CLUB MANOR UNIT 3
�ouu uta we PLAT BOOK 12. PAGES 75 AND 76.
iasm
am a SEWINOLE COUNTY, FLORIDA
wdmw O st m"aN
• um 01001 an RAT
UK amass are+ao ST 2
"alt oftm lomm 410
110 a c"I M2r 1 N2V2
m<ta 19 RM 11111/11 400
MP I1111l rma nm/ 410 r
040) monies Ito afolom rYT f
a 1RR taw IOEOI if N tar Y
' �p0
�yoRro9
www."nfordn.gov
(.Ownership
Applicant's Affidavit of Ownership and
Designation of Agent
I, `0'n i mot P a) l A. i4p S hereby attest to ownership of the property described below:
Tax Parcel No(s): 6 5 - ICA - _2T) - c; _) a - C'� G OCD -
Address of property: A�,.1 tl , V D
for which this • Q t SL application is submitted to the City of Sanford.
The ownership, as shown on the deed of record, is in the name of:
-,Y� ; n h04- tj Tz- '-�udk oz,
Individual
Please complete the appropriate section below (type or print legibly)
❑ Corporation
Name:
Provide Names of Officers
Dept. of State Corporate Registration
Number:
Name/Address of Registered Agent:
II. Designation of Applicant's Agent (Leave blank if not applicable):
❑ Partnership
Name:
Provide Names of General Partners
As the owner/applicant of the above designated property for which this affidavit is submitted, I designate the below named individual as my
agent in all matters pertaining to the application process. In authorizing the agent named below to represent me, or my company, I attest that
the application is made in good faith and that all information contained in the application is accurate and complete to the best of my personal
knowledge.
Applicant's Agent:
Applicant's Addres
Contact Person:
Email:
October 2009 Affidavit of Ownership pdt
III. Notice to Owner
A. All changes in Ownership and/or Aplicant's Agent prior to final action of the City shall require a new affidavit. If ownership changes, the
new owner assumes all obligations related to the filing application process.
B. If the Owner intends for the authority of the Applicant's Agent to be limited in any manner, please indicate the limitation(s) below. (i.e.,
Limited to obi ' mg a certifi to of concurrency; limited to obtaining a land use compliance certificate; eta)
AP&L OWA
IV. wledgement
�Zndividual ❑ Corporation
Print Corporation Name
X By:
Signature
Print
Name: Mt 6)4 �1 �
Address-, 1l 121ah SIY,< . a- AA
Phone: 407 - V-31- 7M7
Please use appropriate notary block
STATE OF Q Q ti t A113
COUNTY OF QM t It
Ej Individual
Before me this I 5 N— day of
20-U, personally
appeared N. ; ,hn e l 1�!)Ujbn
who executed the foregoing instru-
ment, and acknowledged before me
that same was executed for the
purposes therein expressed.
Notary Public State of Florida
Victoria K King
My Commission DD788820
Expires 05/14/2012
Personally known or
Produced identification ❑
Type of identification produced:
2nna
Signature
Print
Name: _
Address:
Phone: _
❑ Corporation
Before me this day of
20_, personally
appeared
as
for
a
(i.e.:corporation, Company, etc.)
and acknowledged before me that
same was executed for the purposes
therein expressed.
.0"C' Notary Public State of Florida
Victoria K King
My Commission DD788820
ur a Expires 05/14/2012
My commission expires:
❑ Partnership
Pnm Partnership Name
By:
Signature
Print
Name:
Address:
Phone:
❑ Partnership
Before me this day of
, 20_, personally
appeared
partner/agent on behalf of
a partnership, who executed the
foregoing instrument and acknowl-
edged before me that same was
executed for the purposes therein
expressed.
Signature of Diary
Print
Name: Q t
Notary Public
Afridawt of Ownarxh,n ndf
li..li'VYYTED rO 1N Jr:K Or A -CIFOR N E 1
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: IA. t � I I
I hereby name and appoint: e
(Name of Company)
to be my lawful attorne* in -fact to act for me to aDDly for. receiDt for. sign for and do all thines
necessary to this appointment for (check only one option): v
'1 All permits and applications submitted by this contractor.
'1 The specific permit and application for work located at:
Q 1 q>ei 5ha Lo '1) \ . :GZ NP -p rj ..0 3a7 7 3
(Sheet Address)
Expiration Date for This Limited Power of Attorney: 1Q
License Holder Name:
State License Number.
Signature of License Holder: - n ro e v-(DlN N.n
STATE OP FLOKIUR
COUNTY 0175 �
The tbreeoine instrument was aGnIleed betbre me this day oi`
2003j_, by a t Mme Q D who is ? rsonal
to� me=w? who has produced as
identification and who did (did not) take an oath.
(Notary Seal!
�,yK •oj`
m
ate of Florida
DD788820
1 2
(Rev. 3t27ro7)
. 13
a .
Notary Public- State of Y i 13"
Commission No. 0
My Commission Expires: