HomeMy WebLinkAbout131 Country Club CirPermit # : v —1 — 3 D
Job Address:
Description of work: F fTQ*2l- /&
Historic District: Zoaiog:
Cr M oR RAN ,MRn aRQadrr .opr _r-ATION
Date it In 1p 1h
Value of Work: $ 7p
Permit Type: Building Electrical Mechanical Plumbing Fin SlimWer/Ahum Pool
Elechical: New Service — # of AMPS Addidom/Alteration Change of Service Temporary Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: # of FixAues # 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 #: (Attach Proof of Ownersh & Legal Description) Owners
Name & Address: eok vrZYshP , Contractor
Name & Address(—./io ow Kayii fl Phone &
Fax ` w
Contact
Person: iyNJ SDI` Phone 3 —o 39 Bonding Company:
Address: Mortgage
Lender: —
T Address:
Architect/
Engineer:
Phone: Address: 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 ofpqrnut
is verification that 1 will notify the o n of the property of the require o dda en La 713. / Si, turco
wmer/A tt gentDate Si f rct A \\\ N• t E 0 l •
nMfrUSS;pti . j Pri er/
Agent's Nagg P . Con or gent's me = . 4 C v
6
eta OJ Si Date
Signature; of NotaryState o FloridtG ' g /e/) 4 EXPIRES:
Ftlbruary 8, Z008 % JzyB tl ... aamrdtitruttobyA
t0aftwNna %9`O-r-
S+M0P •
i ti_ SOP\ Owner/Agent
is Personally Known to Me or Contractor/Agent is P n 11 Produced ID - —
produced IDe APPLICATION APPROVED
BY: Bldg: Zoning: Utilities: Initial & Date) (
initial & Date) Special Conditions:
FD: Initial &
Date) (
Initial & Date) t C0 -
1.b(z)
PP
Permit NumbeF *lrK::;.: x?.1)i J°?Ta rs°? ii.s•:1+;a
Parcel Identification Number -
Prepared by fLIS A,KELLEA+ PLO„BOX"`I$1458,I
CASSFZBERR: ;AF W iZll,,,8`
Return to:
IYANNE MURSEt CLERK OF CIRCUIT COURT
IINULE COUNTY
06470 Pg 17741 (lpg)
E RK' S fP 2006 ] 75745
UNDED 11/06/2006 10t14:40 AN
UNDIN6 FEES 10.00
URDED BY t holden
NOTICE OF COMMENCEMENT
State of r-ITZORTDAx
County of 'S . --I -
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. Description of property Pagel description of the properly, and street address H available)
2. General description of Improvements
REROOFCf' t;;` r
tit' a..y :_ .._,_, _;;,. . ;. `CERTIFIED 3.
Owner + fo ation T
Name
Telephone Number.. +;: ; 'MAR Address /
j/G C/l. .C,(% Fax Number CLERK F CI G f
l y, 3a 7 Interest in Property: SEMIN0 C J 4. roe mp a itie Holder ofhesr than owner shown above) Name
N p, Telephone Number Address
Fax Number S.
Contractor Name
JOHN KELLER .ROOFING Address8, .,,
6.
ERRY FL- 32718 Name
Address
N/A 7.
Lender rif any) Telephone
Number Fax
Number Telephone
Number Fax
Number Amount
of bond S Name
Telephone Number ?: Address
NSA Fax Number 8.
Persons within the Stale 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 ",`
rWV ='- Telephone Number AddressNp' ar..`.4._ Number
Faxa =,`. ..
ha
addMon. to it,Tw6ir yr i,2iacir, vv.Ticr d@SiyiiuifsS U10 iviivwiny iv mwive a copy or ine Lienor s Notice as provided
in §713.13(1)(b), Florida Statutes. Name
Telephone Number Address
1Q A , Fax Number i •
I 10.
Expiration date of notice of commencement (the expiration date is one year from the date of recording unI
ss a different date is specified): X
Date
ig d Slgnat of Owner ote: per §713.13(1)(g), 'owner must
sign ...and no one else may be permitted to sign in 1
his
or her stead.' Swgn
to and subsgW before To this ( day of ® i ]9' mD 6 by who
Is impersonally known to me as
Identification. RAYMOND
D. STACEY MY
COMMISSION li DD 269547 EXPIRES:
Febury 16, 2IXI6 A'
F1 n.tt Nowy PW* urW,,M.t, Form
Revised M
AFFIDAVIT
REGARDING ROOF DRY -IN AND FLASHING INSPECTIONS
Company: G Iti 46nraLicense #: Owner:
1 54 Cal b 1/ r
name
eow-
ek add
s phone
Project
Information Permit
M Subdivision:
Lot #:
I,
C , affiant, hereby affirm that I am the duly licensed contr
for of record for the above referenced permit, that all the foregoing information is true and
accurate, and that the dry -in, flashings at the above referenced address or lot has been installed
in accordance with the applicable codes and standards. Contractor:
i
at rc tS
printed
none STATE
OF FLORIDA This
instrument was acknowled before me this _1 day of 11 6Wwzl i 7 , 1H l+i above
referenced individual, ,who acknowledged tot' 1 i, duly
licensed contractor with o , and who a ovc d'e'ft he/
she was a thorized to execu a this document. He/she is either personally knc to m2 or '- 0= produced
LC l,{'y -7/- G r-0— as valid identification. WITNESS
my hand and seal this day of Of
F..a\ Notary
Public