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CITY OF SANFORD PERMIT APPLICATIONi, V'wt, atiq`, tr7 7 // *rtS rt` { All 41
Permit # Date:
OF IF
Job Address:
Description of Work:
Historic District: ' Value of Work:
vi
Permit Type: Buildingy Electrical Mechanical Plumbing Fire SptinWer/Alarm Pool Electrical:
New Service — # of AMPS Addition/Alteration Change of ServiceTemporaryPole Mechanical: Residential Non -
Residential Replacement New (Duct Layout & Energy Cale. 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
mmercial Industrial Total Square Footage: Construction Type: # of
Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X) Parcel #: Owners Name &
Address:
Contractor Name & Address:
Phone & Fax: Bonding
Company: Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
Attach Proof
of
ownership & Legal Description) Phone: State License
Number:
Contact Person: Phone:
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 YO(JR 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: I F2
its his
permit, there
may be additional restrictions applicable to this property that may be found in the public records of this couAy, required
from other governmental entities such as water management districts, state agencies, or federal agencies. ill notify the
owns, of the property of the requirements of Florida Lien Law, FS 713. r S t4
S•
ture of Own r/ nt Date Print O r/
gent' Nam a1 Si ature
of Not St to of lorida Date s' ;a z '
t7 e
Owner/Agent
isv Personallv Known Me v to orgy Produced
ID O AALIC. ION
APPROVED
BY: Bldg: Zoning: Initial & Date) Special
Conditions: Signature
of Contractor/
Agent Print Contractor/Agent'
s Name Date Signature of
Notary -
State of Florida Date Contractor/Agent is _
Personally Known to Me or Produced ID Utilities:
FD: Initial &
Date) (Initial &
Date) (Initial & Date) r 0
Company:
AFFIDAVIT
REGARDING ROOF DRY -IN AND FLASHING INSPECTIONS
License M
Project Information
Owner: X f /
name
address
07
phone
Permit M _
Subdivision:
Lot #:
I, , affiant, hereby affirm that I am the duly licensed
contractor 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:
signature
printed name
STATE OF FLOcRMA
COUNTY OF YEN,' OAF
Q
This instrument -was acknowledged before me this II DAL, day of • O006r- , 22Q , by the
above referenced individual, u eac/L F4 _J P__ , who acknowledged that he/she is a duly
licensed contractor with , and wh%#IbWI'ed that he/
she was authorized to execute this document. He/she is either personal] i produced
D - L- F St D - S 33 - `i= } G as valid identificati,, •0''ss s n- *N
WITNESS
my hand and seal this day of ()r_+cb•eg Q' A :
o s *
a-
p'I t ' • iY Notary
Public //////9y' • P\\
THIS I 1RU NT AR=RED
NAME rK*OTICE OF COMMENCEMENT
ADDR. C.) f"7
Permit No. A,s a Tax Folio No.
u
County of Seminole
W601O
O / CP The
undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter
713, Florida Statutes, the following information is provided in xhis Notice of Commencement. CERTIFIED COPY MARYAN?&-
MAR,,F 1.
Des ttiio i of property:(legal descripti of the property and street address if available) 2.
General description of improvement: 3.
Owner information WWI +
vvv Y
a.
Ne and address - —2-
2 ob.
Interest in property c.
Name and address of fee simple titleholder (if other than Owner) 4.
Contractor ` a.
Name and address 1" I Mill. A_ b.
Phone number Fax nu} 5.
Surety SENINME COUNTY a.
Name and address BK 064 INN! QP ' Sb6
RK' S. * 2006 i 61, 59A b.
Phone number _ Fax n c.
Amount of bond RECORDINS FEES 19- ®0 6.
Lender RECORDED BY H Bailey a.
Name and address b.
Phone number Fax number 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 Fax number 8.
In addition to himself or herself, Owner designates 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 fro of ecordi nless a different date
is specified) _ ALL
S
om to (or a trmed) acid s ubscribed before me this day off Personally
Known Y OR Produced Identification Type
of Identification Produced of
of
Owner 20
Oi> by 01"
N KIMBERLY PAPARO MY
COMMISSION * DD497149 EXPIRES:
Dea6,2009 407)
3W0153 Flodda Notary Swdoaaom