HomeMy WebLinkAbout2100 S Oak AveCITY OF SANFORD PERMIT APPLICATION
Date: 1 / Permit # : 1 3 /0 b
Job Address:
e 2 1 00 5• OAK AV 15 Ati E dRr (:-'L 71
Description of Work: /mooif ey, a _
Historic District: Zoning: Value of Work: S cmoo
Permit Type: Building Electrical _y__ Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/AIteration Change of Service Temporary Pole
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 Commercial Industrial Total Square Footage:
Construction
TypeG 2 #
of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #:. td / " 3o ^ -s-3 e— 0 145 O (Attach Proof of Ownership & Legal Description)
Owners Name & Address: A C Q U G G/ nl &_ &Af2 6.14
wea X 1 , )b 6 5 i Phone:
ntractor Name & Address:
QoX 0011
Phone d Fax: y0 / —
Bonding Company:
Address:
Mortgage Lender:
Address:
E Lt C rAl C
License Number:
Z & (D t.- Contact Person: Phone:
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.
3a
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.
TICE: 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
this county, and there may be additional permits required from other governmental entities such as water management districts, state agencies,.or federal agent
Acceptance of permit is verificatAn 4hatKill notify the owner of the property of the requirements o ridWcn Lays, FS
Si
brute7,,,,Uw
ner/Agent ]` Date
I/4 7.. N G ARC/ /
Pnn/Agent's Nam
Sin a of Notary -State of Florida / Date
Owner/Agent is _X Personally Known to Me or
Produced ID
APPLICATION APPROVED 13Y: Ilidg:
Initial & Dale)
Special Conditions:
Zoning:
of Contractor/Agent ID
Rem I-- l&tiR
tractor/Agent's Name
of Notary -State of Florida Date
Contractor/Agent is
Produced I D _
Utilities:
Initial & Date)
Personally Known to Me or
FD:
Initial & Date) (Initial & Date)
a3ord°
LIMITED POWER OF ATTORNEY
0 3 /0,(
Date
I hereby authorize _ 6Ar K 61-a 9A' 14e N/ y OK
of
to sign his/her name on 'my behalf in order to apply for a S/ar.; r=Q/{ d permit
for the work to be performed at:
Lot Subdivision
Address_2.G U0 S OAK /A-(J
jq&WRY 4,5c rrZ IL Corn R,N y eR oo/0-73'6
Type or print name of comnanv and License # of Contractor
Signature ofLicensed-Con ract
STATE OF FLORIDA
ORANGE COUNTY
dL
The foregoing instrument was acknowledged before me this 3 day of
7 ,
by (fame of person acknowledging).
Signature of Notary Public -State of Florida)
Syr NNBle Pudic State of f=brida
Uaw -V parker
o' My Cornmission DD451612
Print, Type or Stamp Commissioned Name)
Personally known OR produced identification
Type of identificati roduced
r i
mis INSTRUMENT PREPARED BpiNOTICE OF COMMENCEMENT
6 Aial Gt`1 lac-4.
Permit No Q, o ix. 3 0 o l k a-._ Tax Folio No.
State of F1'— —
r --1.. 3 a-7 3 0
County of ;^^
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 this Notice of Commencement
1. scription of property: (legal description of theFKPC-C- 30 - . o- 1
6v - -O A K 2.
General description of improvement: and
street address if available) CERTIFIED O --
6 /. S Onjr+IF 3.
Owner information EPU CLERK a.
Name and address J Ct L 6tNG G A c ' , 210
rJ v . 5 'U rago—L '7. b.
Interest in property c.
Name and address of fee simple titleholder (if other than Owner) 4.
Contractor a.
Name and address0.
66b.
Phone number L 5.
Surety a.
Name and address b.
Phone number _ c.
Amount of bond 6.
Lender a.
Name and address 0
C- <
h in P/VW Y ram
C— 0 - CJ/r2 Fax
number 4/ 69 - 3 0 Fax
number 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 from the date of recording unless a different date
is specified) ignature
of er Sworn
to (or affirmed) and subscribed before we this L day of )SLR 20 O , by b1A6 (
2r, 1 tia-r Personally
Known u OR Produced Identification Type
of Identification Produced z (
101a 19- . - Signktafe
of Notary Pu lic, State of Florida Commission
Expires: OWNNotary
Public State of Florida Diane
M Parker My
Comimssion DD451612 aM1
Expiry.:. u811bl201)9 I1111111111IIIh111II11aINmin
11giII1111110111111asp P1.4RYANNE
WREk, CLERK OF CIRCUIT MDT S'MNOLE
COUNTYBK 06433
Pg 1213; tlpg) CLERK'S :#
L006159271 RECORDED 10/
04/2006 OP:53:03 PM RECORDING FEES
10.00 PUMP PY
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