HomeMy WebLinkAbout2605 Hartwell Ave (2)i
CITY OF SANFORD PERMIT APPLICATION
D-7-5S1
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Calc. 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
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required)
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Name & ddress: tM_'S /1/ c iS G D 4[ I`
v "r .C>7JZ Phone:
for Name & Address: ID4V y
late License lumber: C. Cl O ZS
Phoa &Fax: 0 3 3a 3 Contact Person: GO Phone: 0 3Y Z SS
Booding Compan
Address:
Mortgage Lender:
Address:
Architect/Eagineer: 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: 1 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 of i ' v tication that I tify the owner of the property of the requireme f Flori ien Law, FS
i 2 3Al (Q
of Owner/Agent Date Sign alContractor Agent Daly'
Print
Z 3 b G % -ds
Sign ofof Rotary-S1e of FlopDa Signature of Notary -State of Florida Date
NpAFN5 AYRt ADCOCK
VCC,-B-TlT6 FLOFyQI
or Contractor/Agent is _Personal) Known to Me orcAl'IiASQIg, Vwwx) °A011A Y
ced 1 brIpeen_ Produced ID
APPROVALS: ZONING: UTIL: FD: ENG: BLDG:
Special Conditions:
j
Rev 03/2006 SS . oc)
I
LD41TED POWER OF ATTORNEY
I he::-aby name a -ad appoint
Of 14 C_ 0 CA,
in fact to act for me and apply i-.,
a b
Date: Z G
4214.- ---Fh C/ to
be my_ lawful attomey for
permit
for work to be performed at
a location described as: Sect:.on Township Lot
Block Subdivision i (
v
C) C;' i "-, j I L C owner
o of
Job) ty
and Address) and
to sign my name and do all `pings necessary to this appointment 0
00 Type
o / ): name of Cctified Comma d License #) t
v Sip3wre of C Contractor) Acl
aowledged: Sworn
to d subscri before. me Day
of ``- A.D. OU Not--
y lic, Stale of Florida "' DAFNEY FAYE ADCOCK s '
NOTARY PUBLIC, STAT/ OF FLORIDA MY
Comm, expires DEC. 2, 9008 Seal)
COMM. # DD370009 My
Commission Expires: 9
Range
z-
zs0
tate NOTICE OF COMMENCEMEN'.
Ddof Florida County of Seminole v
Permit No. Tax Folio No. (PID) The
undersigned hereby gives notice that improvement will be made to certain real prop::.y, and in accordance ith Chapter 713,
Florida Statutes, the following information is provided in this Notice of Comment - ent. DESCRIPTION
OF MOPERTY (Legal description of the pro and str et add: - s) GENERAL
DESCRIPTION OF IMPROVEMENT OWNER
INFORMATTON Nalwand
addrss '2.v,.- S L/vt SS Z(od o- C>
Interest
in pro (Fee Sim le, Partnership, etc. fl w r.d_en, _ NAME
AND ADDRESS OF FEE SIMPLE TITLE HOLDER -(IF OTHER T..4 %N OWNER) CONTRACTOR
e
and ad s d
SURETY (
Bonding Company) Name
and address CERTIFIED COPiR Amount
of Bond CLERK CI R UI 'OE. `
COURT,
y `
SEMIN
C
FLORIDA {• LENDER BY
i-'
Name
and
address ., EP TY
K N.. sssstssrtr#tt#
tsrrrs ssttrrtt#stort#ttsttsssttt#rsssr#tsstsrss>-tsrtrsss#ssrst .. rtrrt goo!\1•,` Persons within
the State of Florida designated by Owner upon whom notice or other d•..-.jments may be server as provided ,•1t by Section
713.13(lxa)7., Florida Statutes - Name and
address t#fiit#
it#tititttrritrrrtrtrrrtir#####trtrrrt#rrtt#r#r#irr#r4riy k4#fir####ttt###i. t######### In addition
to himself, Owner designates of to receive
a,:-.-. py of the Lienor's 1, ;tice as provided in
Section 713.13(1)(b), Florida Statutes. srsts•s#
tssttstttrttrtrtsstsrrtsstrttrrstts#tstsssstss#stsst#s#:-stssrss#ssr#stss•s:sssrt Expiration Date
of Notice of Commencement The expiration
date is 1 year from date of recordine unless a difiemnr i¢ a -e ifiro.) m v d o, _ d rn
z c z o wmin
gna of
Owner uo r
Swo
t
an s 'bed fore me this Day of 1- z' a Mgr N, _,
7i `
i
ZCT'9; tr My Commission
Expires - — Nt tD..
c' L
IS
The fore
ing ' ent was eknowledged before me this day of._ l.9 bev (name
of on acknowl. :aed), n 11 kno o z, - _ a meor
364t oduced Mpe . ;it tification) as ic---ntificatton '= who did /
not take an oath ..•b EY FAY AADCOCK } 0 z., NVARY
PUBLIC. STATE OF FLORIDA L as MY 00mm,
Expires' DEC. 2, 2008 COMM, # DD376609
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