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CITY OF SANFORD PERMIT APPLICATION
Permit #: V rl — (y-7 0 Date: t a (- o b
Job Address: y'VU P" S-!ee4- c.-Ir S4r1SorG , rC. 1,) `7 1
Description of Work: C ttop-%i\k Total Square Footage 'I b-
Historic District: 'zoning: Value of Work: $ 7 1 C, . 0-0
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: ( q of Stories: I # of Dwelling Units: PIA Flood Zone: (FEMA form required)
Owners Name & Address: --ea r\ td 1e 1 k W a-1 L1e r1 b e ,, r—
t akando 3arroS Pb..,: 0 o /-7 - . 9 9 - 3((.`-t'
Contractor Name & Address: P • tL • C Or] «rk c*'-a-y. 'F fLt cc-(` !- — ,r, t' ( 1 nd r e.a S . 201 I rr')
5 o o f . ;I-01^ Sir . '11,0 O r CS R— aia'TI \ State License Number: CCU C 15 iJ $4 -1 1 C t^_ C e 1 3 d I Ll S 3
Phone & Fax: tftT1- sa4 -Fai 5& P' 44n-.3 14 4 13:1- Contact Person: Nr%6 re 6 U I 1 f- Pb..,. '*YO -7 - f0 5`1 -5-7 37 V
Bonding Company:
Address:
Mortgage Leader:
Address:
Arebitect/Eogineer.
Address:
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 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.
of rmit is verification that I will n ti e n oft property of the requiremen f Florida Lien Law, 713.
2-/4ll06
i of Owner/Agen Date Signature of Contractor/AAgent Date
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rjy Owner gent ame n Print Contractor/Agent's Name
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BW" Carr 180OA22J
Owner/Agent is — Personally Known to Me or
Produced ID
APPROVALS: ZONING: UTIL: FD:
Special Conditions:
Rev 03/2006
Signature of Notary -State
Contractor/Agent is
Produced ID
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THIS IN TRUMENT PREPARED BY: Building & Fire InspectiorP
Name: A.l- j rew) rZc'/1 a 1101 East First Street j,
Address: D 5 t" CSEMINOLE Sanford, Florida 3277 z
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lorida ALC11010E County of Seminoleg bX
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NOTICE OF COMMENCEMENT
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Parcel ID Number (PID) a S- 9 - 3 0- S A•(,- - oq o A- o i 0 O 0
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The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance witg 0
Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. E: c
DESCRIPTION OF PROPERTY (Legal description of the property and street address) LE U L o 1 ( u + t= , F %
p F vPACl) Si O- w hLK cis U P SPsr'3T--0(Z 6
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GENERAL DESCRIPTION OF IMPROVEMENT GERI IHEU Con V,
CLERK OV RC'' f URT , %.V _Z_
SEMM0 . LORID/I 1 r n
OWNER INFORMATION
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Name and address: - A >v N i` - L • W >a L '•?car .
I -c , tJ L.. K 1 N Lr t fZ 0 IZLAN Lam. ` ` 'U _ t+"
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CONTRACTOR rn
Name and address: i r d re S • Z a l l m
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Persons within the State of Florida Designated by Owner upon whom notice or other documents may be served X
as provided by Section 713.13(1)(b), Florida Statutes. C)
Name and address:
to
In addition to himself, Owner Designates of
To receive a copy of the Lienor's Notice as Provided in w
Section 713.13(1)(b), Florida Statutes.
Expiration Date of Notice of Commencement'
The expiration date is 1 year from date of recording unless a different date is specified.) m
STATE OF FLORIDA
COUNTY OF SEMINOLE
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Signature of caner o
The foregoing instrument was acknowledged before me this day of --NLparj; e_r" , 41
by Sae— a n n—e I L A Q1j 8Eil Who is personally known to mey Name
of person making statement OR
who has produced identification type of identification produced NNN.
N.NNNN..NNNN.NNN.N.N.NS SHRLEY
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No
ry Signature