HomeMy WebLinkAbout540 Valencia StCrl'Y OFSANFORD PERMIT APPLICATION
Permit # : ' ' -3 a 9 . Date: 9—z s - a,,
Job Address:
Description of Work: h Total Square Footage
Historic District "Zoning: Value of Work: S ,i
Permit Type: Building 4E'leclrical 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 tines # of Gas Lines
Plumbing/New Residential: # of WWater Closets Plumbing Repair — Residential or Commercial _
Occupancy Type: Residential t/ Commercial Industrial
Construction Type: if of Stories: # of Dwelling Units: Flood Zone: (FEMA form required)
Owners Name & Address:
Contractor Name & Address: i
f% 4— J 7 Z State License Number: eIL5-73 7
Phone & Fax: 7 —3,e 57W 9 ne , Contact Personel it7 L/( OGt.f Gbone: .07 -,r
Bonding Company.
Address:
Mortgage Lender:
Address:
Architect(Engincer: Phone:
Address: Fax:
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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 woing. 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 I's venficat Ihal city the owner of the property of the requirements of - reds •e Law, FS 713.
Si store of Owner/Agent
7
Date Signature of Date
Print Owner/A ent's Name Print Contractor/Agen 's Name
Signature o Notary- late o Signature of Notary -State e
ip DEBBIE BLANTON
MY
MY COMMISSION # DD ISMI
EEXPIRES:
February 25,2OD7 OwnedAgent
is KContractor/Agent is Ft Notary
Dboo'"aAiC. Co. Produced ID _
Produced ID - ei d S APPROVALS: ZONING:
UTIL: FD: ENG: BLDG: •I Special Conditions:
Rev 03/
2006
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NOTICE OF COMMENCEMENT 14ARYAW MN)RSi'-, ULEW W CIRCUIT LWRT
SIMILE COUNTY
Permit No. TaxleW, ? 139E; t 1pg)
State of Florida
County of Seminole
RI-ulliou 09/ee/I?006 09:4eia AM
RWI1101N1i FEES 10.00
The undersigned hereby gives notice that improvement will be made to certain reg i ORYa>'td VWomance with
Chapter 713, Florida Statutes, the following information is provided in this -Notice of Commencement.
1. Description of property: (legal description of the property and street address if available) 4192C, Gg7-C v2.1<4;t-510"
LyC 'r e!w :1 d I%c peloon &L ld 3/ - / 3l -, . --
i2.. General description of improvement:
3. Owner information
a. Name and address
cr rsrr r'i rY.
b. Interest in property
c. Name and address of fee simple titleholder (if other than Owner)
4. Contractor MOIUV LERN
a. Name and address cc.°
Phone number !k2:Fax number
5: Surety
a. Name and address
b. Phone number Fax number
c. Amount of bond
6. Lender
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(1Xa)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 I year from the date of recording unless a different
date is specified)
Signature of Owner
om to (or affirmed) and subs ribed before me this day of , 20 0(, , by
Gl 1c fir - n
Personally Known OR Produced Identification
Type of Identification Produced` G 0 1
DEBBIEBLANTON THIS INSTRUMENT PREPARED BY:
Signature of No Public, StateW1.4WO0.4%WTARY
COMMISSION # DD 188as1
Commission Expires:ocPiREs:Februaryzs
o NAME
FL Notary Divcur
ADDR, -- 3Lo-
3z7 .