HomeMy WebLinkAbout103 N Mellonville AveCITY OF SANFORD PERMIT APPLICATION
Application # : , J ? -1
Job Address: `
Parcel ID' i Zoning:
Description of r "hTOWIWAAWv' �,'V1!ar�iZl_�J,+L�1�'�ra
Submittal Date: 0'?, Z9, d7
Value of Work: $6�un
Historicc)istrict:
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Permit Type: BuildingA Electrical ❑ Mechanical ❑ Plumbing ❑ Fire Sprinkler/Alarm ❑ Pool ❑ Sign ❑
Electrical: New Service'- # of AMPS Addition/Alteration ❑ Change of Service ❑ Temporary Pole ❑
Mechanical: Residential ❑ Non-Reside6t.ial ❑ Replacement ❑ New ❑ (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential ❑ Commercial ❑ Industrial ❑
Construction Type: I # of Stories: # of Dwelling Units: _
# of Gas Lines
Plumbing Repair -Residential ❑ Commercial ❑
Occupancy Use Group(s):
Flood Zone: (FEMA form required )
.........................,...............c....`............................................}�.(............I........................
Property Owner: (�(�1(1( i , ` 1b�,' 1-/�c� a'J'r1'�Q[� Contractor*- cRqo�!� *r of ` entm1 flor4- !'
Address: KAPAk��111_ l�ft-e- Address: 5108 S. Orange Ave. _ _____
OrlandoF.�802 / �� i►2
Phone: E-mail: Phone: State License NumberCi 1 2 � J -
Bonding Company: r` �� Mortgage Lender:
Address:
Architect/Engineer:
Address:
-_Plan Review Contact Person:
Address:
Phone: Fax:
Phone:
Fax:
E-mail:
Application is hereby made to obtain a permit to do the work and installations as indicated. l 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, BEATERS, 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. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITI-I YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR
NOTICE OF COMTVIENCEMENT.
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.
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Acceptance of perm t i�rifical�ionthat
I willnotify the owner
of the property the requirements of Florida Lien
Law, I -S 713.
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Signature.of Notary -State of Florid
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Notary Public State of Florida
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Kristin Joy Zavodney
DD549683
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ontract rlAgent is 'ersonally Known to Me or
Produced ID
Produced ID
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APPROVALS: ZONING: ___ UTIL:
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ENG: _
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Conditions:
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Special
Rev 07.07
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CONTRACTOR RootMaster of Central Florida, Inc.
Name and address:
Orlando, FL 32809
Persons within the State of Florida Designated by Owner upon whom notice or other documents may be served as provided
by Section 713.13(1)(b), Florida Statutes.
Name and address: _ 1� ,r—\
111111 If Ili 11 ill II Ili II Iii 11111 it 111 if ill 111 111 if 111 it ill 111111
MARYANNE Mt1RS�q CLCRK LIF CIRCUIT CIJURT
S41100L ' COUNTY
V:0"*C' MrJjW Ir UK 068ee I'll 171*; Upp)
CLERK'S # 20071 39568
THIS INSTR I t ;Florida;"Inc. RECURVED 09/28/2001 10:441;09 AM
Name: �) $ S ge Ave. RECURDINS f:ECS 10.00 CERTIFIED COPY
Address: FL 32809 ORO U by N UeVoreMAR`.'A.,NE MORSE
Orlando, p �O� OC,o,CE CLERK 4 GIPS „T COURT
State of Florida SEMINOLI t iATy, 7LORIDA
13Y
DEPUTY C1 f7m,
NOTICE OF COMMFENCEIVIENT Fee
Parcel ID Number (PID)
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.
DESCRIPTION OF PROPERTY (Legal description of the property and street address)
R A 0 L4?3 Ate- -17'1- of - ice: )t q �61C.. i
GENERAL DESCRIPTION OF IMPROVEMENT
OWNER INFORMATION
Name and address:
) CZ-� A-) - ti4/-2 i Ji
In addition to himself, Owner Designates of
To receive a copy_ of the Lienor's Notice as Provided in
Section 713.13(i)(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.)
STATE OF FLORIDA
COUN -Y OF SEMINOLE
OWNERS SIGN URE OWNERS PRINTED NAME
"(NOTE: Per Florida Statute 713.13(1) (g), owner must sign...... and no one else may be permitted to siin his or her stead."
The foregoing instrument was acknowledged before me this day of _'�'Jt 20ojI
by Il�!rl'(lQ;� r 1 `' �I�-� C� Who is personally known to me _
Name of person making statement
OR who has produced identification klu YJY �X(V li type of identification produced
TERRA APPUNG
pCB< : Notary PLI161'lWate of Florida
;MyComm(sssbnExp6esJu129,2WB
Commission # DD 342309 Notary Signature
SOF �' Bonded By National Notorypssn.
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date:
I hereby name and appoint:
an agent of:
6cja�' -
(Name of Company)
to be my lawful attorney-in-fact to act for me to apply for, receipt for, sign for and do all things
necessary to this appointment for (check only one option):
❑ All permits and applications submitted by this contractor.
The specific permit and application for work located at:
(Street Address)
Expiration Date for This Limited Power of Attorney:
� t) C
License Holder Name: �� u '(C IG
�
State License Number:
Signature of License Holder:
fix–
STATE OF FLORIDA
COUNTY OFO/4
The foregoing instrument was acknowledged before me this ZS day of
200 J_, by r _ who is personally known
to me or ❑ who has produc d
identification and who did (did not) take an oath.
(Notary Seal)
rO05'Y °�e^ Notary Public State of Florida
Kristin Joy Zavodney
+y c` My Commiss;or; 00549683
V40, moo°' Expires 05/08/2010
(Rev. 3/27/07)
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Notary Public !"S -tate of
Commission No.
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