HomeMy WebLinkAbout120 Country Club Dr (4)CITY OF SANFORD PERMIT APPLICATION
Application # : 6 ;o 2r, Submittal Date:
Job Address: '``00r"Ve -sc, f0ValueofWork
:$ 'RO�J
Parcel ID: Zoning: Historic District:
Description of Work: e- rQOT Q+_ Square Footage:
Permit Type: Building ❑ Electrical ❑ Mechanical ❑ Plumbing ❑ Fire Sprinkler/Alarm ❑ Pool ❑ Sign ❑
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 ❑ Commercial ❑
Occupancy Type: Residential ❑ Commercial ❑ Industrial ❑ Occupancy Use Group(s):
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required )
..........................................................................................f...............................
Property Owner: L Q e S GY a�n y� Contractor: %-(A l l ('Ot q A RIW r Q
Address: U V "` L/C Address:13
Phone: E-mail: Phone: %7SE-1962 State License Number: CCe (JS-iS C'�
Bonding Company:
Address:
Architect/Engineer:
Address:
Plan Review Contact Person:
Mortgage Lender:
Address:
Phone:
Fax:
Phone: Fax:
E-mail:
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. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
FIRST INSPECTION. 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 permit i- verification that I will notify the owner of the property of the requirements of Florida Lien Law; FS 713.
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Signature of Owner/Agent Date Signature of Contractor/Agent Da
Name
V
�pRA .0SCOTT CAMHI
o Notary Public, State of Florida
My comm. expires Nov. 20, 2009
No. DD 492167
IN
APPROVALS: ZONING: UTIL:
Special Conditions:
Rev 07.07
Signature of Notary-State�f�Ii�X� Date
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Contractor/Agent e all Kiwi�.
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Produce
FD:
NOTICE OF COMMENCEMENT
Permit No.
Parcel ID: EOO •-Oa2d
State of Florida
County of Seminole
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 descr_i do of the pro D-ty and street address if
Lam' T
available) a D-- 17� 1- . "-
r 1, . \-, iM , — a,,,- ", P J- k 1(P P ( l P C-- 2--
2. General description of improvement: 'IF
,._3. Owner Information
a. Name and address:
b. Interest in property: caJ V.,
c. Name and address of fee simple titleholder (if other than owner)
4. ntractor
fa. Name and addre.
b. Phone Number:
S. Surety
I Iiil ii lli fl lii 11 i91 it Ii1 t1 �8 � I� 111u � � � � R iii l iii
MARYANNE MORSE, CLERK OF CIRCUIT
SENINCN_E CftlWY
PK 06817 Pq 09651 t 1 pg')
CLERK'S #;E 2007133177
RECORDED 09/13120t17 1:56:14 IH
RECORDING FEES 10.00
REGURDED BY T "Ithy
�CE.,JgED C�P ,E
�O�
�AR� ANC R ,, tokyRT
c�ERK �F r;riiNT�. FL0?,\DA
CWRT
a. Name and address:
b. Amount of bond $_
c. Phone Number:
6. Lender
7
a. Name and address:
b. Phone Number:
Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by
Section 713.130)(a)7., Florida Statutes:
a. Name and address:
b. Phone Number:
In addition to himself or herself, Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided in
Section 713.13(1) (b), Florida Statutes:
10 A AA�o�o•
Q. LVUllllUllll UUl11 �J.. --
b. Phone Number:
9. Expiration date of notice of commencement (the expiration date is l year from the date of recording unless a different date is
specified)
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTINCE OF
COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713.13,
FLORIDA STATUTES, AND CAN 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 WITH YOUR LENDER OR AN ATTORNEY
BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMYENCEMET.
Signature of Owner or Owner's Authorized
Officer/D i rector/Partner/Manager
Signatory's Title/Office
The foregoing instrument was ackno � ISI CN this day of
�` ' tP rpt tic r� 20 by I J�Ik t2C'>,i (fir
,4 �h �� (name of perso • ^ ' type of authority ...e.g. officer, trustee, attorney in
-'^{ - SSame of parry on if -whom instrument was executed).
fact for l� TRUMENT PREPARED BY;
1 � •-� JAZ,` , �� PT
NAME Ji��^t✓ lG,��� ��
Signature of Notary Public Stag Fltori a.....
2 . � . , 3oi2�z? r"o�� ADDR. _ .. L'
Commission Expires: i o� . e a o"O „F4 , 2
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fit., �QT�
614
HUM
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: 8-3 f —(3q
I hereby name and appoint: V,4,. p a "; tL
an agent of: ('j ( � E C['; V—:
(Name
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):
n
0
All permits and applications submitted by this contractor.
The specific permit and applicationforwork located at:
I Z -o C—n,j ..T/L /
_ (J,. /L, /i i
(Street Address)
Expiration Date for This Limited Power of Attorney:
License Holder Name: K i
1( c4 ; �-
State License Number: C,C C -,o'5 1 S S' (
Signature of License
STATE OF FLORIDA
COUNTY OF 0 c�
W
IZ— ( —0'7
The foregoinginstrument was acknowledged before me this 51day of
200 -1, by �� t(k\oLrGk �ci �� I �P who is(;person ly known
to me or ❑ who has produced as
identification and who did (did not) take an oath.
Signature
(Notary Seal)
Mtl ]FlorM
Notary Public - State of My Commission Expires AprCommission i DD 06folios Bonded Though National Nal
(Rev. 3/27/07)
Print or type name
Notary Public - State ofCommissionNo.
My Commission Expires: 1-1 2O t j