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CITY OF SANFORD PERMIT APPLICATION
Application #: yll�ll -� Submittal Date:
Job Address: % a. � Ores d. C+. Value of Work: $
Parcel ED: 33")9 , 30-.509— 0000— SdyQ Zoning: Historic District:
Description of Work: fe- rw+ Square Footage: L� se'vat-
........................................................................................................................
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 9r,
Commercial ❑ Industrial ❑ Occupancy Use Group(s):
Construction Type: # of Stories: I— # of Dwelling Units: Flood Zone: (FEMA form required)
........................................................................................................................
C L MID -FLORIDA ROOFING LLC
Property Owner: a. i �l JI-J�' T Contractor:
168
Address: ) aZl sI Dies ,,n 6+- Address: L10A1r.Wnr...Z,), V.L d�a713
n T�y FL 3 2-7 11
Phone: E-mail: Phone: *�7 83d9Ssq State License Number: UC- OS -7'53`
Bonding Company:. .., ... x. _ .. Mortgage Lender: _ .. .
Address: _ Address:
Architect/Engineer: Phone:
Address: Fax:
Plan Review Contact Person: 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. IF YOU INTEND TO OBTAIN FINANCING; CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
NOTICE: In addition to 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 y additional permits required from other governmental entities such as water management districts, state agencies, or federal agencies.
Acceptance of permit s erif f n ill notify the owner of the property of the requirements of Florida ien La FS
Si of Owner/Agent Date Signatu oofff C for/Ageen�t C % tD`ate
rin r/Agent's Nagre Print Con /AgW
ature of No Stateof Florida Date ure of NotaryDate
�E ason Kantarjian �� ON ErikCommission DD318091 My
O ti Expires May 12, 2008« Expires May 12, 2008
Owner/Agent is _ Personally Known to Me or Contractor/Agent is _ Personally Known to Me or
Produced ID Produced ID
APPROVALS: ZONING: UTIL: FD: ENG: BLDG:
Special Conditions:
Rev 02/2007
After Recording return to: • " ••""" " "' !"' �� 4 m a Ip IA ATI Il r1i I tell
NARYANW NOR;1;, CI.ERK.OF CIR(;UIT COURT
IIIA RRJLFOR13 ROOFINQ SE NitlE COUNTY
780FERNEDF&E Notice of Comm encemeAG764 PSIM
g 1769; Opp)
' FS 713.13 CLERK'S # 2007105861
Rr;:Cf1tZDEo a7iaeliWa7 a9:aa:aa flm
Permit No. RrCi11;DING FEES It3,@a
Tax Folio # :(3" 12 — 3' -5-01— L W- _ St74U R600WO AY H OpVore
THE UNDERSIGNED hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, th
following information is provided in this Notice of Commencement.
Legal description of pioperty:
2.
0
CERTIFIED ,C€ h
MAR YAi NE NOTRSE
CLERK CSF CIRCUIT COURT
SEW iU UKTY 1101, DA
�U l �C�
aY EytU.'2007
Street address if available:
General description of improvement:
Owner: Name and address '.
a. Interest in property 719Z-7`) • `= C `ten
b. Name and address of fee simple titleholder (if other than Owner)
YID FLORIDA WOOFI. _:.j tsLIA� c i 7 2 /
4. Contractor: Name and address bA Rs"OR0�FING 7 b a SSH 67 J v�lO
a. Phone number LWWWOWKWAtional, if service by fax is acceptable) 4 1IU7 CorsaSy
5. Surety: Name and address Bond $.
a. Phone number Fax number (optional, if service by fax is acceptable)
6. Lender: Name and address
a. Phone number Fax number (optional, if service by fax is acceptable)
7. Persons within the State of Florida designated by Owner upon notices or other documents may be served as provided by Section 713.13(1) (a) 7.,
Florida Statutes: (name and address):
a Phone number Fax number (optional, if service by fax is acceptable)
8. In addition to himself, Owner designates to receive a copy of the Lienor's Notice as provided in
Section 713.13(1) (b), Florida Statutes.
a. Phone number Fax number (optional, if service by fax is acceptable)
9. Expiration date of notice of commencement (the expiration date is one (1) 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 NOTICE OF COMMENCEMEt
ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13, FLORIDA STATUTES, AND CAN RESUI
IN YOUR PAYING TWICE FOR IMPROVMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCMENT DIUST BE RECORDED Ar,
POSTED ON T11E JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND jO OBTAIN FINANCING, CONSULT WITH YOI
LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YO /R NOTICE OF COMMENCEMENT.
Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it . trete tylhCbesI of my knowledge and belief
j)b"� Erik Jason Kantariian
t�2tg• My Commission DD 318891
d° Expires May 1 8
State of Florida °'^
County of t .1hilsfu/C
The fnrevninv instniment was a nwledeed before
me this
(Signature
day of /
or Owner's Authorized Officer/Director/Partner/Manage
(Signatory's Title/Office)
, 2ct)-7 by )JAw,-i St,,e f (nan