HomeMy WebLinkAbout138 Clear Lake CirPermit # :_c
Job Address:
CITY OF SANFORD PERMIT APPLICATION
Date:
o.V� C_�.5-
Description of Work: 11,c X1011"'
Historic District: Zoning: Value of Work: $
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary PoF'
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 Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel 4: C)d,-.LO- SU-- Jt VJ
Owners Name & Address: 9,,t- Gu'
-0230
(Attach Proof of Ownership & Legal Description)
G t,'_� N C_� T'
Phone:
Contractor Name & Address: Ae "MJ'4C'5— CA03 f",
S-`0 a" L _ oZ $ O�? State License Number:
Phone & Fax: Contact Person:
Mortgage Lender:
A
Architect/Engineer: Phone:
Address:
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.
t Acceptance of permit is verification that I wonotify owner of the pi
r ignature of Owner/Agent Date
, r (I �1
z• tJ r< rintOwner/Agent - \ —
E`: � El 'XJ ry l
r-a•i- G''7 ...t.
r -D Signature of Notary -State of Florida
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c�. ! -7t, {:oil :�
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f 1 t Owner/Agent is Personally Known to Me or
f o o ---produced ID� . �--
f' %1D 14D A
APPLICATION APPROVED BY: Bldg:
(Initial & Date)
Special Conditions:
)perry of the requirements of Florida Lien Law, FS 713.
Signature of Contractor/Agent Date
19107 ` ,-O
Pr t Contractor/A ent' Name
Date Signature of Notary -State of Florida Date
Zoning:
Contractor/Agent is *'--Personally Known to Me or
Produced ID
(Initial & Date)
Utilities: FD:
(Initial & Date) (Initial & Date)
Power Of Attorney
Date: (i ivs- 11.0—
I herby name and appoint 5���� � c �-�'�of Advantage Roofing Inc.
To be my lawful attorney in fact to act for me and apply to the C_1_±4L 4L S C� -fel t
for a roofing-t)ermit for work to be performed at a location described as:
Parcel ID#: o2- - 2 b - 3 0 - s (-i ) - 00o 0 - 02 2) Q
Legal Description: ( 1 n fi (
Address of Job: l 3 o Ay, Fmr'i( 2,-7,
Owner of Property and Address: T (-A�'� �l
And to sign my name and do all necessary to this appointment.
Contractors Name: Typed: Thomas Ringler. Advantage Roofing, Inc.
State License#: CCC052477
Signature of Certified Contractor: (-'2-
Acknowledged
- 2 -
Acknowledged before me this ?,S day of ,S ut-� , z-4 2
By Thomas Ringler
ID Or Personally know to Me
Notary Signature: seal
My Commission Expires:
"OTARY PLTRjiC-5TATF OF FLORIDA
Rase Smith
;�_ Commis o : DD 11199 "
Expires: M' 24, 2009
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r
Power Of Attorney
Date: (i ivs- 11.0—
I herby name and appoint 5���� � c �-�'�of Advantage Roofing Inc.
To be my lawful attorney in fact to act for me and apply to the C_1_±4L 4L S C� -fel t
for a roofing-t)ermit for work to be performed at a location described as:
Parcel ID#: o2- - 2 b - 3 0 - s (-i ) - 00o 0 - 02 2) Q
Legal Description: ( 1 n fi (
Address of Job: l 3 o Ay, Fmr'i( 2,-7,
Owner of Property and Address: T (-A�'� �l
And to sign my name and do all necessary to this appointment.
Contractors Name: Typed: Thomas Ringler. Advantage Roofing, Inc.
State License#: CCC052477
Signature of Certified Contractor: (-'2-
Acknowledged
- 2 -
Acknowledged before me this ?,S day of ,S ut-� , z-4 2
By Thomas Ringler
ID Or Personally know to Me
Notary Signature: seal
My Commission Expires:
"OTARY PLTRjiC-5TATF OF FLORIDA
Rase Smith
;�_ Commis o : DD 11199 "
Expires: M' 24, 2009
_-�_ ,
9
on Number A!! 3o5�000a3
Return to: 0 3
FL
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MARYANNE MORA, CLERK OF CIRCUIT COURT
6EMIWJLE COUNTY
DK 06738 Pg 1459; (1pg)
CLERK' S 11 : C)07+:?9342E,
REG*ORDED 06/226/2007 1215005 PH
RECCRDINC FEES 10w0
NOTICE OF COMMENCEMENT REC>ORDED BY T Smith
State of ��oR a _�Y inrtaTIFIED COPY
NNE MpRSE
County ofYMARYA
- 5e rr.;..ol CIRCUIT COURT
CLERK OF ORIOA
The undealgned hereby gives notice that Improvements) will be made to certain nal pro(erq, and In acoordanci; 140 COUNTY F
Chapter 713, Florida Statutes, the following IMormatlon Is provided In this Notice of Commencement,
1. Description of property: (legal description of propeft and street address If available) Ty Ci f of
I�} a3 ti,aa« L C', v;1v,>,s
2. General description of Improvements)
R e, - I.vo,
3. Owner kdwmadon'10—
La
Address 138 G1\z,.r m Cit .
$u.n'�cct^ j=L. 3a--113
4. Fee dimple Title Molder (Mother than owner shown above)
Nams
Address
5. ContractorName
Address
Ori, -,aa, Fir, 3a8�'1
8. Surely (M amd
Name
Address
7. Lender (N any)
Nanta
Address
Telephone Number
Fax Number
Interest in Property
Telephone Number
Fax Number
Telephone NwWbw
Fax Number
Telephone Number
Pa Number
Amount of bond =
Telephone Number
Fax Number
8. Persons within
Prov the Stab of Florida d (a)7., tlo by Owner upon whom n0doea or other documents may be
served as Provided by Section 713.13(a)7,, Florida Statutes.
Name
Adder Telephone Number
Fax Number
9. In addition to hWWW or NMR, Owner des(p uW the fotiowinp to fr)aeive a gaily of Llenor's Notice as
provided In Section 713.13(1)(6), Florida 8talutea
Name
Address Telephone Number
Fax Number
10. Expiration date of notke of commencement (the exphedon dab is 1 yaw than the data of
dl fennt data Is specCtW: r0o ding unless a
Date Siprted _.
Slpnature Of Owner [Nabs: Por Section 713.13( g� *owner must
Won --m d no one alas may be PWmkbd to sign In his or her
sto
subscribed before me this _ day of - j by
)n n f% \�"�, ii i
who Is Personally imorm to, me OR
Y
as IdsntlNcatbn,
Form Pavbd: 30
8% (► aaN to appear tebw}
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