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HomeMy WebLinkAbout1904 S Summerlin Ave✓� J , /CITY OF SANFORD PERMIT APPLICATION Application N: yr1' q '7' _/ Submittal Date: Job Address: J 9� J 1.r(/ y19 y1'I�G / %i/� � Ue Value of Work: Parcel ID: ' Zoning: Historic District: Description of Work: i 0 d a 001,'4 ,4 %d a A( Square Footage: I V1010 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 O Replacement ❑ New ❑ (Duct Layout & Energy Calc. Required) Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines PlumbingtNew Residential: # of Water Closets Plumbing Repair Residential O Commercial ❑ Occupancy Type: Residential ❑ Commercial ❑ Industrial ❑ Occupancy Use Group(s): Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required) ............................L./.......................................................:................................ Property Owner: A0 & /7/11' V t k Contractor: 1101Co Ck "ry-t fAddress: Addressi X00 Y{�/C -2771 Phone: E-mail: Phoney �' l I r�tate License Number. C (C Z 2.r o Bonding Company: Mortgage Lender: Address: Address: Architect/Engineer: Phone: Address: JY IT 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 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 "t 't is verification that I will notify the owner of the property of the requireme f Florid Lien Law, FS 71 Signature of Owner/Agent e i Co r /ate bokl . IlAiP0,0�_ 07 MY Comrni4on DDAIdn a ni Expires December 09, 2WO Owner gent is _Person ly Kno to IJv e roduced ID �. n O A& � 7 Y APPROVALS: ZONING:. UTIL: FD: Special Conditions: Rev 02/2007 P# Linda A Keeling My Commission DOM9W9 p Expires December (`E .e A,t Signature of Notary -Stat ,SOCA �ti5•?jDa. ':. Contractor/Agent is `^' Personally Known to Me,or _ Produced ID ENG: BLDG: LEff ED POWER OF ATTORNEY Date: I he<:eby name avid appoint U � R N U/'G of _ /Jd Co G G o , ,s to be my lawful attomey in f-:_ct to act for me and apply �K 0 Ic/V 1ov for a — --- -6 v a a (-- permit for work to be performed at a location des,,ribed as: Secdon Township Range Lot Block Subdivision / D f' fv 'n,2fit t ,l Fly/ a v. -Q (Address of Job) ZAZIIA ZG (Owner of Property And Address) and to sign my :name and do all things necessary to this appointment. -f Al T �1dlC0c 1 CCL Q I2 f0 (Type or Print name of Certified Contractor and License #) Aci.,nowledged: Sworn to and sr:bscribed b Day of _ Nov— Public State of Florida Signature of Certified Contractor) me this LindaA Keeling MY Commission DD3WM nd'* Expires December 09, 2009 My Commission Expires: /.2 - 9- D NOTICE OF COMMENCEMENT State of Florida County of Seminole Petmit No.l "m' Tax Folio No. (PID'%T 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) f `lbY 'r j-(1 :2!2 -t"AkZ,`A-1 v j1Cw1�gktZ )C/ P z7 1/ GENERAL OWNER INFORMA' Name and address OF IMPROVEMENT Interest in property (Fee Simple, Partnership, etc.) NAME AND ADDRYS� E SIMPLE TITLE HOLDER-qF OTHER THAN OWNER) _ CONTRACTOR Name and address ( I ?I - L_ Cz � � a z Q SURETY (Bonding. Company) Name and address hi f 114 Amount of Bond LENDER Name and address 8118111! 8118111811 MARYANNE MORSE, CLERK OF CIRCUIT COURT SEMINOLE COUNTY AM Persons within the State of Florida designated by Owner upon whom notice or other RaffiRfiftGci provided by Section and address xa)7., Florida Statutes: RECORDED BY H DeVore 5 %"w %"w In addition to himself, Owner designates t t to receive a copy of the Lienor's provided in Section 713.13(1)(6), Florida Statutes., Expiration Date of Notice of Commencement (The expiration date is I Year from date of recording unl diffemnt elate. is gr v ifiM' ) Signature of Owner Sworn . to and sc " be this d Day of 190 . Cj GG My Co fission Expires: 1.2 — N to ublic v The foregoing,instrument a ackp � ledged befog me this day of 19a by (� ftu) (name of person acknowlc ed), who is personally known to me or who has produced 0 (type identification) as identification d who did / did not take anoath> Linda A Keeling Y; MY Commission ©O or Expires Decembar og,