The URL can be used to link to this page

Home My WebLink About209 Melissa Ct (2)CITY OF SANFORD PERMIT APPLICATION ,, Permit # 25,45 Date: `/- Z 5 7 Job Address: 7DC1 �el;ssa rI. far rpt �t �3 Description of Work: Historic District: N* r Zoning: Value of Work: S Z (a 2-4-1 Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool 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 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 #: to::: Zo "' 36- S -n1_ is � /oiG<> (Attach Proof of Ownership & Legal Description) Owners Name & Address: �Q_/� N• M:Ile ✓ Edi /�(e,� ! S5K Lr = Sam ' V%, 3Z77 --.v Phone: c - Contractor Name & Address: S.¢0.✓S f6w,&— �r`� dv��y�o�.✓4- P 7 a Z 5 7_ , State License Number: Phone & Fax: % _C%gi �ntact Person:Phone: �tTi-yB�l—�6$3 Bonding Company: f �� Address: S - Mortgage Lender: Address: Architect/Engineer: Phone: Address: Fax: Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet standards of all laws regulating construction in this jurisdiction. 1 understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS; POOLS, FURNACES, BOILERS, HEATERS, TANKS, and AIR CONDITIONERS, etc. OWNER'S AFFIDAVIT: l certify that all of the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. NOTICE: In addition to the requirements of this permit; there may be additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional permits required from other governmental entities such as water management districts, state agencies, or federal agencies. Acceptance of permit is verification that I will notify the owner of the property of the requirements of Florida Lien w, FS 713. .�.�� Z s 7 Signature of Owner/Agent Date Signatu a of Contractor Agent Da e Print Owner/ gent's Name Print fres Ag , :T) i°, p4 S a S� �' to of Florida Da S nature of Notary- _ Commission ' DD 0 u Expires: Jars 11, 2005 Banded Thnt ftQ_Q=_�,R($rsonally own to Me or Contractor/Agent is . Produced ID L I _ Produced ID _ APPLICATION APPROVED BY: Bldg: Gk Zoning: Utilities: (Initial Date) (Initial & Date) Special Conditions: Date MY COMMISSION # DD629090 EXPIRES: February 25, 2011 r,Knovf0.fAth§0* -t Asses: Co. FD: (Initial & Date) (Initial & Date) June 2007 a v tLE'i5 1024 Florida Central Parkway, Longwood, FL 32750 PH: 407-551-6000 LETTER OF AUTHORIZATION 2Oq me'l i 5:; . I, Alfred W. Nyman, Jr., Assistant Secretary and Florida State Qualifier for Sears Home Improvement Products, Inc., grant permission to Jeana Young and associates, Chris Young and Brent Titcomb to submit permits and licenses, pick up permits and licenses, make changes to permits, licenses and plans and initial changes made by the building department on behalf of Sears Home Improvement Products, Inc. I also grant permission to Jeana Young and associates, Chris Young and Brent Titcomb to purchase permits and/or licenses with a company check, personal check, personal credit card or cash. This authorization is valid through August 13, 2007. I certifiy that the above information is true and correct. C n -io , Alfred W. Nyman, Jr., As stant Secretary and Florida State Qualifier (CGC012538, (CMC1249510) Sears Home Improvement Products, Inc. STATE of Florida COUNTY of Seminole SWORN TO AND SUBSCRIBED BEFORE ME THIS 6th day of June, 2007, by Alfred W. Nyman, Jr., Assistant Secretary for Sears Home Improvement Products, Inc. and who is X_personally know to me or has producted a valid Drivers License. Seal: NOTARY PUBLIC -STATE OF FLORIDA Deborah P. Phillips Commission # DD520380 Expires: AUG. 13, 2007 Bonded Thru Atlantic Bonding Co., Inc. OIL Print Name: Deborah P. Phillip Notary Public, State of Florida Commissin #: DD520380 MY COMMISSION EXPIRES: Aug. 13, 2007 «k -1A This instrument Poeparedby! Name: SEARS HOME IMPROVEMENT PRODUCTS, INC. P.O. BOX 522290 LONG WOOD, FL 32752.2290 1-407.551.5376 NOTICE OF COMMENCEMENT State: f -L- �+ County: ey"a A& II�a��aaaaala�lal�a�M�lo��au�i��iau MARYANNE MORSE, CLERK OF CIRCUIT COURT SEMINOLE COUNTY BI( 06737 Rg 0864; (1p9) CLERK' S #1 2007092829 REWWD 06/a M27 03153:02 P4 REM, RDIN6 FEES 10.00 REC(IRDED BY T Saith %RTIFIED COPY 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, I. Description of property: (legal description of property, and street address if available) (y-Zo��o-Sol-trvzr0-1o�0� 444 IOIQ C7iotre.y;ew ('b Iq PWS `i —(A -zp,,k 114, e,l s�4 C4. ,.dl > i_ 3 27 7 3 2. General description of improvements: 3. Owner information �^ 6 -1 Opp 209 �� L. e. Name and address: N. � /J �, s b. Interest in property: O'La-�,�TJ_ C. Name and address of fee simple titleholder (if other than owner): 4. Contractor: (name and address) SEARS HOME IMPROVEMENT PRODUCTS, INC. P.O. BOX 522290, LONGWOOD, FL 32752-2290 1-800-222-5030 5. Surety a. Name and address: NA b. Amount of bond $ 6. Lender: (name & address) NA 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be Served as provided by Section 713-13(I )(a)7, Florida Statutes: (name and address) 8. In addition to himself, Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(I)(b), Florida Statutes: (name and address) ABOVE NAMED CONTRACTOR 9. Expiration date of Notice of Commencement (the expiration date is I year from the date of recording unless a different date is specified) qdtl,- ,Q 2?aetl-, (Signature of Owner) J _ /�/Vi1_ `/r,•l// Drivers License N: Owners Name: .-eo ,. Owner's Address: Ale". All information must be typed or printed legibly to comply with recording requirements. STATE OF FLORIDA� / �p 0 73 �e��r D COUNTY OF LC. The foregoing instrument was acknowledged before me this '1Q17by ACC, f, ��• �/ Who i ars ly own to me or has produced /'z- ��L as identification and who did (did not) take an oath. (Signature of person taking acknowledgement) (Name of.officer taking acknowledgement - typed, printed or stamped) �Otle or rank) (Serial number, if any p Na Expires: Jon 11, 2003 Aftdc Bonding CO., 100� `you .As '"�� 4' �lrfl�is�TtlTti M9 - Rev. 08/03 WIARYANNE MORSE CLERK OF CIRCUIT COURT SEMI )LSE MY, FLORIDA Y CL1YU �tl 2 5 20071 Seminole County Property Appraiser Get Information by Parcel Number 06/24/2007 06:34 PM PARCEL, D-ETA94 DjewinJOHNsom CFA. ASA PIROPER 1.A.V APPRAISER SEMINOLE COUNTY FL 1101 E. FIRST ST SAMFORD. FL 32771-1468 407.6551-7506 2007 WORKING VALUE SUMMARY GENERAL Value Method: Market Parcel Id: 10-20-30-501-0000-1060 Number of Buildings: 1 Owner: MILLER KAREN S Depreciated Bldg Value: $122,193 Mailing Address: 209 MELISSA CT Depreciated EXFT Value: $132 City,State,ZipCode: SANFORD FL 32773 Land Value (Market): $33,000 Property Address: 209 MELISSA CT SANFORD 32773 Land Value Ag: $0 Subdivision Name: GROVEVIEW VILLAGE Just/Market Value: $155,325 Tax District: S1-SANFORD Assessed Value (SOH): $111,952 Exemptions: 00 -HOMESTEAD (2005) Exempt Value: $25,500 Dor: 01 -SINGLE FAMILY Taxable Value: $86,452 Tax Estimator SALES Deed Date Book Page Amount Vaclimp Qualified 2006 VALUE SUMMARY WARRANTY DEED 05/2004 05418 1062 $123,000 Improved Yes Tax Amount(without SOH): $2,091 WARRANTY DEED 06/1997 03254 1518 $69,300 Improved Yes 2006 Tax Bill Amount: $1,648 QUIT CLAIM DEED 08/1996 03254 1517 $54,000 Improved No Save Our Homes (SOH) Savings: $443 WARRANTY DEED 03/1989 02058 1447 $60,000 Improved Yes 2006 Taxable Value: $83,721 WARRANTY DEED 04/1978 01167 0117 $28,900 Improved Yes DOES NOT INCLUDE NON -AD VALOREM CERTIFICATE OF 01/1975 01063 0880 $100 Vacant No ASSESSMENTS TITLE Find Com arable Sales within this Subdivision LEGAL DESCRIPTION LAND Land Assess Land Unit Land PLATS:' Pick... :.Pick... '' Frontage Depth Method Units Price Value LEG LOT 106 GROVEVIEW VILLAGE PB 19 LOT 0 0 1.000 33,000.00 $33,000 PGS 4 TO 6 BUILDING INFORMATION Bid Num Bid Type Year Bit Fixtures Base SF Gross SF Living SF Ext Wall Bid Value Est. Cost New 1 SINGLE FAMILY 1976 6 1,218 1,904 1,218 CONC BLOCK $122,193 $140,857 Appendage / Sgft ENCLOSED PORCH UNFINISHED / 252 Appendage / Sgft OPEN PORCH FINISHED / 112 Appendage / Sgft GARAGE FINISHED / 322 NOTE: Appendage Codes included in Living Area: Base, Upper Story Base, Upper Story Finished, Apartment, Enclosed Porch Finished, Base Semi Finshed Permits EXTRA FEATURE Description Year Bit Units EXFT Value Est. Cost New http://www.scpafl.org/web/re-web.seminole_county_title?PARCEL=102...25&cctr=&ctotal=&cfparcel=10212952117602810&cmap=Y&cdor=&crank=2 Page 1 of 2 Sears Home Improvement Products, Inc. Location:_ , License No. CGC 012538 Phone P.O. Box 5222J0'♦ Longwood, FL 32752-2290 ISEARIS qO mnM Job #: _ E�.M PnOVMb�MEN T l%� Replacement Windopf� _ Name: r Phone: Res 7 J gus. Address: _170 17 44,e �rrg � y— St.: L�zip: Z % 7 �/ City : �:-.- �.-�. . f I/We, the owners of the premises described below, hereinafter referred to as "Purchaser" offer to contract with Sears Home Improvement Products hereinafter referred to as "Contractor", to furnish, deliver, and arrange for installation of all materials necessary to improve the premises located at: (Street) (City) (State) (Zip) According to the following specifications: 1. Remove existing units to be replaced. (NOTE: Removed units are likely to be damaged.) 2. Prepare openings as necessary to receive replacement units. (No finish work other than normal installation i to be done unless otherwise noted below.) 3. Instal) Sears Weatherbeater_ C �S Windows in openings described below to the following specifications: Color: White ❑ Tan ❑ White/Light Woodgrain Interior ❑ White/Dark Woodgrain Interior ❑ Beige/Dark Woodgrain Interior Type: 7 D ❑ SH ❑ 2 -LR ❑ 3 -LR ❑ PW ❑ Other ❑ Other— oty-!3 therQty 3 oty— oty— Qty_ Qty_ Qty— Qty— y 0 ❑Other ❑, Other Qty— Qty— ss ❑Clear ❑ Bronze ❑ OBS F Qty_ Screens: CHECK IF OTHER THAN FIB�LASS Low E2/Argon E3 Gray E3 OBS FUII Qty_ (On Sashes Only) El Alum ❑Tempered Qty_ [3Keepsafe Qty_ NOTE: Tempered glass will be installed to meet building codes. Gnds. Col Sculp of Flat Diamond Top Yes ❑ White ❑ No Tan Full Wd Grain ❑ Bottom Brass 13rt)p Warranty: Manufacturer's Warranty ypon letion. 4. Existing units NOT to be replaced: / a Gr/2�/ X d.,-• 5. If applicable, after completion of project, the application and removal (storage) of shutter panels shall be the responsibility of the purchaser. In the event the project requires the installation of storm shutters or egress windows, Contractor will not re -install any effected security bars. 6. Special in tructions: _ // /vP� 1 �✓ ; n �� l f / J� ei 7t 0- Z", 7. Clean up job related debrls and provide necessary permits and insurance. 8. If applicable, in the event that Contractor is unable for whatever reason to obtain the proper permits prior to the commencement of any work, Contractor shall refund any previous payment and this transaction shall be automatically cancelled. 9. Allow approximately 3-6 weeks for installation. NOTE: THE WARRANTY PROVISIONS AS STATED ON THE REVERSE HAVE BEEN EXPLAINED AND UWE UNDERSTAND THEM FULLY. ADDITIONAL PROVISIONS AND WARRANTIES ARE STATED ON THE REVERSE SIDE AND ARE A PART OF THIS CONTRACT. I X /- Please read the following bold type and initial corresponding line. Verbal understandings and agreements with representative shall not be binding. All understandings and agreements must be set forth In writing in this Contract. Due to climatic conditions, Interior condensation may occur. Purchaser Initials: Ix 42d— The TOTAL PRICE for all Labor & Materials (including any applicable discount) is $ �2 �� ,OO F(Ifa act Price $ Down Payment $ �" 00 Sales Tax (_ %)$ Balance Payable $ �. E� 7` .00 plicable) $Contract Price $ E v t Terms: Credit ❑ (Subject to the approval of the Credit Department) Cash ❑ (Final Payment payable to Installer upon completion) Funded by: Bank: City . Acct 0 1096 Preferred Customer Discount (PCD) awarded for any future Sears Home Improvement Products purchases. Current pricing available for one (1) year. If this is a credit transaction, the agreement for credit is contained in a separate document which is incorporated herein by reference and made a part hereof. VWe the undersigned are hereby authorizing Sears Home Improvement Products, Inc. to verify and review my/our credit record with an independent credit reporting agency and release them from all liability incurred from inadvertent cdnissions or errors. IN WITNESS WHEREOF Purchaser(s) have hereunto signed their name(s) this aJ dayof 20 6 i and acknowledge receipt of a true copy of this Contract and unless otherwise specified, it is understood that the owner is rFtady for work to begin. THIS MESSAGE APPLIES TO DOOR-TO-DOOR SALES ONLY: You the Purchaser(s) may cancel this transaction any time prior to midnight of the third day after the date of this transaction. See accompanying notice of cancellation form for an explanation of this right. Signature affixed below acts as receipt that Purchaser(s) received separate cancellation forms. Isue", TTED :Representative pate Purchaser Date 2�` X507 ACCEPTED BY: Se Home improvement Products, Inc. atv Purchacor Date F7 -SO 09104 DESIGN PRESSURE WORKSHEET For use with Florida Building Code ASCE?-98 Name: �G j,- do— r, Job Number: 470 93,�o OFFICE NOW ME FRONT 4tf 7YIJ __0_ - -- • User: Public User -Not Associated with Organization - Application #: Date Submitted: Code Version: Product Manufacturer: Address/Phone/email: FL5167 08/30/2005 2004 Simonton Windows 1 Cochrane Ave Pennsboro, WV 26415 (800)746-6687 Need Help_? Technical Representative: Chuck Anderson Technical Representative Address/Phone/email: 1 Cochran Ave. Pennsboro, WV 26415 (800)746-6687 chuck—anderson@simonton.com Quality Assurance Representative: Quality Assurance Representative Address/Phone/email: AAMA 1827 Walden Office Square Suite 550 Schaumburg, IL 60173 (847)303-5664 webmaster@aamanet.org Category: Windows Subcategory: Double Hung Evaluation Method: Certification Mark or Listing Referenced Standards from the Florida Building Section Standard Year Code: AAMA 101 I.S.2 I.S.2 1997 Certification Agency: Quality Assurance Entity: Validation Entity: American Architectural Manufacturers Association http://www.floridabuilding.org/pr/P _deti.asp?IPT=5167&RV=O&fin=ROSrch 10/13/2005 h The �Ivr ilat�epai �ent of mmurrity Affdrrs� hlI f /1 bont t l t�ygl'll f U/1 jfS f ei, i lt;Z = Prodi,ctTyne t eta Product Search Organization Product Search. plicationOverview User: Public User -Not Associated with Organization - Application #: Date Submitted: Code Version: Product Manufacturer: Address/Phone/email: FL5167 08/30/2005 2004 Simonton Windows 1 Cochrane Ave Pennsboro, WV 26415 (800)746-6687 Need Help_? Technical Representative: Chuck Anderson Technical Representative Address/Phone/email: 1 Cochran Ave. Pennsboro, WV 26415 (800)746-6687 chuck—anderson@simonton.com Quality Assurance Representative: Quality Assurance Representative Address/Phone/email: AAMA 1827 Walden Office Square Suite 550 Schaumburg, IL 60173 (847)303-5664 webmaster@aamanet.org Category: Windows Subcategory: Double Hung Evaluation Method: Certification Mark or Listing Referenced Standards from the Florida Building Section Standard Year Code: AAMA 101 I.S.2 I.S.2 1997 Certification Agency: Quality Assurance Entity: Validation Entity: American Architectural Manufacturers Association http://www.floridabuilding.org/pr/P _deti.asp?IPT=5167&RV=O&fin=ROSrch 10/13/2005 Authorized Signature: Evaluation/ Test Reports Uploaded: Installation Documents Uploaded: Product Approval Method: Application Status: Date Validated: Date Approved: Date Certified to the 2004 Code.- Page: ode:Page: !'-7 IN Chuck Anderson Chuck-Anderson@simonton.com PTID 5167 1 Frame_ Sash_approval.pdf PTID-5167 I_gold AAMA 40-17 72x60 R35.pdf PTID _5167_1 _ Id HAMA 40-17 2606 R50_pdf PTID_ 5167_ 1_ Gold AAMA 40-17 48x80R30.pdf PTID 5167 1 gold AAMA 40-17 5201 R35.pdf PTID 5167_I gold AAMA 43-17 3604 LC50.pdf PTID _5167y1 profile change to 0709 approval.pdf PTID 5167_1 _ S-101 R3.pdf PTID _516715- I j 5 R3.pdf PTID-__5167_I_-5-116R3.pdf. PTID_ 516_71_S-120R3_pdf PTID__5167_1_5-124R2.pdf PTID _5167 I S-129R2.pdf PTID _5167_I_S-15 5-1 R.pdf PTID 5167_I 5-159-2.pdf PTID-51671 S-166-2.pdf PTIDa5167 I 5-167-2.pdf PTID 5167 I_5-174-2.pdf PTID 5167 I S-190-2R.pdf PTID 5167 1 Simonton Waiver 40- 06etc.pdf Y Method 1 Option A Approved 10/05/2005 10/11/2005 Page 1 /I App/Seq # Product Model # or Name Model Description Limits of Use 07-09 waivers to 07-09 waivers to 75-75 5-75, Reflections see attaches( waiver 500, Prism 36x6O DP = +I- H -R50 167.1 7-09 waivers to 75-75 Platinum, PL 3602 DP = +/- H-LC55 Ultimate, 9300, 52x7l DP = +/- H-LC35 tormBreaker, Non -Impact, Not for use in Vinyl DH HVHZ. 07-75 waiver to 75-75 see attached waiver, Vinyl DH 48x80 DP = +/- H -R35 167.2 7-75 waivers to 75-75 07-75 waivers to 53x74 DP = +/- H -R30 5-75, THD @ 53x80 DP = +/- H -R40 Home Services 36x60 DP = +I- H -R50 http://www.floridabuilding.org/pr/pr detl.asp?IPT=5167&RV=O&fin=ROSrch 10/13/2005 �OOy O l ,_ -�� 10 MODEL nFCIGNA.TION: Simonton Double Hung Series 07'70 5-70 / 07-09 Vinyl Window - 1- x 2" MAXIMUM OVFRAII NOMINAL SIZE: Single up to 52 . 71 Z 2.0" NRRING DRYWALL ..-,'; Ade MASONRY LINTEL MIN. ._ F. k' n_ccln_N PRESSURE RATING: Anchors: PDsitiv, 50.0 PSF Negative 50.0 PSF I?;t � Windows: Design ''ressure Ratings Vary: See N SILICON 1- x 6- , +r`• t ` 1 ,�1 `. n ... 2- . � Correll ,nding A.AMA Test Report or. Dade NOA ;� � FURRING �1L/1f.V'+�rt+� �`• or Florida P.E. Evaluation. "� .. } 1/4- $11111 ;f,(Q + ° p � x 3/1 : T y r b 1'a SARI F rONFlGURAT10N5: X 4 o Z ` TYPE �> %<r ss X STUCCO ( ;� `3; �/�•. E. GENERAL DESCRIP7' ";!L The head and side jambs ore extruded PVC SILICONE r - '• The wall thickness through CAULK DRYWALL which the anchor screw penetrates1/4' MAX. 1 x 6' +v�• `e is a minimum of 0.070-. SHIM SILICONE CAULK 1.! !`. HEADER JAMB INTERIOR SASH TRACK EXTERIOR SASH TRACK INTERIOR SASH TRACK - RAIL EXTERIOR HEAD JAMB SILICONE CAULK STUCCO -� MASONRY SILL 3 1/2 x 3/16 TAPCON TYPE ANCHOR Il�. 1.25- MIN. EMB. SILICONE CAULK z 3 1/2- x 3/16' TAPCON h O 3 TYPE ANCHOR a E g 0 N rn SILICONE CAULK Z ray a STUCCO RTICAL JAMB ° L � O _ u � O m a c SILICONE CAULK I- INSIDE STOOL SHIM 1 x 2- FURRING r DRYWALL Z } O O� U O SASH TRACK I �(4 O ^- 7.625" HOOKABOU LEG SHOWN . SILL OPTIONAL CARIBOU' CD LEG U U W EXTENSION DETAILED. O m m Z Z x.p j NOTE: O 1. This installation has been evaluated for use in locations adhering to the Florida Building Code U and where pressure requirements as determined by ASCE 7 Minimum Design Loads for Buildings Z O and Other Structures do not exceed the design pressure ratings listed herein.- Q LL 2. For installations where the sub -buck is less than 1-1/2- (FSC section 1707.4.4: Anchorage Methods and sub -sections 1707.4.4.1 and 1707.4.4.2) Tapcon type concrete anchors mustbeiused and the � arc 4/12/02 length must be such that a minimum 1-1/4" engagement of the Tapcon into the masonry ;wap js".obtained. SCALE: NTS 3. All interior and exterior perimeter surfaces of the window must be caulked. Deo ar: WLN 4. See Manufacture's Instollation Instructions for additional hardware anchoring if required. aK sr; RW 5. Adjust Topcon anchor locations, if necessary, to maintain a minimum 2.0- clearance from mortar joints. DRO" NO.: 6. When the optional Head Expanders are used the Installer Must Adiust the anchor length to maintain the S-101 required minimum embedment into the substrate. sNccr 1 or 1 CITY OF. SANFORD PERMIT APPLICATION % Permit # : Date: Job Address: Description of Work: Historic District: All* Zoning: Value of Work: S Z Z y Permit Type: Building Electrical Electrical: New Service — # of AMPS Mechanical: Residential Non -Residential Plumbing/ New Commercial: # of Fixtures Plumbing/New Residential: # of Water Closet Occupancy Type: Residential t Commercial Mechanical Plumbing Fire Sprinkler/Alarm Pool _ Addition/Alteration Change of Service Temporary Pole — Replacement New (Duct Layout & Energy Calc. Required) # of Water & Sewer Lines # of Gas Lines Plumbing Repair — Residential or Commercial Industrial Total Square Footage: Construction Type: # of Stories:" # of Dwelling Unit: Flood Zone: (FEMA form required for other than X) Parcel #: ( fes Zo -30- S01" U>CR-)n I0(00 I (Attach Proof of Ownership &,Legal Description) Owners Name & Address: • KQ,r� N At -111e ✓ 2(Q AW f Sal (A= SaHTw� VZ' 3Z 773 ,,`` Phone: CJQ % ' 3(/ Z-•%2 S Contractor Name & Address: �✓S A&WA— :r2mWIe- e=ftlu.k— P.0, (-10>c 5ZZ 24 e% 't S State License Number: Phone & Fax: 1--ntact Person: Phone: �tli1!—bb� Bonding Company: �x Address: Mortgage Lender: Address: Architect/Engineer: Address: Phone: Fax: Application is hereby made to obtain a permit to do the work and installations as indicated. 1 terrify 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 M 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 permit is verification that I will notify the owner of the property of the requirements of Florida Lien w, FS 713. LA" � aSo7 zs Signature of Owner/Agent Date Signaru a of Contactor Agent Dae Print Owner/ ent's Name Print tra Ag ' N e ` N Irl k�S tp of Florida Da SiVnaturc of Notary -State of F o ' Date a:8 Conmvssion 3 "I�itl' iD B � EICp1I8S' Jan 1 I, 2Q0& . MY COMMISSION # DD629096 � Bonded Tluu EXPIRES: February 25, 2011 4111,,`_ . rally wn to Me or Contractor/Agent is �jCttov� 04ftntrmoc Co. Produced ID`L�" _ Produced ID i400 -N APPLICATION APPROVED BY: Bldg: Zoning: + Utilities: FD: (Initial & Date) (Initial & Date) (initial & Date) (Initial & Date) Special Conditions: