HomeMy WebLinkAbout2415 Summerlin Ave (2)1 _ CITY OF SANFORD PERMIT APPLICATION
Application # : 0 Submittal Date:
Job Address:
X4(5 SSI Mer I )n) f- w SW(; rd Value of Work: $ FA 5q .
Parcel ID: } j ice, Zoning: _n Historic District:
Description of Work: -ShVilalf- GA.�......�.yr•. fCh...............................................
.............Square•Footage:..a3yo•
J z
Permit Type: Building CJ 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 1 Commercial ❑ Industrial ❑ Occupancy Use Group(s):
Construction Type: # of Stories: —I # of Dwelling Units: �_ Flood Zone: (FEMA form required)
...
......... ..... .............................................................. . .....
Property Owner: � J_ Contractor. & i' ) NL
Address: 1 t,
Sym r * Address: Z�2o � AJb �
N F ► . ----- ns��3 to r �L
Phone: 0] — 32 �( 'd2 �l{E-mail: Phone - ` MY State License NumberC� 1321C_1 79�
Bonding Company:
Address:
Mortgage Lender:
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. 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 is verification that I will notify the owner of the pro ty of the re uiremen of Florida Lien Law, FS 711
ignature of Owner/Agent Date Si ature o 'C actor/Agent Date
Print Owner/Agent's Na,e Print Contractor/Agent' Name
cs
Signature of otary tate of Florida Da Signature of Notary FloridaNOTARY PUB 5 CITE OF FLORIDA
NOTARY PUBU&STATE OF FLORIDA We:. Sanborn
Wendy Sanborn ` Comm s3;on #DD400982
Commission 7 DD400982 Expire(;: FEB, 28, 2009
Expires: FEB. 28 ?pOq Bonded Th Atlantic Bonding Co,, Inc,
*mjiul� � t$ C�, 1t"rio, n to Me or Contractor/Agent is Personally Known o e or
roducedID Produced ID
APPROVALS: ZONFNG:
Special Conditions:
Rev 07.07
UTIL: FD:
ENG:
BLDG:
WT i
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PE12A!t1T NO. TAX FOLIO NO.
STATE OF:FLQ L�
COUNTY O*,f�
i N
THEUNDE12SItiNED hereby gives notice that improvement will be made to cel rain real property, and in accordance With
Chapter 713, Florida Statutes, the following information is provided In this Notice of Commencement.
[ Description ofproperr (legal description of the
property and street address if available)
?: Gezier�l descriptioiz of improvement: IZER001'
3 Owner information:
a Name z,nd address ` 7 7
L) Interest in property0. ua 1�16
IVanie and address of fee simple titleholder (if other than owner):
4. Conti actor ((Name and address) Bill Jack Inc. 5570 7211d.Avo. Pinollas Park, f-L 33751 Lic.#CCC7325799
5. surety:
a) Narne and address:
b) Amount of bond
- --- .... ... _ _ .......
6. Lender (Natn.e
and address): -—
7. .Persons within. the State of Florida designated by Owner upon whom notices or other documents may be sen, ed as
provided. by Section 713.13 (1) (a) (7).; Florida Statutes (Name and address)
S. in addition to himself, Owner designates of
------ - - — _ -- — - —
to ie=M' a. copy of the Lied or Notice as provided in Section 713.1391(1) (b)Florida Statutes,
__
9. expiration of date of notice on commencement (the expiration date is I year from the date. of.rec rding wiless a
different date is specified):
o'.,..._,.,_ /_�...._.�...%- f,� .._—. +C� ..�r-..�
(Signature ...fC7wvnerJ _. �L /,���� /`�' 3 ,)5 9.P
STATE OF FLORIDA
COUNTY OF , M fN
The foregoing Instrcrment vtirnowledged before rze thls day of 2l`0_bY
pz'aduced __ _ a (1 `C' as identification Idwho loci tare an oath.
Sip attire' of Nota __...�_ — My commission expi.re5 � � _1'ri
Name .N-0G
TitlercetPj&Prepared Pd By: Bill Jack Inc..58 /0 72nd Ave P' ella Park, FL. 33741
-.f?,`rW Vii.
MARYANNE MORSE, CLERK OF CIRCUIT COURT
CLERK OF--SEMINQLE--CB®NTY---=-=- - CEL2iIF1ED :COPY
PK 05742 Pg 1000; i 1 pg) q Woa.ei,,as,ory euuoi� es�o-eevl�a
;+iiAY}�:�../JrSE oloz'r'uer:saalaxn
FILE NUM 'c^t2112i709490a CLERK Or vl'i il Cl?Ul2T 91MiUO#NOISSIWWOOAW
RECORDED @6/c8120@7 11:06:25 AM S��n1NG. L CI° <� t. Fl ORID� xDt+r n►mda �,e
RECORDING FEES 10.00
RECORDED BY H DeVore
oFPury CI_.-Rir
Illl {ill {9111 II Ili 11111 II !li 9119111901 II 111 II 119 II lR 91 1111 I " JUN 2 8 2001