HomeMy WebLinkAbout101 Upsala Rd (2)\� Permit # : y
Job Address: ktA r 6 NI— R
Description of Work:
Historic District:
Zoning:
CITY OF SANFORD PERMIT APPLICATION
Date:
Value of Work: S_ L-0 % � RA , Z;�)
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 #: )�-`q-�� �a(� .. (\'1,2D (Attach Proof of Ownership & Legal Description)
Owners Name & Address:
tt1„y,��
\L` 1, S OrL& ` Kn P'N`�7 me �L Z�1� Phone:
'
Contractor Name & Address: W �)yl,�y., � % l�%�S bL 1� i���tir'�=�`"✓
L ��'� State License Number: _
Phone &Fax: � � ZZ . 'J 4 l) Contact Person: pm.—. -
Bonding Company:
Address:
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. 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: tavm t- ., acing
construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT n4 VMTPt. €'hYING
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.
AcceptanASignature
rification that 'll notify the owner of the.property of the requirements of Florida Lie w, FS 713.
i( a-
ne / ent Date Signature of Contractor/Agent Date
Print caner/Ag t ' Nam nt ContractodAgent's Name
i �l®ti� �nate
zooy OV
.... I��,3� v y
e o ota - to of Honda Icy Commist�onSignature of Notary -State of Florida Date
1 , P®brWy 1$ 2=
O.,vner/Agent is _' pPersonally Known to Me or Co tractor scat 's _ ersonal t e or
AZ Produced ID FFS�L # ��ZQ-11514 Oq O l7 ID „
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MYCOMMISSION# DD 188491
APPLICATION APPROVED BY: Bid13 Zoning: °' �eSXPIRES: February 25,200 FD:
(Initial &Date) Initial & D ARY F'
( (I�14' M &-43ate}75soc. co. Initial &Date)
Special Conditions:
"2063 NOT-FOR-PROFIT CORPORATION
---idNIFORM BUSINESS REPORT (UBR)
DOCUMENT # 700493
1. Entity Name
-_'
�\
UPSALA PRESBYTERIAN CHURCH INC
�/
` �\'�
Principal Place of Business Mailing Address
UPSALA ROAD & WEST 25TH STREET 101 UPSALA RD
SANFORD FL 32772-1526 SANFORD FL 327711
US us
I IIIIII ILII VIII III�I ILII VIII IIII ILII VIII VIII ILII VIII VIII IIII
XCHECK HERE IF MAKING CHANGES
2. Principal Place of Business
3. Mailing Address
Suite, Apt. #. etc.
Suite, Apt. #, etc..
City & State
City & State
4. FEI Number 59-2349093
1 1 Applied For,
I I Not Applicable
—TCountr
Zip
Country
I
Zip
y
5. Certificate of Status Desired El $8.75 Additional
I
I
Fee Required
6. Name and Address of Current Registered Agent
7. Name and Address of New Registered Agent
Name
G, e 9 6, in Nn s
GANAS, ELIZABETH
Street Address IP P.O. Box Nu ,bgr is Not Acceptable)
215 RIDGE DRIVE
SANFORD FL 32773
citycle
t� elx
8. The above named entity submits thisAatement for the purpose of changing its
registered office or registered agent, or both, in the State of Florida. I am familiar with, and accept
the obligations of re
-3
SIGNATURE
Signature, typed or pr name of registerej agent and title it applicable, (NOTE:
Registered Agent signature required when reinstating) DATE
F ILE NOW FEE !S $61.259. Election Campaign
Financing $5.00 May Be .6ake'ChecWP5yabId,to,'-,
Trust Fund Contribution. El Added to Fees Florida. Department of State' -'r:-:'
10. OFFICERS AND DIRECTORS
11. ADDITIONS/CHANGES TO OFFICERS AND DIRECTORS IN 10
TITLE
VD 0 Delete
TITLE
V El Change �KAddition
NAME
WILLIS, BEM
NAME
STREET ADDRESS
2W MIRROR DRIVE
STREET ADDRESS
!-A %( It - ftw%
CITY -ST -ZIP
SANFORD FL 32773
CITY -ST -ZIP
TITLE
NAME
TDelete
PENNINGTON, JAMES F
TITLE
NAME
0 ❑ Change Addition
fte'r 1 111 tr". DL -'W -r%
STREET ADDRESS
300 TEMPLE DRIVE
STREET ADDRESS
i I rG co 'A P—
CITY-ST-ZIP
SANFORD FL 32771
CITY -ST -ZIP
C
- ;) A�[
TITLE
NAME
P Delete
GANAS, ELIZMETH
TITLEChange
NAME
Addition
LL*,
STREET ADDRESS
215 RIDGE DRIVE
STREET ADDRESS
'YALL
161� �(' W aLk
CO -ST -ZIP
SANFORD FL 32773
CITY-ST-ZIP<6
TITLE
D ❑ Delete
TITLE
ID El Change ?Wdition
NAME
O'BRIEN, GRACE
NAME
F.,A7 Fie tA,
STREET ADDRESS
476 ROSALIA DR
STREET ADDRESS
U'A
CITY' -ST -ZIP
SANFORD FL 32771
CITY -ST -ZIP
TITLE
DDelete
TITLE
El Change E] Addition
NAME
FRYSINGER, RUSTY
NAME
STREET ADDRESS
412 TANGELO DRIVE
STREET ADDRESS
CITY -ST -ZIP
SANFORD FL 32771
CITY -ST -ZIP
TITLE
❑Delete
TITLE
Change >�Addition
NAME
NAME
STREET ADDRESS
21
CITY -ST -ZIP
—S'j , G �l 0 F4-32- 7 7.1
CITY -ST -ZIP
12. 1 hereby certify that the information supplied with this filing does not.qualify for the exemption stated in Section 119.07(3)(i), Florida Statutes. I further certify that the information
indicated on this report or supplemental report is true and accurate and that my signature shall have the same legal effect as if made under oath; that I am an officer or director
of the corporation or the receiver or trustee empowered to execute this report as
required by Chapter 617, Florida Statutes: and that my name appears in Block 10 or Block 11 if
changed, or on an attachment wit n addr with all other like empowered.
SIGNATURE:
D
U
\1
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0
' Permit No.
Tax Folio No.-�5-"-ih -
Notice Of Commencement
STATE Of C �j
COUNTY OF S�lh l t101�
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.
1. Description of property: (legal description of property, and street address if possible).
%k Q�NA K0 coff
KARYANNE MORSE .
I s�EAK OF CjRfU1T COLM
csaHaaenl c d.�di. FEURPDB
2. General description of improvement: ...�---
3. Owner Information:
a. Name and Address:
l o t c r X T
S Rr�� a1�0 iF� 3ti11 ` m
rry= 7 v 5 �.
IV Ln m
b. Interest in property: �,�, s y `p i m °� ... U? @ n
'<r�*ta w��
C. WMf►�r
Name and address of fee simple titleholder (if other than owner): en w
P
4. Contractor: (name and address)Ln Ln rl
rpi Z �Iti S , %+nA(rrL8� F�U�CD
ro NJ
�z713
5. Surety:
a. Name at E+Lddress
b. Amount of bond $
i6. Lender: (Name and Address) � d
7. Persons within the State of Florida esignated by Owner upon whom notices or other documents may be served as (provided by
section 713.3 (1) (a) 7., Florida Statutes: (name and address)
8. In addition to himself, Owner designates the following persons (s) to receive a copy of the Lienor's Notice as provided in Section
713.13 (1) (b). Florida Statutes: ( name and address)
9. Expiration date of notice of commencement (the expiration date is 1 year from the date of recording unless a different date is
specified)
w o and subscribed before me this (�
y of 20D (Signa hire O er)
1AS 4ec� %1 7
(Signature ofNoblit ( Owner's ame)
Marie Lola Remota 10k Ursa ( A
My CornmissiUn D0292VO%-y S �r� a2 -
THIS
2THIS INSTR . MENT p or Expires Feft6ry 18 2M ( Owners Address)
R�PARED ft. �
NAME
ADD ��lr. Ae—