HomeMy WebLinkAbout110 Drew Ave (3)4;
Permit #
Job Address:.Gi�c�Lc��N�r�
Description of Work: .e� Ae /W
Historic District: Zoning:
Permit Type: Building Electrical
Electrical: New Service - # of AMPS
Mechanical: Residential Non -Residential
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets _
CITY OF SANFORD PERMIT APPLICATION
Date: Id T
Value of Work: S
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
Occupancy Type: Residential _'Y,- Commercial Industrial _
Construction Type: / # of Stories: _ / # of Dwelling Units:
Plumbing Repair - Residential or Commercial
Total Square Footage:
Flood Zone: (FEMA form required for other than X)
Parcel #: a3 - ��� I-/n� o�� j!94::�CW. " �� (Attach Proof of Ownertshhip & LegalDescription)
AOwners Name & Address: h R f- 0 a v, c� S o w F l o Q P Q,.,> A J-0- S A tv l- p (l 1 (=1 � 3 2-1 T 1
Phone:
Contractor Name & Address:
Phone & Fax:
Bonding Company:
Address:
Amortgage Lender:
Address: 1'
Architect/Engineer:
Address:
State License Number: /L C -Oa La G-- /.;,/-
Contact
.;CContact Person: �/1/✓% Phone:
nti .c ('*v'\ c) Q V G -A,
D r- <
Phone:
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.
Acceptance of permit is verification that I will notify the owner of the property of the requirements f Florida Lien L FS 7Al�.
ignature of Owner/Agent ( Date S' nature Contractor/Agent Date
R UC-
t Owner/Agen d Zi Print Co ractor/Agent's Name
Signature of Notary- t jdaTr Clayton Jr Date Si tary- o a ate
MY COMMISSION # DD 188491
CMY, Co��mmission WISS519 EXPIREB: February 25, 2007
� p E*kn � 17, 2007 t ap03NOTARY Pt- Notsry Ciscount Assoc. Co.
Groduced
gent is w Personally Known to Me or Cot nt rs^—�� PerSafia nown to Me or
ID _ Produced ID
APPLICATION APPROVED BY: BIV ILy'zJt
(Initial & Date)
Special Conditions:
(Initial & Date)
Utilities:
FD:
(Initial & Date) (Initial & Date)
LTN\LV O!.
V NAME: !�,lr, Building& Fire dnspecto,
' ADDRESS. ASEnutio 11101 East I" St:
r �. itl)YIILI3N�Z:q�lClfOlCi Sanford, FL 327.
NOTICE OF CONCEMENT
State of Florida County of Seminole
Permit No. Tax Folio No. (PID)
The undersigned hereby gives notice that improvement will be made to certain real property_ and it. accordance with Chapter
713, Florida Statutes, the following information is provided in this Notice of Commencement.
DESCRIPTION OF PROPERTY (I.egat description of the property aad street address)
�L 3o-7-71
GENERAL DESCRIPTION OF U*IPROVENENT
OMINM INFORMATION.
y -Name and address (Lit t`�e v
Interest in property (Fee Simple, Partnership, etc.)
110 0(Z --k,, Au S)
WlFn Do"
.�a RK (W c,Rcurr odd
,.
• - ul c I -M4
HERE In OW,wat� Ali ai . '
.i fill
NAME AND ADDRESS OF FEE SIMPLE =E HOLDER (IF OTHEAb gMAWHNNE M) CURT
BK 05491 PG 0141
-- CLERK'S # ;✓'C>Ci4163431
RELUNUED 10/21/2004 lla29W AN
CONTRACTORRELONOiN8 FEES 10.00
?dame and address RECUR I) ftK i n 1 e
Oqle,
SURETY (Bonding Company)
Name and address
A -mount of Bond
LENDER
Name and address
14 LA Ui 0,2�s 3o
Persons within the State of Florida designated by Owner upon whore notice
0 -other doamtents may be served as provided by Section
7I3.13(1)(a)7., Florida Statutes.
Naive and address
Persons within the State of Florida Designated by Owner upon whom notice or other documents may be served as
provided by Section 713.13(1)(a)7.,Florida Statutes:
r Mame and address:
In addition to himself Owner Designates of
To receive a copy of the Lienor's Notice as
Provided in Section 713.13(1)(b), Florida Statutes.
Expiration Date of Notice of Commencement
(The expiration date is 1 year from date of recording unless a different date is specified.)
Signature of Owner
Aj
worn to and su "bed before me this Day of
My Commission Expires: ,y+ Twner
_ C_..IaYton. Jr
Notary Public' W comml"on DD18tib19 .
I
g /y
F1 Ot h(YOM Y 17> 2007
foin
o�'nst��eat was aclaao ledged before me this�dayof � ✓✓ ° b�
=e of person acknowledged), who is Perso Zknown to me or who has
produced (Tyne of identification , as identification and who did/did not take