HomeMy WebLinkAbout112 French Ave_ J CITY OF SANFORD PERMIT APPLICATION
Permit # : OS O Date: �� ✓� L/
Job Address:
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Description of Work:
Historic District:
Zoning: Value of Work: $_ ;�, 9/ 51) - C"o
Permit Type: Building Electrical Mechanical ->!L 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 X Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than x)
Parcel #:
Owners Name & Address: _
&2 66)( (F;2 -?CC
Contractor Name &address:
Phone & Fa - / ( 7^[6
Bonding Company:
N
y—
(Attach Proof of Ownership & Legal Description)
Phone: �.�� ��
is J `e -c. ,2.��/a
t C V I Uf !i cc + 310 3 State License Number: CR c C>
3 "3 d' Contact Person: 6� 61,110Q—
Address:
1,110
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 laww regulating
construction and zoning. WARNING TO OWNER- YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT 114 i`MTR, 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 add' ' nal permits required from other governmental entities such as water management districts, state agencies, or federal agencies.
ce o it is verifi o that I will notify the owner of the property of the require of Flori a Lien FS 713.
Q) 00 c7
t- c t Si to a of wner Date Signature of Contractor/Agent Date
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ContraodAgent's N ne
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Date Signalure of Notary -State of Florida Date -- - -
C```ont/tr///raa���ctor/Agent is ersonally Kno�(n to Me or
r -e cd ID �''\U`b
TION APPROVED BY: Bldjkau- /D) WRI91 1 UdGries:
(Initial & Date) (Initial & Date)
Special Conditions:
FD:
(Initial & Date) (Initial & Date)
c
Print ner/A ent's Name
40 E q:
E
Sig ature of No -State of Florida
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Owner/Agent is _ Personally Known to Me or
_ Produced ID
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ContraodAgent's N ne
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Date Signalure of Notary -State of Florida Date -- - -
C```ont/tr///raa���ctor/Agent is ersonally Kno�(n to Me or
r -e cd ID �''\U`b
TION APPROVED BY: Bldjkau- /D) WRI91 1 UdGries:
(Initial & Date) (Initial & Date)
Special Conditions:
FD:
(Initial & Date) (Initial & Date)
't✓�_rmit Number
Parcel Identification Number
Prepared y:
Retum to: L61% P
i /z w r l �,� -T7-1-7 c S, r c. ze 3 7
NOVICE OF COMMENCEMENT
State of
County of L it:-
i iaat to Ila a au a not a ala at as In all at all 11 lea at Ila In all 11181
MARYANNE MORSE, CLERK OF CIRCUIT COURT
SEMINOLE COUNTY
BK 05495 PG 0467
CLERK'S # 2004165716
RECORDED 10/26/2004 01:58:26 PM
RECORDING FEES 10.00
RECORDED BY t holden
YdARY, NNIF— N4
,01AGE
y
C}t'� `1t�NTY iii'
'QCT `2 6"20N
The undersigned hereby gives notice that improvement(s) 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 the property, and street address if available)
2. General description of improvement(s)
3. Owner information iI
Name /ne-Da�AVC� S C--Im
RrOXe-all TelephoneNumber (� o
Address P, 0: ?6X !kQ 7 6 C Fax Number
q3 ' /,? Interest in Property;
4. Fee Simple Title Holder (if other than the owner shown above)
Name Telephone Number
Address Fax Number
5. Contractor y
Name el6 �}�L Telephone Numbe
Addressz,� 110 C
; Fax Number _ c
S , i, C3 5 Z� 3 2 �( 3 ` -
6, Surety (i any)
Name �,J/ Telephone Number
Address ( Fax Number
Amount of bond S
7. Lender (if any)
Name Telephone Number
Address Fax Number
8. Persons within the State of Florida designated by Owner upon whom notices or other documents maybe
served�,s provided �y §713.13(1)(a)7., Florida Statutes.
Name hrN%5 Telephone Number L401- 3 3b- 0-1 U L,,
Address[ 1.a �t�,�jn C.%� � • � Fax Number Lt p b '1 Lo 3
9. In addition to himself or herself, Owner designates the following to receive a copy of the Lienor's Notice as
provided in §713.13(l)(b), Florida Statutes.
Name / Telephone Number
Address f [/ Fax Number
10. Expiration date of notice of commencement (the expirati n date is one year rom ie date ofymording
unless a different date is
specified): A. L
I
I V114 A
Date Signed Si e of Owner : p 713 , "owV'znir
must sign ...and no one else may be permute
hisor her stead."
Sworn to and subscribed before me this day of 6 L7a� 6a 20 6 by
efHRI.s ff X Y
who is _personally known to me OR produced
as identification.
XP
JPy'pGi Kathryn M. Grosse
,oe%,
=. :=Commission # DD284687 Signat e of N't ry (notarial seal must appear below).
=;� Expires February 23, 2008
Form Rcviscd; 3/04 """ Bonded Troy FWn•Insarmce,ft. 900385-7019