HomeMy WebLinkAbout131 Anthony DrPermit#: O 5- (4 J-7
Job Address: %�1 AQ
Description of Work:
Historic District:
❑9
631
CITY OF SANFORD PERMIT APPLICATION /
Date: /( / -/V
/5 of 4XI LI . AjD Oak -T lW VI'�Il
Zoning: Value of Work: $ _6 7�a -UO
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarni Pool
Electrical: New Service - # of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential V Non -Residential Replacement New (Duct Layout & Energy Cale. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential # of Watt Closets Plumbing Repair - Residential or Commercial
Occupancy Type: Residential i/ Commercial Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel 0: /0 C90 3® 000t) 0/470 (Attach Proof of Ownership & Legal Description)
Owners Name & Address:
3rinn7% Phone: 'ice /" ,303—
Contractor N e &A!tet_[ ddress: /2 t -eS�L a SO QS
CIeub 2L {e!2 3,;,7707 Statatte�LLicense Number: i! o/ O '7��2,149 I !�
Phone &Fax: U'1- S37 .9131—� intact Person:���
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 pennit 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 maybe fou ' the public records of
this county, and there may be additional permits required from other governmental entities such as water manage>Law,
cts, sta encies, or federal agencies.
Acceptance of permit is verification that T will notify the owner of the property of the requireme a Liel3.
Signature of Owner/Agent Date Sig tune o rc
t tor/Agent Date
��ee V
Print Owner/Agent's Name rint tract r/Agent's N ne
y
Signature of Notary -State of Florida Date Signature of Notary -State of Florida al
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Owner/Agent is _ Personally Known to Me or Contractor/Agent is _^Aels(M lly K ii f t I
Produced ID _ Produced ID
APPLICATION APPROVED BY: Bldg: _ Zoning:
Initial & D (Initial & Date)
Special Conditions:
Utilities:
FD:
(Initial & Date) (Initial & Date)
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3a-773.-
Permit Number_
Parcel Identification Number
Prepared by: '
Return to:
NOTICE OF COMMENCEMENT
State of
County of
MARYANNE WORSE, CLERK OF CIRCUIT CUT
SEMINOLE COUNTY
BK 05521 PG 1014
CLERK'S # 2004179166
RECORDED 11119/2004 091in>142 AM
RECt]RDINS FEES 10.00
RECORDED BY t holden
CERTIFIED COPY
MARYANNE p,"ORSE
CLERK OF CIRCUIT COURT
SE OL COUNTY, FLORIDA
BY
?004
The undersigned hereby gives notice that improvement(s) will be ade 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)
;t6>? P14
2
3.
4
7
General description of improvements)
o �1� s ys_
Owner Information
Name 7:::)jr—ye-� '/50 Telephone Number
Address Fax Number
Fee Sim le Tit a olde—;'t�73 Interest In Property:
p (if other, than owner shown above)
Name Tele ho�e_ti
Address ax Number
Contractor
Name A-� 4-10,0
Address of a�zs
Surety (if any)
Name
Address
Lender (if any)
Name
Address--�
Telephone Number t y_ �-3 / - 3 6 00
Fax Number
X07_ gzi- 4Lss.3
plitme Ivumoer
Fax Number
Amount of bond $
Telephone -Number
F umber
8. Persons within the State of Florida designn y Owner upon whom notices or other documents may be
served as provided by §713.13(1 aY, Florida Statutes.
Name Telephone Number
Address Fax Number
9. In addition to himself or herself, Owner designates the follo ' to receive a copy of the Lienor's Notice as
provided in §71�3.13(1)(b), Florida Statutes.
Name Telephone Number
Address Fax Number
10. Expiration date of notice of commencement (the expiration ate is one year from the date of recording
unless a different date is specified): 1 �/ a
of
Da igned Signature of Owner Note: per 713.13 1
[_.__ p § ()(g), "owner
must sign ...and no one else may be permitted to sign in
his or her stead.'
Sworn to and subscribed before me this /% day of 1VD0
20,91/
by
Q . -CLS
who is personally known to me OR produce
as identification.
Signature of Notary (notarial seal to appear below)
Form Revised: 12100 for 19 to 20
,.
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Novern` e E, 2c95