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Home My WebLink About1168 30 St (2)(,, 7 CITY OF SANFORD PERMIT APPLICATION Permit #: 0 �" r � J Date: Job Address: a-1-1 A Description of Work: (t - (()f Historic District: Zoning: Value of Work: $ 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) o ,a, 3 a»lo Parcel #: ®� O ` w D Attach Proof of Ownership & Legal Description) Owners Name & Address: 50c11-Gc-d NVu Pot --i- P t .-_*kGf �+,/ , 1 .00 _�&V'd,– Contractor Address: Mortgage Lender: Address: Architect/Engineer: LA 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 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 iim Florida Lie r Law, FS 71 Signature of Con`tractor7Agen ? Date 3 +� A f Gcc6es %,.-r Pri ontractor/Agent's Name x � C A�919719- Signaturep of Notary -State of Florida Date m 3 o � �� O Contractor/Agent is rI .onally Known to Me or Produced ID Utilities: FD: ",-" f .� F•' (Initial & Date) (Initial & Date) Special Conditions: (Initial & Date) (Initial & Date) CA -05 z 10-1 _ Si�re of Ow`r/Agent Date v, r M o �(t i�dnn sYr��Dn CZ g ,, Print Owner/Agent' am C,Si V VDaft gnature of otary-State da 0 O Owner/Agent is _ Personally Known to Me or r64, —Produced ID �}CATIONAPPROVED BY: Bldg: Zoning: iim Florida Lie r Law, FS 71 Signature of Con`tractor7Agen ? Date 3 +� A f Gcc6es %,.-r Pri ontractor/Agent's Name x � C A�919719- Signaturep of Notary -State of Florida Date m 3 o � �� O Contractor/Agent is rI .onally Known to Me or Produced ID Utilities: FD: ",-" f .� F•' (Initial & Date) (Initial & Date) Special Conditions: (Initial & Date) (Initial & Date) AFFIDAVIT REGARDING ROOF DRi' -IN AND FLASHING INSPECTIONS 41111141M !''I"AIM01111712 Q62 License #:-0- __o (i g' q 5 Project Information Owner:,s m Ig U el° l o 4_14) my -441 S Permit #: name a3lo (n,,,e S4-, SE "anAA 4A.3XM Subdivision: 5w4)r[ t P fo�(-� address Lot #: phone, I, C�- i , affiant, hereby affirm that I am the duly licensed contractor of record for thd above referenced permit, that all the foregoing information is true and accurate, and that the dry -in, flashings at the above referenced address or lot has been installed in accordance with the applicable codes and standards. Contractor: printed name STATE OF FLORIDA COUNTY OF O 00.0 -- This instrument was acknowlecLaed before me this a% day of d.VL , 206%-, by the above referenced individual, Oe , who acknowledged that he/she is a duly licensed contractor with 1 , and who acknowledged that he/she was authorized to execute this document. He/she is eithown to me or produced as valid identification. WITNESS my hand and seal this �� h day of _, 2 Notary Public CdA" Lisa Manch %- My Commission DD357981 and Expires September 26 2008 POWER OF ATTORNEY Date: I D- CL- os I hereby name and appoint MA M ,nz PA i(6 S(n of �ieS �-ti'j(O*(S &A (Q to be my lawful attorney in fact to act for me and apply to the l -k4 or S A(1 ft) CA Building Department for a (-p - r(pr permit for work to be performed at a location described as: Section Township Range Lot Block Subdivision (Address of Job) A11� (Z l a! (n.n l r (1 i�iP S 936 S E Hi'WW� �sA (Owner of Property and Address) 3D. -173 and to sign my name and do all things necessary to this appointment. Type or Print Name of Certified Contractor and Contractor's License Number The foregoing instrument was acknowledged before me this�� day of 20 OS by who is personally known to me/who produced as identification and who did not take oath. State of Florida County O ca _ Notary Public, Orange County, Florida x.00 Lisa Mwsh My Commission 00357981 rvdP Expires September 26 2008 Seal • h+ �:. ice.. v. { - THIS INSTRUMENT PREPAREil3%Y'. --%,T. J F COMMENCEMENT NAME Permit No.�-`... Tax. Folio No. State of Flori v County of Sem 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 the property and street address if available) act- 3l - 300- Cbl 0 - onci A I I lof 3� S+. 2. General description of improvement: -( - 3. Owner information I ll Tc a. Name and address 4 �— f alb fed Llevelaw� Qlvci. FL b. Interest in property c. Name and address of fee simple titleholder (if other than Owner) 4. Contractor La. Name and address ( S 5N H -Amp -S Pik �Ybqripin, P-1. -r�N65 b. Phone number (LI JUSD - Fax number 4n LPSD - 00 Ito 5. Surety CERTIFIED COPY a. Name and address N �� IWARYANTKir mnint-r- CLERK OF PIRCInT nn,e— b. Phone number Fax number SEN IN 0! F rnll Iry i,.,.. c. Amount of bond cs.� 6. Lender -- � -- ( EP i Y a. Name and address t V /A CLERK b. Phone number Fax nianber - , t. LVUjj 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes: a. Name and address Larry A. DC�I_e , Presidar�CD, SC�trc�acd'Psirt�h At.l�r�-%y l �b0 t2>zc1 Ct�v�e l[ nd l -or,A FL 3 2073 b. Phone number L14 6Z S 8 S- 4 pdZ Fax numberd� 5$ S 5 8. In addition to himself or herself, Owner designates I�rek W d i nk+ of Sht is � Bouttn, LLP to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. a. Phone number (Liq tl t% -a 3 - 3 � Fax number 9. Expiration date of notice 6fcommencement(the expiration date is 1 year from the date of recording unless a different date is specified) i Crew VICA-t'res. o� AGlmi �S-%ra i&k Sign6ture of Owner Sw to(or affirm andrsu!gcribed before me this -day of®�' '20 by Personally Knosaua —k—OR Produced Identification I R �� QUIT Type of Identification Produced SENWE CUM Signature of Notal'yT Commission Expires: Ann Q Gifford MYCOMMISSION# DD105515 ESS lul 14,1006 , p BONDED TNRU TROY FAN INVANKE I(C BK 05946 PC, ] 32-9 `E�i3£tI,co lt1llm"pW 1L:161% FSB REU31Z1X--D 6Y l holders