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Permit # : 0J� J -D
Job Address: 1701
Description of Work:
Historic District: _
CITY OF SANFORD PERMIT APPLICATION
Date:
Zoning: T1Z • t Value of Work: $ �t Cid �Cyj
Permit Type: Building --IL Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/AIteration 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 V/ Industrial Total Square Footage: cL-1
Construction Type:�NK4 of Stories: I # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #:
Owners Name & Address: SarE'd Airr_
Contractor Name & Address
Phone & Fax:
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
Contact Person:
(Attach Proof of Ownership & Legal Description)
Phone:
State License Number:
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
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T;i naturerpfOwner/Agent Date
Y� M 1J • .l. 'ni iDIn�SAA
(Prpt Owner/Agent's Name
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w6Q wCn Si n t�oNotary-State of Florida Date
Z�gr
ao
tjy0 o
O� Owner/Agent is—V/ _Personally Known to Me or
Qi _ Produced ID
APPLICATION APPROVED BY: Bldg: Zoning
(Initial & Date)
Special Conditions:
CCon :t:o Agent is Per Known to Me or
ced ID
(Initial & Date)
Utilities:
FD:
(Initial & Date) (Initial & Date)
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LIlVIITED POWER OF ATTORNEY
I hereby name and appoint
Of �r-. \.0C- k C ��.r�s� cvc�<<�� _Lc) 1 -
Date: O VA()q
to be my lawful attorney
in fact to act for me and apply to (:;:,a n�o 4 for
a C bo permit for work to be performed
at a location described as: Section_ Townships Range `?� ( c�
Lot Block Subdivision P� c J044
(Address of Job)
of Property and
and to sign my name and do all things necessary to this appointment.
Acknowledged:
Sworn to and subscribed before me this
Ll Day of 41 n U A.D. on U
Notary Public, State of Florida
(Seal)
My Commission
Expires• CG
SHERRIE L. NICHOLSON
Notary Public, State of Florida
My comm. exp. Oct. 5, 2007
Comm. No. DD 255515
Permit Number ;
Parcel Identification Number
Prepared by:
Papered By & Rob
Robert P. Bailey►
P.O. Box 9M 1
Return to: Lake Mary, F9ot9d
JCX)1-UUl U—
i To:
32795-0821f
NOTICE OF COMMENCEMENT
State of -V\QcC &Cl
County of c)�.
1101I1INli981poll 11loll 1muioluiII1911911 WiIf11f11191
14ARYMM MORSE, CLERK OF CIRCUIT COURT
SEMINOLE COUNTY
HIS 05504 FIG 1542
CLERK'S # 2004170718
RECORDED 11/04/R004 12t17ii57 RM
RECORDING FEES 10.00
RECORDED BY 8 O�Kelley
CERTIFIED COPY
WRYANNE MORSE
CLERK OF CIRr1!':T COURT
S NTY. FLORIDA
BY
TY CLERK
NOY -- 4 2004
The undersigned hereby gives notice that improyement(s) will be made to certain real properly, and in accordanc.
wilh Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement,
1. Description of proper (legal d
Lec) S-erz o(o Twp 2C�S
2. General description of Improve
�,e-woo ,
3. Owne Information
Namen��
Addressl-)�)U leC L. `
4. Fee Simple Title Holder (if other
Name �--
Address
5. Contractor
Names ,\-eX- UC
Address C)
6. Surety (if any)
Name
Address
7. Lender (if any)
Name
Address '-
8. Persons within the Slate of Florida
served as provided by 713.13(1)(
Name
Address
9. In addition to himself or herself, O�
providin §713.13(1)(b), Florida
Name . 6c)O(A.
AddressL\\tea
10. Expirations date of notice o coni
unless adifferent date Is specified)
/
Date Signed
Sworn to and subscribed before me this _
who is personally known to me O
as identification.
a.0014� Mafcena Bz
My'commis:
NoF rpl Expires May
I !
sr,r �lion bf l e property, an slree address if avail ble)
'.CsC' 31e OG t-�tztc� ct
,o?) st
�� -6)-M
nent(s)
)C,40 f Telephone Number 40 7•C
v�C, v� ^ (CMCJ a
Fax Number
3�i� Interest in Property:: "' w lQ>
ian owner shown above)
Telephone Number
Fax Number
CO Telephone Number � 3C -n-()()(,,
Fax Number
3�J C) dal
Telephone Number
Fax Number
Amount of bond S
Telephone Number
Fax Number
designated by Owner upon whom notices or other documents may be
3)7., Florida Statutes.
Telephone Number
Fax Number
ler designates the following to receive a copy of the Lienor's Notice ;
talutes.
Telephone Number l-� V -� - -� (-j Ct -CX) 6
Fax Number _-3,Un -OG j- (,
nencement (the expiration dale is one year from the date of recordirn
signature of Uwner Vie: per §713.1307(g), "owner
must sign ...and no one else may be permitted to sign it
his or her stead." /-+'c,n IL
day of !ij 20e-�)-_ by
_produced
DD121761 Signature of Notary (notarial seal tor below)
2006