HomeMy WebLinkAbout184 Edgewater CirPermit #
Job Address:
CITY OF SANFORD PERMIT APPLICATION
O�J I S Date:
Description of Work:
Historic District:
Permit Type: Building Electrical
Electrical: New Service — # of AMPS
Mechanical: Residential Non -Residential
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets _
Occupancy Type: Residential Commercial
Mechanical PlumbiT12 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
Plumbing Repair — Residential or Commercial
Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: c (Attach Proof of Ownership & Legal Description)
Owners Name & Address: �%i-IV / VA,-tP. J 1?—!d �1�6D � ��>v�f✓ cLirc
</1 -NJ :3a-713'-- Phone:
Contractor Name & Address:
3 Gi
Phone & Fax:'
Bonding Company:
Address:
Mortgage Lender:
Address:
zit T _ 5L%7,L-zState License Number: <f_ _FS�,/ ell -�
1,16 Contact Person: r A r? Phbt ! Z11 61.oC5
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 terrify 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 is verification that I will notify the owner of the property of there a iien'ba y, FS 713.
C9y
1-69
- •Signature o Owner/ gent at Signature of Contrac r/Agent Date
-D i ?A to E lY\F'r2 t+ C - C, G -r2
Print ner/Agent's Name _ Print Cr "orgon Name
- l•Yt(� lit • C- (b -
-0 /K U rc�sr✓c.� (d ' �� �j`�
Sip` tc�&fNotary-St5�*S�rl�aWart Date `Sig ti... Notary-StatI"o&�Flaiid teWart Date /
`"*: MY COMMISSION # DD180561 EXPIRES
*_ MYCOMMISSION# DD180561 EXPIRES *:
February 16, 2007 - February 16, 2007
BONDEDTHRUTROYFAININSURANCE,ING
BONDED TNRUTROY FAIN INSURANCE, INC
Owher t gent is Personally Known to Me or Contraltor/Agent is Personally Known to Me or
Produced ID Produced ID
APPLICATION APPROVED BY: Bldg 6t b 101 Y/®Z bning:
(Initial & Date)
Special Conditions:
Utilities:
FD:
(Initial & Date) (Initial & Date) (Initial & Date)
�} THIS INSTRUMENT PREPARED BY:
NAME= --L ���
NOTICE OF COMMENCEMENT
PermitNo.AD-D-R.� Zohj ��_ Tax Folio No.
State of Florida I
County ofr
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)
18-q 3-177
2. General description of improvement:
3. Owner information
a. IName and address D ?oreQ -e /V)4n , i �' 1l :EDG e I L fk tEr-,z— C-, i
b. Interest in property CIS&2G°L
c. Name and address of fee simple titleholder (if other than Owner)
4. Contractor
(-G�s a. Name and address CfZit�-- r
3 6o61 Z4 �s4 wz%� 2 ;570
b. Phone number 3 --�
5. Surety
a. Name and address
14
Fax number
KARYANVE no i� -
I K OF,CIRCUIT. CilURT
b. Phone number
c. Amount of bond
6. Lender200
a. Name and address
Fax number
LZ Udorw
b. Phone number
Fax number
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
b. Phone number
Fax number
8. In addition to himself or herself, Owner designates
of
to receive a copy of the Lienor's Notice as provided in Section
713.13(1)(b), Florida Statutes.
a. Phone number
Fax number
9. Expiration date of notice of commencement (the expiration date is 1 year from t ate of recording unless a different
date is specified)
Signature of 04her
Sworn to (or affirmed) and subscribed before me this
day of (���> , 20 D , by
1111111111111 91111111 II 11111111111111111 11111111111
Persit OR Produced Identification NARYANNE MORSE, CLERK OF CIRCUIT COURT
e of Ideion Produced SEMINOLE COUNTY
BK 05469 PG 1949.
a 5, CLERK'S # 2004152620
RECORDED 10/04/2004 09:57:43 AM
RECORDING FEES 10.00
Sz u� of ry,T;4 If .State ofFYorida�
RECORDED BY t holden
cl 0 ission Exp res ` et c,P�e,: lam Stewart';.(%,CC�,U. MY COMMISSION # DD180561 EXPIRES
r otic' February 16, 2007
BONDMTHRU MOY FAIN INSUP.ANCE, INC