HomeMy WebLinkAbout211 W 20 St (3). 'aS ti4
CITY OF SANFORD PERMIT APPLICATION
• Permit # : VQ Date:
Job Address: Ail
Description of Work:.��">�il���i'/l�r/�2
Historic District: Zoning: Value of Work: $.
Permit Type: Building Electrical Mechanical dumbing Fire Sprinkler/Alarm Pool
Electrical: New Service - # of AMPS Addition/Alteration Change of Service Temporary Pole _
Mechanical: Residential �on-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: V-0
Construction Type: # of Stories: I # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #:
Owners Name & Address:
(Attach Proof of Ownership & Legal Description:)
h� Phone: �7 "Qi l �-� l _— —
Contractor Name & Address:
l l�� iii/1, ,>y�'�S�State License Number:
/t-4,47
Phone & Fax: 7 '61/if 1Gl -�/-4,47/
6qZ 1 Contact Person: /i [Lli� Phone: �!E?
Bonding Company:
Address:
Mortgage Lender: _
Address:
Architect/Engineer:
Address:
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 underswuid 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 Ll•i,NDER 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 requirements of Florida Lien Law, FS 713.
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Signature of Owner/Agent Date Signatures oof��C��onttractor/Agent / Date
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Print Owner/Agent's Name Print Contractor/Agent's Name
of Florida
DEBBIE BLANTON
MY COMMISSION # DD 18845
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APPLICATION APPROVED BY: Bld
Special Conditions:
DEBBIE BLANTON
MY COMMISSION # DD 188491
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Utilities:
(Initial & Date)
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to Me or
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(Initial & Date)
Date
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Zoning:
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(Initial & Date)
DEBBIE BLANTON
MY COMMISSION # DD 188491
UCNRES: Febrm25, OQ7
irf. gent is ona y c
` iscount Assoc. Co.
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Utilities:
(Initial & Date)
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Date
to Me or
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(Initial & Date)
Permit No.
State of Florida
County of Seminole
NOTICE OF COMMENCEMENT
Tax Folio No.
The undersigned hereby gives notice that improvement will be made to certain real property, and in accoiff'
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Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. m
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1. Description of property: (legal description of the property and street address if available) ad's' r 0 V n
2. General description of improvement:
3. Owner information `c
a. Name and address
b. Interest in property
c. Name and address of fee simple titleholder (if other than Owner)
4. Contractor
a. Name and address 7C- 11
b. Phone number�C? ' l �f 1 'j Fax number 11,P7 WV ,7-�j
5. Surety
a. Name and address CE12IfIEQ COPY
—1APYANINF MORSE
b. Phone number Fax number M ERK OF CIRCUIT COURT
c. Amount of bond LE COUNTY, FLOR DA
6. Lender
a. Name and address
b. Phone number Fax numberjWV
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7. Persons within the State of Florida designated by Owner upon whom notices or other documenfs'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 the date of recording unless a different
date is specified)
Signature of Owner
Sworn to (or affirmed) and subscribed before me this day of /� , 20 Q, by
A m - �, r L)
Personally Known OR Produced. Identification r,,/
Type of Identification Produced F h L
THIS INSTRUMENT PREPARED BY:
NAM E Zf/®r� Ge;t'fi�r
Si ature of Notary Public, Sta a'— ADDR.
Commission Expires: DEBBIE BLANTON
MY COMMISSION # DD 188491
a EXPIRES: February 25, 2007
1 -800-3-NOTARY FL Notary Discount Assoc. Co.
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