HomeMy WebLinkAbout211 S Somerset CtPcrtili441
Job Address:
Description of Wot-Ic:
Historic District: _
Zoning:
CITY or, s kNromn P1 I21vf IT APPLICrlTIOl�r is `:
Date:
Value of Work:
tz-I 32`1
(P2V0-UD
5
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Poem•^•^_-_
3�rSac� �tNG
Electrical: New Service — It of AMPS Additior/Alteration
Change of Service Tempor-'ary Pole
LWcltanical: Residential Non -Residential 1Zepincement New (Duct Layout & rncrgy CR._IZcquired)
Plumbing/ New Coniniercinl: It of Fixtures Ii of watcr & Sevier Lincs
h' of Gas Lines
Plunibing/New Residential: I/ of Water Closets
Plumbing Repair– Residential or Commercial
Occupancy Type: Residential Commercial Industrial
'Total Square root-Ige:
Construction Tyoc: II of Stories: fI of Dwelling Units:
Flood Zolle: (FrMA form required for other than X)
(Attach Proorof Ownership & Legal Description)
Pnrcel it:
�ri K�� 1 C—L
Iz��
-76 M E
Owners Name & Address:
G?yk-1 '�o g—fes �i —7 —?
/L
Phone: ' 01
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Contractor Name 'Address: `�`r! �� (.--i—,/ tZ0 D t N
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C1 32-7't
Q n n Ci%% ���,4—� � J'� 9A� �t� (fir% _�
Slate License Kwt,ber: GGC0 ZZ
Phone & rax:
Bonding C
Address:
NIortgage
Address:
Architect
Address:
Contact Person:
Phone:
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 certify that no wort; or installation has conn cncui I)i )or to the
issuance of a permit and that all work will be performed to meet standards of all laws regulating construction in this jurisdiction. 1 understand that a separate
permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, DOILI:1 S, I-IEATER.S, TANKS, and
AIR CONDITIONERS, etc.
OWNER'S AFFIDAVIT: I certify that all of the foregoing infomuation is accurrte :utd that all work will be done in compliance with all applicalAc. lawn re:i;uLaing
construction and zoning. WARNING TO OWNS[:: YOUR FA1LUl�E'TO RECORD A NOTICE OF C04tMENCEivtENT P.4AY R. - ULT 11\1 YOUI;.I'/.1'TNG
TWICE FOR IMPROVEMENTS TO YOUi: PROPERTY. IF YOU INTEND TO 013"I MN FINANCING, CONSULT WITH YOUR LENDER 01: AN
ATTORNEY BEF01'tE RECORDING YOUP� NOTICE OF•COMMENCEIMENT- . .
Nola(; 1 : in nddition to the requirements of this permit, there miry be additional i rstrclions applic:,blc to tlti; property that ntay be lound in till,: public records of
this county, and there cony be additional permits req i« d from other governmental entities such as water nunagcment districts, stale. al cncic:, or cral agencies.
Acceptance nn vcrific• •on t .'t 1 hili li 'til o:vncr of tits propct;y of the requirem of. r ` a Lien
m i ( „ Arent Dattf Signature Contractor/Agent D:ue
specia! Conditions: --_—_—_----.------------ ----
I t Contractor:\!;cat's Name
CA
Si!.:aturc of \,:ary-State of Florida Datc
DEBBIE BLANTON
MY COMMISSION # DD 18r
€FRI6ti �.'�'eb�rtial1 �I"I07 1i tit
!i-�3�N01)M'>1�•----Ft-hlc'1'c,njDr5�2iiiiif'Assoc. Co.
(Initial fi Dahl
t-473
^(Initial f: Date) (Ittitial & D^_tr
.... ....... 6Y
MINDLE WATY
BK 05493 PG 0a48
CLERK'S #.a,-0o4IG4702
--b 0--(� 3�'I, ( -EIGL7 or, 10,251,eW 08%M37 PA
j\T0 -rMMM,-fEE5 10.00
perillit No. —
Q f.- t, of TT lorl(I -,I
RECOM by b w
—olinty of ScIllilloic
and izl alco Willi
ll be 1,11,16c to .11 property,111e uridcrlsigacd licrcby gIv(;:; lioUC(;'that illlPf0VclIlcIlL wl.
iuforlllatioll 1) rovidccl ill L11I.S'Not,cc, of collUllcliccalcilt.
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1. D cs crip Lioll of 1) 1-01) cf LY: I (I r,�, Grip Li Oil of tlic 1) rop crty :incl street 3 cid rc,'*1 j*f-
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Owner iliforill"ILlon
-,211 15, 6Z) t -i
b. Interest ill PrOPGrLy
c. Jtir;Jlllr, -,Ill([ zlddrcs.,; of f CC siflnplctitleholder OV111CL)
(if officr 01"
4. Q0Lltr--lCl0r
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5. SurcLy CUTIFIED COPY
------------7---'WA—RYANNE WWM
a. N;iiiic;llld Idcic(;sj _h/—A mfim —
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pliolic. minibcr
A11101111L Ofbond
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a. Name and addl-c"',
raw
j;zIx nuillucr
d as
b. Ijaolic, aumbcr or othcr docuillcilLs way bc scrvc
'Alcr UP 01'� ',%"lorn not'""
7.
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Xu addition to 11 I'ScIf Or IIG' to rccclvc I Copy 0, �.Ilc NoL*cc rovIcIcd ii-1cctl0u
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Florida Fax ilmlibcr I co ill 11111GS'S 3
a. pliolic liumbor date is I year f-forn• c;iL(;
9. datc of 11 oticr, of co al I lclIGcIllclIL(Lh(;cxplr� olld
datc, is II)CCIFicd)
by
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Sworn to (OF
Pasoil.,111y I(liov"ll
'(,,6 40 �00,
POWER OF ATTORNEY
Date: /O/Z( 10i
I, Andrew T. (Andy) Adcock do hereby authorize Ruben Birch
To pull the R e r o o f permit for
(type of permit) (address)
r"I 32-1-
Sil?nature
2ojoy N Linda A Keeling
y, My Commission CC985428
9jFov r,d'Q Expires December 09 2004
Stamp
(.er:so:n:,ally to me or driver license 11 , of State of Florida, County of
__`bI day of , 2004.