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Job Address:{Y
Description of Work:
CITY OF SANFORD PERMIT APPLICATION
/� .. Date: S, -,Q' - /S Zoe
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 tae other than X)
Parcel #:
Owners Name & Address:
Contractor Name & Address:
Phone & Fax:
Bonding Company -
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
(Attach Proof of Ownership & Legal Description)
Phone: _.I -P 7 ) -:0 3
State License Number:
Contact Person: Phone:
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 i cp dating
construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IAF 1' OUR A -Y ING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR &N
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 oKrm 's verification that I wi!t�qyify the owner of the property of the requirements of Florida Lien Law, FS 713.
of Owner/Agept - /J/ mate +: Signature of Contractor/Agent Date
l�
not wner ent s NadF Print Contractor/Agent's Name
1
Si nature of No ate o oa ate DEBBIE B
LASi�q We of N tary-State of Florida Dale ---
MV cc
* DD 188491
Ili �1Z (k,. t� , SPI S: February25, 2007
✓` A R U Notary Disco nt
a e o - �irt6t9A nt is _ Personally Known to Me or
Produced ID Produced ID
rn.3ad- 013- Ems. ja.?Jv
APPLICATION APPROVED BY: Bldg: Utilities: FD:
Initial & ate (Initial & Date) (Initial & Date) (Initial & Date)
Special Conditions:
� SS
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P�
CITY OF SANFORD BUILDING DIVISION
OWNER/BUILDER AFFIDAVIT
CONSTRUCTION CONTRACTING
Owners of property when acting as their own contractor and providing direct, onsite supeniision.
themselves of all work not performed by licensed contractors, when building or improving farm,
outbuildings or one -family or two-family residences on such property for the occupancy or use of such
owners and not offered for sale or lease, or building or improving commercial buildings, at a cost not to
exceed $25,000, on such property for the occupancy or use of such owners and not offered for sale or
lease. In an action brought under this part, proof of sale or lease, or offering for sale or lease, of any such
structure by the owner -builder within 1 year after completion of same creates a presumption that the
construction was undertaken for purposes of sale or lease. This subsection does not exempt any person
who is employed by or has a contract with such owner and who acts in the capacity of a contractor. The
owner may not delegate the owner's responsibility to directly supervise all work to any other persona
unless that person is registered or certified under this part and the work being performed is wi.thir:r. the
scope of that person's license. For the purposes of this subsection, the term "owners of properi.y"
includes the owner of a mobile home situated on a leased lot.; To qualify for exemption under this
subsection, an owner must personally appear and sign the building permit application.
State law requires construction to be done by licensed contractors. You have applied for a permit uuid.er
an exemption to that law. The exemption allows you, as the owner of your property, to act F.s your own
contractor with certain restrictions even though you do not have a license. You must provide d.i.r cct,
onsite supervision of the construction yourself. You may build or improve a one -family or two-4.arrr.i.l.y
residence or a farm outbuilding. You may also build or improve a commercial building, provided your
costs do not exceed $25,000. The building or residence must be for your own use or occupancy. It may
not be built or substantially improved for sale or lease. If you sell or lease a building you have built or
substantially improved yourself within 1 year after the construction is complete, the law will presume that
you built or substantially improved it for sale or lease, which is a violation of this exemption. You an? y
not hire an unlicensed person to act as your contractor or to supervise people working on your building. It
is your responsibility to make sure that people employed by you have licenses required by state law and
by county or municipal licensing ordinances. You may not delegate the responsibility for supervising
work to a licensed contractor who is not licensed to perform the work being done. Any person working
on your building who is not licensed must work under your direct supervision and must be en.-)ployed by
you, which means that you must deduct F.I.C.A. and withholding tax and provide workers' cor;,r1s<r-.�4,.tion
for that employee, all as prescribed by law. Your construction must comply with all applicable hers,
ordinanc®4b 1dmg codes, and zoning regulations.
do hereby state that I am qualified and capable of performing the
requested construction involved with the permit application filed.
I will assume full responsibility as an Owner/Builder Contractor, and will personally supervise all work
allowed by law on the permitted structure.
;Signature
Print Owne uilder _ ame pBBIE BLANTON
.L N1�ON1 -6s # DD 188491
February 25, 2007
Notsry Discount Assoc. Co.
Si nature of Notary—State of Florida Date
Owner is Personally Known to Me or has
Produced ID
NOTICdE OF COMMENCEMENT
Permit No. Tax Folio No.
State of Florida
County of Seminole
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 roperty: (legal description of. the property and street address if available)
1-i� Ayi, 'rJ�z'>iPi�% .�� ' i 73
-2. General description of improvement:
Owner information �/j
a. Nameand'address l`j' A /'�/�? 7?� �/� ��%/J�'l/c'u'd ��,✓P � �c� ��3
y 1
b. Interest in property
c. Name and address of fee simple titleholder (if other than Owner)
Contractor +
a. Name and address .G//�p Rl< 0 GAY
�
c► c, PG 030
b. Phone number Fax nt j j , �Ep�g i5� I y a 5` s 15 AN
Surety REC13RDING FEES 10.0
a. Name and address RECORDED BY L McKinley
THIS INSTRUIN1ENT PREPARED B
b. Phone number Fax number WfflflEQ
c. Amount of bond IWARYAN�" NO
j�. Lender ADDR. / gLMK IN CIRCUIT C LW
a. Name and addressMOM Imo. TL DI
b. Phone number Fax number -
s..
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. 5 2004
a. Name and address 1"
I
b. Phone number Fax number
' 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 I Fax number
9. Expiration date of notice of commencement (the expiration date is 1 year frz the date , recording unless a different
date is specified)
I ,�2k, ,
Signature er
Sw to (or affirmed) and sub 'bed before me this Lf day of 520 07 , by
to
n0- Z21 MQ n S .
Personally Known OIC Produced Iden1
Type of Identification Pro uc d`
Signa e of Notary Public, State of Florida
Commission Expires:
DEBBIE BLANTON
F1-800-3-NO-1.--.---1.-----
MyCOMIPISSION # DD 188491
EypiRES: February 25.2007
TA�7'{ FL Notary Oi5°Ount AssoC- Co.