HomeMy WebLinkAbout2449 Mellonville AvePerinit it
Job Address: Z `7 �"/ � i LID
Description of Work:
Historic District: _
Zoning.:
CITY Or S lNFORD I ERMrr APPLICAT1Ut\
Date. lD
Value of work: S /0 2Z; o
3 -T A -g ep) N_ -)L, .ES
Permit Type: Building Electrical Mechanical Plumbing Firc Sprinkler/Alarm
Electrical: New Service — It of AMPS Acid Ition/Alteratlon Change of Service Temporary Pole
Mechanical: Residential Non -Residential I:eplacement New (Duct Layout Z-nergy CiiiG, Required)
Plumbing/ New Commercial: Il of fixtures It of %',rater & Sevier Lincs Il of Gas Lines
Plumbing/Ncw Rcsidcutial: it of Vl'atcr Closets Plumbing Repair Residential or Commercial
Occupancy Type: Residential Commercial Industria! Tota! Square Footage:
Construction Tyne: — it of Stories: It of Dwelling Units: flood Zone: (FrMA form required for other clian ;C)
Parcel it:
O N---- & Address
(Attach Proofof Ownership & Legal Description) .
Z'.a cc-? Nut' N3 --
Contractor Nano &'Acldress: `l�C7C0 t �f— 2a t N ----..-..---.......__.-._
UD �2fG NC� �' -ice Fp �(Z ✓` 1 32?'1 State License Ntmiber. GCili 0 ZZ r.
I'hone & Fax: Contact Person: _ —Phone: --_----.._,..--
Bonding C
Address:
.Mortgage
Address:
Architect/
Address
Application is hereby made to obtain a permit to do the work. and installations :ts indicated. I certify that no wort: or installation has commenced prior to the
issuance of a permit and that all work willbe performed to meet standards of all laws regulating construction in this jurisdiction. I understand that a separate
permit must be secured for FLECTIZICAL WOU' , PLUMIlING, SIGNS, WELLS, POOLS, FURNACES, BOILEP.S, I-[EA1'EI:S,1'ANICS, and
AIR CONDITIONERS, etc.
OWNf:R'S AFFIDAVIT: I certify thatall of the foregoing infomintion is accurttc and ti;at all work will be done in compliance with all applic;ihAr.. lass rrl;ulsaing
constriction and zoning. WARNING 1'0 OWNER: YOUR FA1LUitE'f0 RECORD A NOTICE OF COMIrIENCL•MENT MAY R1- Ui T IN YOUR I'/t,l'(NG
TWiCE FOR IMPROVEMENTS TO YOUR PROPERTY. iF YOU INTEND TO 0B'1'ATN FINANCING, CONSULT WITH I YOUR LENDER OR AN
ATI.ORNEY BEFOf'.E RECORDING YOUR NOTICE OF COMMENCEMENT.
In addition to the requirements of this pelmil, there miry be adr!ilional natrictions :ipplicahic (o this Property that cony be found in the p�u 'tic rccordi of
this county, and there may be additional permits rcquireci from other gover111nc6tal entities such as vialer neutagement districts, slate al encic: Ic+dcral agencies.
Acceptance of permit is verification that 1 will notify the Owner of lite property of the re(Iu
Signature of Owrter/Agent
/-_'E',VN t7fY
Print Own /Agen ; Nan
Sien arc of 'ottuy-Stale of lurid. Cate
�.►+' Lirfda A seting
y
CNy �ornmission DD&%M
Owi r Avpit a er IIs ' no to Ing\g1.c�uprpg �+
-- Produced II)�.SCQ1_' nd �'
Florida Jet te1A, FS 713.
iit•;T7turc O�onlr;tclor/Art:nl r .. Date
APPLICA11ON APPROVI l) BY: Bldg: ____—. •ting: —_--_-•
r Initial ,C: I) a) (Initial �°t Daltl
1pccia! C'onililiuns:
(Initial f: Datcl (Initial L D^_l:
_1
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�e `__..__.___-------._..___._.._.___..._..._..___._------•-•--•-----------•- Y 11 4�RSE, CLARK 0 CIRCUIT COURT- �` C A D S S f] L° D C MINOLE COO
BK 05493 FSS 0847
t�T07:ZC1 Ole G01'fi\'t1NCi��J�1`lk
LERK'S # 2004164701 :1
2g004 06159137 i4
Crllli.t No. RECORDED BY 541' Kelley
tatc of Floricki
.oullty of Sczuiuolc
llc ulldersiCuccl ltcrcUy i, %c; alot'icc that iulprovculcnL NvI. Uc :rlac{c to ccrt;lirl IC nzopclty, aucl ill accoxclattce wills
llaptcr 713, 1'lol'icf:i St:ltutes, the followilli; tills .NoticC of Cd1nI1tC11GC 111C11t,
J
5.
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AcscripLiou of liroperty: (lc f -:ll dcscrip ioll of tilt property :lllcl strcct llciclres<: if a� <lilablc:) 3
zwL-6) ME(�1�V tr 1C �j � n�Fo��CD �I
General dcscripLioll ol: ullprovcnlclit: —
OWltcr illforinatiolt
;1. Z`Ia111C 1111 C{ aC{CICC/S�s / - 1
b. X1ILCCCsL ill property blt-� ti �2—_--_----- -------- --
c, hrlunc and ;idc(ress of iCc slllll)1C t'lt'lClldldCl' (11 othcl t11;'.n Owner) ___
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Contractor ' L,P
a, •l`lalllC 1114 s AK •, �.
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b• p11011C 1111111bCr ��Q_] ����9s�6 —
S u r•cty ':
l a:l ltutnbcr .
b. I llonc 11lunbcr
c• A11101111t of bond '
Lender
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a. I`llunc
n
11ZIX lit INoCl 4
U. J'laollc 1luulbcr — - —
� � � „'t11i111r11c Stale; of l�lorida dcsil;uatccl by Owner ullol:.,'110111 notices or otllcr docu111c11ts nla. be ;;trued as
proviciccl by SecLioll 71 �l ., l a 7., I locida St;ltuLcs:
a, •.Tlamc artd addre,,'s — ---'--
l';1� 11111t11)CL' of
b. J'11o11c n>1111bcr ------
�i- la addition to 111111Sclf or 11cfScli; 0 ,'; Ilcr C1C:;1g1uItCS t0 rCCCI ;�C a col)y. dl tl1C �1CnOr'S L`loticc a ; 111;ovidcd ill SCctiola
713.7:�(l)(l?), ;:'lorida Sia.Lutcs.' �
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a. Phoac 1111111bCC ,
ClatC Of nOtICC Of CdI11I11CRCCIIIC[lt (L'l1C Cx�)1r-11t1011 dlltc is 1 year fronl'tlle date Oi rCC01'Cllll£,T 1111105S a dif'cl'ellt
9. Expiration
date is spcciCiccl) � � �
Si1"llat.urc 01 Owner
S�vornto or afiunlccl) and s�bscribccf before nlc this dlly of
7 r.�ti� (� , 20 by
�4rN Linda A Keeling
My Commission DD359999
I'crsou-illy X(nowll OR Produccd ldcutiiication' - -+� > (] �,,,EX iresDecemberos, Zoos
"� . , . • r' .... _ .. �� .. _ .I ...- ...I '.' J//1/////{j��--�/SCJ //'/ 0 M1 P
POWER OF ATTORNEY
Date. -
Andrew
ate:
re J. (Andy) Adcock do hereby authorize A Ruben Birch ,� /
To pull the R e r o o f permit for 2 ��� % I �L%� �i C�� 7�V C
(type of permit) (address)
Signatur
,00" °r� Linda A Keeling
r
, , My Commission CC985428
OF 'lop Expires December 09 2004
Stamp
(Personally know to me or driver license # , of State of Florida, County of
2 day of �(_D � L 2004.
,