HomeMy WebLinkAbout2504 S Oak AveCITY OF SANFORD PERMIT APPLICATION
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Permit # : Date:
Job Address: it S0y so Oak #ad, 3-12Gt24V-O ""c
Description of Work: __ Ave -A& oopk^d-k %t?p lo(��pj feyyj�
Historic District: Zoning: Value of Work: S
Permit Type: Building Electrical N Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service - # of AMPS '20000 Addition/Alteration Change rvice X TemporaryPole
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 for other than X)
Parcel #:
Owners Name Address:
s� dFC 3z
Contractor Name & Address:
c (Attach Proof of Ownership & Legal Description)
O T CD ICistK `o$ Z -S -o v S-10 ooh.l&, 4dA. ,
Phone & Fax: 40147-12 2' /S"4 Z 330^176,x/ Contact Person:
Bonding Company: 'y Ar
Phone:
"11212- Sr 40-
State License Number: 40 /.3�av
WL Phone: 07 -.4117 -OP -17
Address:
Mortgage Lender:
Address:
Architect/Engineer: Phone:
Address: Fax:
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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 repLgati.ng
construction and zoning. WARNING TO OWNER- YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR F."1 NWIG
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 of permit is verification that I will notify the owner of the property of the requi%Wnts of Florida Lien Law, FS 713.
Signature of Owner/Agent Date
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is _ Personally Known to Me or
Produced ID
APPLICATION APPROVED BY: Bldgo r� (1,k %2��jgq
�/( nt t && Date)
Special Conditions:
of
v-•-�icW /CT • .4c.
Print Contractor/Agent's Name
Signature of Nota
Contractor/Agent lis
Produced ID
Utilities:
(initial & Date)
Date
0-1
da DEBBIE Bb tMTON -
MY COMMISSION # DD 188481
EXPIRES: February 25, 2007
iAY Kn.4h htffe offoum Assoc. Co.
FD:
(Initial & Date) (Initial & Date)
�1, t>�,{-ei tRl� ili} °1fa�xtl, tK t r 4.
CITY OF SANFORD PERMIT APPLICATION G�rkLr,7 tt 1� te`tr} r�ir jaticl" ��Jrt�!4, sY u
,
Permit #: Date: __ -
Job Address: 2 f G a VA
Description of Worlc� Ji0 0 /` — po%r P ✓ / w
d
Historic District: Zoning: Value of Work: $ Z
Permit Type: Building 1017ty Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service - It of AMPS Addition/AlterationChange of Service Temporary Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & EnergyGa Required)
Plumbing/ New Commercial: it of Fixtures If of Water & Sewer Lincs it of Gas Lincs
Plumbing/New Residential: It of Water Closets Plumbing Repair- Residential or -Commercial
Occupancy Type: Residential Commercial _�1 Industrial Total Square Footage:
Construction Tyne: Aac it—of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for outer ehan X)
Parcel il:
Owners Name & A.yldress: �// r' ) Z -
Contractor Name &'Address:
,77771
Phone & Fax:y 1 L ? • / f r�
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
(Attach Proof of Ownership & Legal Description)
v
Phone: 1/0-7- -j f
4e a�
_ State Liccense \umber: C C c d Z ?
Contact Person: 41&e/I Phonc: Z `61 Z C
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 WORE, 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 applieablc lavas rry;,,l.r.ting
construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT iW YOUR 1:111YING
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 fount[ in thr, public records of
this county, and there may be additional permits required from other governmental entities such as water management districts, state arenc.ics, or federal atincies.
Acceptance hpennitis verification that I will notify the owner of the property of the require t of ori Lien FS 713.
f r
r X12.4.
Signature of Owner/Agc t Dat C Sigiaturc of Cont ctor/Ager Dc c �y
Print Owner gent' am• Print Contra rAg i's
i 61V
igna re of t tart' -S at o rA Keeling
lorida o`°"T4?rr(e Linda Sienal e o Noy too, orida Date Y
aV . My Commission CC985428
dos n� Expires December s
09 2004
O atcroduced/Agent is __ 1 rsonall R to ?.I �-7 Contrtclor/Agee: is Pcrsonaii. Known to ,\1c or
Produced Ii •G � ���� / � O- f'rucluccc :J ---
-- - - — 3g, 3�/�- b --- --- - -- ----
:�ITL Ic:\ floN AI'1'ROVED BY: Bldg: c7n t(,% l t.::ics: I D: _--
r I n i ia! & Da C) (Initial I: Date) (Irwial & D21:
Spa:ciul Conditions: — -- - ----- ----- - --- - —
1 ' 00
POWER OF ATTORNEY
Date: F` Z 3, G !
1, Andrew J. (Andy) Adcock do hereby authorize Ruben Birch
To pull the R e r o o f permit for ZI G l/ f
(type of permit) (address)
Si ature
P Linda A Keeling
My Commission CC986428
Expires December 09 2004
Notari ' \ /% Stamp
PersoDknowto me or driver license IT , of State of Florida, County of
day of _'2004.
C l MARYANNE M JRSE, MEN OF C1101T emu
-ell,
e v �c SEMINQLE CES NTY
BFC 05429 PG 1534
e°G 2 T 1 /
r CLERK'. $ 1# `00413i?�13�
_. -
-----._... PH--- -- RECORDED'-BTd�lE l!24:014r
.___G.U._� �__./! ___.__ _..____._---•--..---_-----_-_.. _._._.._____—__ RECORDING FEES 10,00
RECORDED BY L McKinley
NOT ICI✓ OI, COI CvENCENMqT
I?erinit No.. I a. Folio No.
State of Florida
County of Scalinole
'1 llc ulldelsigued hereby ivcs lloticc'th- 1111proV(;mcnt will be made to ccrtzlill real property, and ill -accordance with
Chapter 7.1,3, Florid, -,Statutes, talc f0110\VIII, lnformatioll is pzovidal ill this Notice of Colllnlcncemen ���$)PI
1. Description of property: (legal description of ttic pro �erty alld st~'cct Address if:lv-allable)
2. General description of itllprovculellt:
Owner i. llforlll;ltioll F G /�IL'
a. Na. me alld address
r 7/
b. Interest i.Ii property T�
C. Name and address of fee silllplc titleholder (if 0' Icl. than Owllcr)
4. Contractor
a. Nalllc
d address
I ,,/ --/ -
b. Phone number
5. Surety
a. Nalllc and address-
G
1). Pllolle number
c. Amount of bond
Lender
a. Nalllc and address
Fax milllber
Fzix nunlbcr
b. Phone nllinbcr Fax number
i
da designated by Owner upon whom notices or otllcr doculllents lnay be served as
7. I'crsons within tllc State of Flor
provided by Section 713.13(1)(a)7., Florida Sultutcs:
a.. Nanlc and address
b. Phone number
8. Ill addition to himself or herself, 0wncr designates
I'a\1111111ber
of
to receive a copy of tllc Ucnor's Notice as provided ill Section
713.13(l)(b), Florida SL--llutcs.
a. P11011C numberI'ax nlllllb�f"
9. Expir hon date of notice of colllnlcllccmcnt (tile expiration date is 1 year frons-t11c date of recordin3 unless a different
date is specified) //
,yr k� Linda A Keeling
My CommissionCC98- 8 r Signal 1C OfO\Y Cl
AYor hd0 Expires December 09 004
<, a� day of ?_0 by
XSworn to (or affirm5tl) and 3CIbSCI'lbCCl befOCC 111C tills
c) . /U!
Personally I(uo\vll OR
Produced ldcntificatioll_____O 70 -