HomeMy WebLinkAbout2847 Grove Dr0 15- 31r, 95CITY OF SANFORD PERMIT APPLICATION
Permit #: Date:
Job Address:
Description of Work: S
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 for other than X)
Parcel #: — !-Y ~�V/)�/�-/ - V OCWA(ch Proof of Ownership & Legal Description)
Owners N me & dress: 77 �
7 tv�V Phone: 3—
Contractor;Vame & Address: S
Phone & Fax:
Bonding Company:
Address:
Mortgage Lender: _
Address:
Architect/Engineer:
Address:
State License Number:
Contact Person: 01-1-h Yhone:
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 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 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 a e ageme districts, state gencies, or federal agencies.
Acceptance of permit i cati 11 notify the owner of the property of the require en f 1 n 713
Signature of Owner/Agent Date i re of Con acto Age t gate
Print Owner/ gent's Na?) PrimCoy6a tor/Agent's e
il AV
Notary -State of Florid& NOTARraueuc KariW'Schroeder
��JCommission # DD385450
Expires March 27, 2009
Owner/Agent is eersonallyK�9►Aft_�fflIWl�br)tone�gtrorf.m•Inlvrnnl
_ Produced ID V1 I C6
APPLICATION APPROVED BY: Bldg: ` Zoning:
(Initial & Da e
Special Conditions:
(Initial & Date)
of Notary -State of Florida
r/Agent is ersonally 9rATEOF s
luced ID
_ Utilities: FD:
(Initial & Date)
Karin Schroeder
Commission # DD385450
Expires March 27, 2009
amAnd Trov h1n • Insurdna. lnt. 800.3957019
(Initial & Date)
AFFIDAVIT
REGARDING ROOF DRY -IN AND FLASHING INSPECTIONS
• •. W1D1 ► ROOFING, INC.
• • BOX 520997
•N••D
Owner: 7Z� /t{
name
G tOv6
address
phone
License #: 6�� /9,; Y�!
Project Information
Permit #:
Subdivision: %►%Dd rn�t't�i r GZ/�-4
Lot #: ,71
I, fiant, hereby affirm that I am the duly licensed
contractor of record for the above referenced permit, that all the foregoing information is true
and accurate, and that the dry -in, flashings at the above referenced address or lot has been
installed in accordance with the applicable codes and standards.
/.-
itm
Contractot
Ana re
l? G
printed name
STATE OF FLORIDA ' /�
COUNTY OF c��°/�'1 / tyIL
This instrument was acknowled2ed beforeme this l day of , 20 b the
above referenced individual,ho acknowledged that he/she is a
duly licensed contractor with Zit , and wh wledged that
he/she was authorized to execute this document. He/she is either per ally known to m))r
produced as valid identification.
WITNESS my hand and seal this day of
NOTARY =Schroeder eder otary blicDD3854506 27, 2009e Inc. 80p 385 7019
Permit Number
Parcel Identification Number
Prepared b
Return to: WADDEN'S ROOFING, INC.
P.O. BOX 520997
LONGWOOD, FL 32752
NOTICE OF COMMENCEMENT
State of orlD"ice
County of
The undersigned hereby gives notice that improvement(s) 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.
Description of pro ie legs description of the property, and street address if available)
2. General description of improvement(s)
&4o00C
3. Owner information
Name 177wyj?� ��J Ole Telephone Number
Address6W Fax Number
Interest in Property:
4. Fee Simple Title Holder (if other than owner shown above)
Name Telephone dumber
Address Fax Number
5. Contractor MCFADDEN'S ROOFING, INC.
Name P.O. BOX 520997
Address LONGWOOD, FL 32752
6. Surety (if any)
Name
Address
7. Lender (if any)
Name
Address
Telephone Number
Fax Number
Telephonie'Number
Fax Number
Amount of bond $_
Telephone Number
Fax Number
8. Persons within the State of *Florida designated by Owner upon whom notices or other documents may be
served as provided by §713.13(1)(a)7., Florida Statutes.
Name Telephone Number
Address Fax Number
9. In addition to himself or herself, Owner designates the following to receive a copy of the Lienor's Notice as
provided in §713.13(1)(b), Florida Statutes.
Name Telephone Number
Address Fax Number
10. Expiration date of notice of commencement (the expiration date is one year from the date of recording
unless a different date is specified):
7
Date Signed Signature of Owner Note: per §713.13(1)(g), "owner
must sign ...and no one else may be permitted to sign in
his or her stead."
Sworn to and subscribed before me this day of , C& GL ��J by
who is p6rsally known tom OR
as identification.
N01111C Karin Schroeder
Commission It DD385,.__
Expires March 27, 2009
$TATEOFFLORCA. §b dWTrovFain•In3urona.Inc. 800.3857019
Form Revised: 3/98