HomeMy WebLinkAbout2856 Gale Pl'AR
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Sb'VI
CI i 1' OT SANI ORD PL APPLICATION
Date
Job Address: Zr�5C AL, C, PL ACE 5AN(7-0 C_1 3*2-1 3
Description of Work: �E e00
00
Historic District: Zoning: Value of Work: S u 0 UD . ;cam _._•._.__—_,
Permit Type: Building Electrical Mechanical Plumbing fire Sprinkler/Alarm
.I
Electrical: New Service — it of AMPS Acid i tion/Al tcmtion Change of Service Tcmpodiry Pole
Mechanical: Residential Non-Rcsidential Replacement New (Duct Layout & Energy CalGt Required)
Plumbing/ New Commercial: f,' of fixtures It of Water & Sewer Lincs fl of Gas Lines
Plumbing/NeNv Residential: It of Water Closets Plumbing Repair— Residential or Commercial_
Occupancy Type: Residential �—' Commercial Industrial Total Square rootage:
Construction Tyne: (ZOO F # of Stories: fl of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel It: r I (Attach Proof of Ownership & Legal Description)
Owners Name & Address: �vt't E \,(At..1 tA E V LE tJ 2$ 5 (o GA -C nC ACE
_Phone: LIb1 320 OL41(P_....._....__--
Contractor Name &'` Address: Aptoe-K. kDO Ct 1JG qOU F2EiJC-4 AV
P 3Z-7-1 1 State License Number:
Phone & Fax: y0l 371? Contact Person:
Bonding Company: ---._.._..—
Address:
'Vtortgaoe
Address:
Architect/
Address:
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has conuTtencui price' io 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 WOR}., 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 r(:gld.-ging
construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT Il\ YOUR PAWNG
TWiCE FOR IMPROVEMENTS TO YOUR PROPERTY. iF YOU INTEND TO OBTAIN FINANCING, CONSULT W1TIJ YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
NnTl.41 : In addition to the requirements of this pennit, Ihcrc may be ;ldditional're%trictions applicable to this properly that may be found in the, public records of
this county, anti there may be additional pcnnits required from other governmental entities such as water management districts, state a}rcncics, or i<xlerol agencies.
Accepts of pern tis verification that I «ill olify the o :mer o(titc propery o(thc rcquirem o orida Lien (av713.
S :cure of Ornter/ALent Dale Signature of Contractor/Agent Date
wrier/Agent's Narnc
Print ContractorAi,ent's Na
Signature of Notar St:uc84° f'n21 r: _1111 --VIS
tmI tiieit
Y "Y COMMISSION # 340975
EXPIRES: July 26,
2008
n,' , ,7 rhru Notary Public Underwitters
O„Ener/Agent is _ Personal -1k Kno,cn to \-lc or
Produced ID
AITLICA'VION APPROVED BY
Special Conidilions:
Bldg:lti1.t �� Zoning:
tlntn !&I>al�l
(Initial .l': Dat�1
�i
ry•St6tg�lLll'� kXNTON
MY COPv mII3;SION # DD 188491
EXPIRES:,Fepruary 25, 2007
�4Mpt�ty: Ri�R �t &R•t
9/1y/Oy
)ate
(Initial .t: Date) (Io;tial t Del:
$7 0
;tate of Florida
;oulrty of Sculillolc
_ .._ ._.;__ _w_._.�_----------------------•------- t RRI'RI�IE 1MRSE, CLERK OF CIRCUIT COURT
MINGLE CO1JM
r BK 05451 PG 0438
I CLERK'S # 2004142742
i, ICL OF COIFiv11: [NTC'31:i 0.:N`-I�Ei.ORDEO 09/141204 1203:33 PM
'rAEMU01fEES 10.60
RECORDED BY 5 O'Kelley
,
Clic ulidcrsigacd hereby gives notice that ilmprovM11 nL will be in;ldc to ccrWili real property, andi11 in -accordance wills
:llapter 713, Florida SLat11LGs, the followinr� illfor111ation is prop: idccl in Uns Notice of Coinlllencelncut.
CER T1'rib '`com
1. Description of property: (legal cicscriptioll of the property and st<,cct adclress if awdkiblc) _
ZS6�j(.o i��l-� PGC- �i�N Fo20 FI 327-1 3 -�
2. General description of iluprowlilcnt:
Owlier hifornlation
a. Nan1'cr and address L/L/
b.. Interest ill property 0
c, Name and adclress of fee-iIllpic titleholder (if oilier than Owner)
a -♦. � 3
1'11
I.. Contractor
a.
Name and address !J�1_IL4�' N�--�0—
b. Phone number Fax 111I111VCr;, `
5, Surety
a.
Nam c and address
b. Phone number ! l a:: lluulbcr
c. AmomiL of bond
6. Lender
a. Nalmc and address
b. Phone .uunlbcr _ I ax number
7. Persons witllill the Suite of plolida designated by O1Y1lcr upon, whom notices or other docullicn� nlay be served as
provided by Scctioll I13.13(1)(x)7., Florida SLaL'ULCs:
a.. -Name and address
b. Pllollc Number I'ax number
of
8. In. addition to himself or llcrsclf, 0��; llcr clesi�nalcs
to receive a copy of the Lienor's Notice as provided in Section
713.13(1)(x),Florida St.tutes. �
a. Phone number l'ax 1111111bGC
9, Expiration date of Notice of commencement (the C-xplr:1t1011 elate is l year fro' sate of rccording unle
different
date is specified)
Slnat.Urc Owiler
��ro 11 to (o " affirl lc) and sub ribcc
l CfOCG 111C this lay of 2� by
Personally l(rloNvil v Ul'` 1'.roduccd ldcntiCication �;�;,y,�, PATRICIAMCFADDEN
r .... _ -. n __ -r......,1 = � *"s_ MY COMMISSION # DD 340975
* EXPIRES: July 26, 2006
Bonded Thru Notary Public UnderOhm
POWER OF ATTORNEY
Date:
I, �rlrcw T (And ) Adcock do hereby authorize Ruben Birch
To pull the "Reroof permit for
(type of permit) (address)
opv-1 ot4�, Linda A Keeling
My Commission CC985428
N - �
OF nc Expires December 09 2004
Nota V Stamp
me or driver license # , of State of Florida, County of
— day of , 2004.
y
V
POWER OF ATTORNEY
Date:
I, �rlrcw T (And ) Adcock do hereby authorize Ruben Birch
To pull the "Reroof permit for
(type of permit) (address)
opv-1 ot4�, Linda A Keeling
My Commission CC985428
N - �
OF nc Expires December 09 2004
Nota V Stamp
me or driver license # , of State of Florida, County of
— day of , 2004.