HomeMy WebLinkAbout300 W 12 St (2)C
I
CITY OF SANFORD PERMIT APPLICATION
Permit # : 1 �i Date:
Job Address: 6�tAlf S /
Description of Work: ivw5
Historic District: Zoning: Value of Work: $ Z �Je�
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 #: Of .J
Owners Name &
Contractor
Phone &49W f
Bonding Company:
Address:
Mortgage Lender: .
Address:
Architect/Engineer:
Address:
Attach Proof of Ownership & Legal Description)
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 a tcaol 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 s h as ter management Oii; c�s, state agencies, or federal agencies.
Acceptance of permit is n cation that I will n t the owner of the property of the requi e s of F da Li 7l3
Signature of Owner/Agent
Print
Agent's
Date
�2gnature of Notiry-State oT Florida / Date Si 6f Notaty Date
�a _ �'�'r �,AMMISSION 4 DD 164280
RICHARD D. RUSSI '14 Q'.LAPIRES:November 12,2006
Notary Public, State of FlorloF, Pcrd.T u dget Notary Services
Owner/Agent is _<Pe,nallW0VMMMeRp. May 31 ?_0%, Contractor/Agent is ersonally Known to Me or
Produced ID , DD 31214'' Produced ID
APPLICATION APPROVED BY: Bldg:
(Initial & Date)
_kq� � 0_�_r
Zoning: i Utilities: FD:
(1 itial k, Date) (Initial & Date) (Initial & Date)
Special Conditions:
1� '73 O(�
r
i
CEit'TiFIED COPY
RARYANNE MORS
liFA g OF' CIRCUIT COU
ME CQU FL
' ; Ll; F&I
NOV
I HIS INS I tN I N tN HE HY
NAME: n'i`6>2�dr
ADDRES : //),�S?� SEMINC)LEColI'N'fY
RT
�p
Building & Fire Inspections
10101 East 1ptStreet
�� 77I FLC.)RII IA'ti Iv 1TUN:1L CfIlIIC!
Sanford, FL 32771
NOVICE OF COMMENCEMENT
State of Florida
County of Seminole
Permit No. Tax Folio No. (PID)
and in accordance with Chapter
The undersigned hereby gives notice that improvement will be made to certain real property,
713, Florida Statutes, the following information is provided in this Notice of Commenc
me/nt_.
DESCRIPTION OF P OPERT (Le al description of the property a stree addr s
/ e �% 3
S 3 a
5� P.
GETL DESC IPTION OF IMPROVEMENT
OWNER INFO ION J
Name and address
3
Interest in property (Fee Simple nership, etc.)
NAME AND ADDRESS OF FEE SIMPLE TITLE HOLDER. (IF OTHER
OWNER) 5_ ,WfT tP
9 NTRACTOR
a e and addr s g
6 3x771
/�
zz
SURETY (Bonding Company)
Name and address tiiflll
1111111 II I111111111Ill11011111fill EMUWIIIII
Amount of Bond MARYA
E MORSE, CLERK OF CIRCUIT COURT
SEMIN(
E COUNTY
LENDER BK 0
CLEWCO R
//W
504 PG 16.49
8
2004168588
Name and address � RtCIIHI
I) 1 0
:U 11/01/2004 03t06r43 f�M
RECONt
INS FEES 10.00
*�: -k'X•Wk#A=k *-k�*k �:**:k �: :*�*k �a�*�:kk*##:kkW:k#*********�:k �: *:k.I:k#*
k � *�:*��*�:��#W�-1=k�*8: 1<
Persons within the State of Florida designated by Owner upon whom notice or other documents
may be served as provided by Section
713.13(1)(a)7., Florida Statutes:
Name and address o
Persons within the State of Florida Designated by Owner upon whom notice or
other documents may be served as
provided by Section 713.13(1)(a)7., orida Statutes:
Name and address:
In addition to himself, Owner Designates a
of
a copy of the Lienor's Notice as
To receive
,Provided in Section 713.13(l)(b), Florida Statutes.
Ex #ation Date of Notice of Commencement
(The expiration date is 1 year from date of recording unless a diffe ent date is sp
ci fid.)
Signatur f Owner
�pn9R� Q L a,)/
c
6?
w"or o e efore me this 27 Day of O�To
My Commission Expires: RICHARD D.
RUSSI
Notary Public, stale
of Fionr:
Notary Public MY comm. exp. May
311, 2011j:.
comm. No. DD
The foregoing instrument was ackngwledged before me thisz� Y day o
;t�7^�
by
(Name of person acknowledged), who is personally
known tome or who has
produced (Type of identification), as
dentification and who did/did not take
and oath.