HomeMy WebLinkAbout2519 Hiawatha Ave (3)J
Permit #
Job Address:
Description of Work: --Mut-
Historic
,' -Historic District:
CITY OF SANFORD PERMIT APPLICATION
Date: _
�q 'M�� IA•1_ I,
Zoning: Value of Work: S
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 t/: a Q 161_ D o Ol 7 O (Attach Proof of Owne®hiP g P &e► LSescrl/ on ) U�v'b
Owners Name & Address: / /= T ,n _ . ; ' / i—A , '7— — hY1 x i --rte _ :/
Contractor Name & Address:
Phone & Fax: L
Bonding Company -
Address:
Mortgage Lender:
Contact Person:
Phone:
State License Number:
MI.
Address:
Architect/Engineer:
Phone:
Address:
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 undcrstand 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 lawn regulating
construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN VOITII, 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 as water management districts, state agencies, or federal agencies.
Acceptance of ermit is verification t I will notify the owner of the pro of the requirements of Florida Lien Law, FS 7l .
�. ��
ignature of Owner/Age Date
Signature of Conaactor/Agent Date
mc-. i�C.) l les., �4;
6111 1/0 f
P t Owner/w ent's Name T c�1f� Pri Contractor/Agent's Name
Signature of Notary -State of rich bate, / Signature of Notary -State of Florida Date
r' - PATRICIA W. AUSTIN
MY COMMISSION # DD 129074 DEBBIE BLANTON
Owner/Agent is 1/ Peru k m MY COMMISSION # DO 188491
CdCRES: September 30, 2006 nnt pp
Produced ID i ''2 ••• d•' BondedThruNotaryPublicUnderwriternPiRES�YygP�°lbY°M or
4,,4d ID
.,., •9003•NOT;, R'Y .
APPLICATION APPROVED BY: Bldg: Zoning: Utilities: FD:
(Initial & Date) (Initial & Date) (Initial & Date) (Initial & Date)
Special Conditions:
.r -
Permit No.
STATE Of q �! & /3
COUNTY OF ivr , -,v u Le,
Tax Folio No --N- 7/0'
Notice Of Commencement
THE: UNDERSIGNED hereby gives notice that improvement will be made to certain real property, and in accordai
713, Florida Statutes, the following information is provided in this Notice of Commencement.
1: Description of property: (legal description of property, and street address if possible).
Dt� el� W1 Gi 6 L D
P -7 OC -7 46
2. General description of improvement:
3. Owner Information:
a. Name and Address;
MC11-11 r( -
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SfkN fo �)- C'/{ /� 33� 77 3
b. Interest in property:
c. Name and address of foe simple titleholder (if other than owner):'
4. Contractor: (name and address)
� �lL . s . 4�•tlola�l may,
S. Surety:
a. JIM Address
b. Amount of bond S
with Chapter
y -7o
GF_RTIVIED COPY
ARYANNE MORSE .
6. Lender. (Name and Address)
7. persons within the State of Florida designated by Owner upon whom notices or other documents may be served'
section 713..3 (t) (a) 7., Florida Statutes: (name and address)
8. In addition to himself, Owner designates the following persons (s) to receive a copy of the Lienor's Notice as
713.13 (1) (b). Florida Statutes: ( name and address)
9. Expiration date of notice of commencement (the expiration date is I year from the date of recording unless a
specified)
Swom to and subscribed before me this
day of �t� ,20r9� A(Si�tureOf Owner)
(Signature of Notary Public) (Owner's Nartt
PATRICIA AUSTIN
MY COMMISSION # DD 129074
EXPIRES: September 30, 2006
Bonded ThruNotaryPublcUnderwriters
or r .•`
date is
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date is
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(Owners Address)
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