HomeMy WebLinkAbout3304 S Park AveV"
Permit # :
Job Address: -
Description of Work:
Historic District:
(112 CITY OF SANFORD PERMIT APPLICATION
Date: O a d<-
Permit Type: Building Electrical
Electrical: New Service — # of AMPS
Mechanical: Residential Non -Residential
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential commercial
Construction Type: __L_ # of Stories:
Parcel #:
Owners �Name & Aj(dress:
Is
Contractor Name & Address:
Phone & Fax: -5x — %%
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
Value of Work: $
Mechanical Plumbing Fire Sprinkler/Alarm Pool
_ Addition/Alteration Change of Service Temporary Pole
Replacement New (Duct Layout & Energy Calc. Required)
# of Water & Sewer Lines # of Gas Lines
Plumbing Repair — Residential or Commercial
Industrial Total Square Footage:
# of Dwelling Units: Flood Zone: (FEMA form required for other than X)
�IJ�tJ, O r,
(Attach Proof of O
o' s /4? -,
Phone: 14
Contact Person:
tcense Number:
/C�Ul
hip & Legal Description)
9-
cc
13,-2
�f:4hone: _6' 11r? 7
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: 1 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 as water management districts, state agencies, or federal agencies.
Acceptance of permit is verification that 1 will notify the owner of the property of the requireme��s of Florida Lien Law, FS 713.
Signature of Owner/Agent Date Signature of ntractor/Agent Date
Print Owner/Agent's Name
Signature of Notary -State of Florida
Owner/Agent is Personally Known to Me or
Produced ID
APPLICATION APPROVED BY: Bldg:
(Initial & Date)
Special Conditions:
Date
Zoning:
Pr &tractor/ gent's Name
��`��
Signature o ,StatI da Date
icDEBBIE BLANTON
tv1Y CU0,NUSSION # DD 188491Contractor/ gens" P isahally Kno. py
Prod ed"4'i$-a-VOTA,/' F Notm� D.... o C-)
(Initial & Date)
Utilities: FD:
(Initial & Date) (initial & Date)
.r riniF MQF: st
tAP'R , ��1T CCtIRT
NOTICE OF COMMENCEMENT CLERK �F C.R FLORit
_..,�an►F COUNTY,
Permit No. Tax Folio No. lt4ay
State of Florida
County of Seminole L 2M
The undersigned hereby gives notice that improvement 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.
1. Description of property: (legal description of the proper"d street address if available)
2. General description of improvement: roo ' (� ; ( S ►'y�
3. Owner information
a_ Name and address G 1a t'`l e— f3 v r k e; 4 6, 'dle A0,
b.
C.
Interest in property W ✓1 e 1 -
Name and address of fee simple titleholder (if other than Owner)
Contractor �pG
a. Name and address
/elf
c`rt\� T-Y►C ,
CLERK OF CIRCUIT COURT
b. Phone number 3 67& 77q-,5 7/ max numb K SWL -1`7G 1W4 F r
5. Surety CLERK'S # 2005185261
a. Name and address REFUNDED 10/26/2005 10.58:45 Ali
HELURVINIS FLES 10.0D
b. Phone number Fax numb*LEIRDED BY D Thomas
c. Amount of bond
6. Lender
a. Name and address t l f k1
b. Phone number Fax number
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as
provided by Section 713.13(1)(a)7., Florida Statutes: \
a. Name and address 1U
b. Phone number Fax number
8. In addition to himself or herself, Owner designates A) 1 A of
to receive a copy of the Lienor's Notice as provided in Section
713.13(1)(b), Florida Statutes.
a: Phone number Fax number
9. Expiration date of notice of commencement (the expiration date is 1 yearto of recording unless a different
date is specified)
Signature o er
Sworn to (or affirmed) and subscribed before me this day of OC I c A e r , 20 0.5- , by
Personally Known ORProduced Identifinaticm—Fl- N
Type of Identification Produced ���0 - a (-7 < <-j - -0
Signature of Notary Public, State of Florida'; SARA R. PALMER
MY COMMISSION # DD 453687
Commission Expires: ,- EXPIRES: July 21, 2009
Bonded TIn Nwry PL*k underwritero
H
0-gqv
AFFIDAVIT
REGARDING ROOF DRY -IN AND FLASHING INSPECTIONS
r r--�
Company: 9 Z License #:
Project Information
Owner: aal�t dU/-ks Permit #:
name
3 Cy `{ S Subdivision:
address
Lot #:
phone
affiant, herebyaffirm that I am the duly licensed
Y
contracto 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.
Contractor
signature /
printed name
STATE OF FLORID,
COUNTY OF
This instrument was acknowledged before me this 0 day of _ C,� , 20 by the
above referenced individual, ;who acknowledged that he/she is a
duly licensed contractor with , and who acknowledged that
he/she was authorized to execute this document. He/e is either personally known to me or
produced as valid identification.
WITNESS my hand and seal this
day of Gif
Notary Public
8tANTON
ppP' iCiv DD 188491
YAs
u.,ruary 25, 2007
x' .1 Discount Assoc. Co.
w.,�d �.,.... �. - .....,,..e