HomeMy WebLinkAbout432 Scott Ave (2)Job Address: y 32 Cj e -D
Description of Work:
Historic District: _
CITY or, s morm PVRMIT APPLIC,ITION s I t m rra�,f ; rnz t'r
Date: IC) �. :6'
Zoning: Valuc of Norte: S (O LO (IP r7 ' O 0
Permit Type: Building electrical Mechanical Plumbing vire Sprinkler/Alarm r Pootl•^ _
Electrical: New Service — it of AMPS Addition/Alteration Change of Service Tcmpot:iry Pole _,-____•
Mechanical: Residential Non -Residential Replacement New (Duct Layout & energy CiilG, acquired)
Plumbing/ New Commercial: I/ of rixtures 11 of Water & Scwer Lincs 11 of Gas Lincs
Plumbing/New Residential: ll of Water Closets I'lumbing Repair— Residential or Commercial
Occupancy Type: Residential Commercial Industrial 'fotat Square rootage:
Construction Tyne: 11 of Stories: 11 of Dwelling Units: Flood Zone: (FrMA form required for outer than X)
Pnreel il: II'' ..y (A(tach Proof of Ownership & Legal Description)
Owners Name & Address: 14 3 L - a1 G C -7 f_o ��
Phone: _...----- - --
Contractor Name S.' Address:
Phone & rax:
ponding (
Address:
\4ortgagC
,\ddress:
Architect/
Address:
(Z0.0 t— I
cc iZfD •C
Person:
State Liccnsc \wnbcr: Ci�iCi 0 77- 95
Phone:
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 iu the
issuance of a pemlit and that all work will be perfomled to meet standards of all laws regulating constntction in this jurisdiction. I understand that n separate
permit must be secured for ELECTRICAL WORE, PI_U1vi11ING, SIGNS, WELLS, POOLS, FUlZNACES, BOILERS, HEATERS, TANKS, and
AIR CONDITIONERS, etc.
OWNER'S AFFIDAVIT: I certify that all of the foregoing infomntion is accurate and that all wore: will be done in compliance with all applicable, laws r(:1 uL:ting
construction and zoning. WARNING TO OWNER: YOUR FAILURE "r0 RECORD A NOTICE Oh COMMENCEMENT I MAY RESULT 114 )r 0 u ,. I'AYING
TWiCE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAiN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BC -FORE RECORDING YOUR NOTICE 0. COMM ENC EMf NT.
In addition to the requirenl(a1L: of this PC? Ihere may be addition:ll reslrictions applicable to Illi..: propel that play be found in the public records of
this county, and there may be addition:11 permio: required front other l;nvcnnncntal entities such as water manac.cmcnt districts, statearcncl�r fcdcral agencies.
Acceptance of permit is verification that i will notify the owner of titc property of the rcquircm • of FI da Licn to /S 713
I_rel✓ L
Signauue ( Owner/Ahent Date
Siena ol'Co tt .ictor/Atter/
--
t'rinl Owner/Ager, -Name
Sif;1 aturc of N t y -Stat, of Florida NECIA J. SOLLI'�`N
NOTARY PUBLIC - STATE OF FLORIDA
COMMISSION # DD301783
EXPIRES� 6/28/2008
O«yacr/Al;cnt is __— Pcr,onall� Kno,�Q�R6Q771 1-888-NOTARYI
1/ Produced ID _-.^._—__-------_--_--
AITLIC'ATION APPROVED BY: Ill(Ig: __. L011lu': _
I I itial & D:I.c)
special Conditions:
tractor Ai,*it's
x6 --VA-"
ore of No:ary-Smte of Florida Date
FLORENCE A. DE GRAVE
* * My co ISSION DD B4
�'NYpi�fOlr'12 Cll'
.. once 2006
(Initial ,L D:ucl (Initial Dated (Initial L Da1r
1__...._...- _...yam _..-- -- .. _ __ _ - --- .............._......---............
....
.....__... -- .... got)
tz
C&MFIED COPY
N07 zCL or CO-�r� NCLMEN7: MARY, NNE MOPAE
Permit No. T,1 , Folio No. t�LRK OF CIRCfil7 egt=
ODUBTL so=
State of Florida
CountyOf Sctllitlole
Zl1c lltldelsi3aeci hereby Live s lloticc plat iulprovealcnt will be made to certzlin real property, and illaccordance wills
Chapter 71.3, 171o1'ida Statutes, the following informatioll is provided ill d,is 1`loticc of Comaimcclnctlt.
1
D-riptioa of property: (legal (lcscriptioll of the property alid sCl'cct aciclress if m allabl(')
MAX-rZ4Ss --
l e o 1T A J E S A N r"o Z -r-> ( 3 Z
2. Gctleral descriptloll of 1111provclimit:
4.
Owner itlfort11c1tiotloiT,� ��D �� t 3z -7—Z
a, Narnc and adcllcss M Q.� F�AS�7 43Z. 5 C
b. Interest ill property i,y .
c. Name atld addl-c-ss of frc silllplc ttticlloldci' (if other than Owner)
Cotltractor
a . Name and address
b. Pho11c munber ,L6j - J,? 7
5. Surety
a, Namc and address
N
number s-s(_--=�—� J '
nu 11"WL" LIAM T
b. Phone 1111111bcv BK 05WG'_cF_ FSG 18@11
C. Anloullt o1 bond 5_18
6. Lender RECORDED 18/602M M36:28 AN
a• Na111C 111 C1 addt'Css __ ___%Y ? Ri.`fY�W Mla rre�
M
—ax nu mb cr
b. Tholle llunlbcr
7, p rsons witllitl tllc SC<ate of Florida dcsiUaatccl by Owner upon. whom 11oticcs of other doculneuty may be served as
provided by Scclio" 713.13(1)(x)7.,Florida StltlltCS:
a. Name and address `
b. Phone number
l�axnulnber of.
8. In addition to hitllself or herself, 0 , ner dcst nates
• to receive x copy of tllc z,ienor's I�lotice as provided utio
1 Secn
713.13(1)(U), Florida Stztutes. 1 -ax uumbcr
a. I'houc number
9. Expiratioli dale ofnotice of corluncnccnlerlt (the C%piration date is 1 year from U10 date orrecordin� unless a diffcrellt
date is spccificd)
Sil�uat:urc o1:•Owncr
clx oC/ 20 OV , by
�( S�,o (or x�Cirl. c) an slUscribccl before me this _ Y
crsouall Known OR 1?roduccd ldcatification
NECIA J. SOLLIEN
NOTARY PUBLIC - STATE OF FLORIDA
COMMISSION # DD301783
EXPIRES 6/28/2008
BONDED THRU 1 -888 -NOTARY?
POWER OF ATTORNEY
Date: 0
I, Andrew J . (Andy) Adcock do hereby authorize Ruben Birch
To pull the Re r o o f permit for 3z ( L'oTr- Fo ft -0
(type of permit) (address)
e
Signat e
f
=o.01 n<en Linda A Keeling
My Commission CC985428
w N*'Ioi ndO4 Expires December 09 2004
Notaly Stamp
CPersLonallyown to e or driver license # , of State of Florida, County of
day of �( C7 0 12, E 2 )2004.