HomeMy WebLinkAbout611 S Park AvePermit #
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Descripti(
Historic District:
^ CITY OF SANFORD PERMIT APPLICATION
0 Date: llf��`T//g
Zoning:
Value of Work: $ J FCs2
Permit Type: Building Electrical _X— Mechanical Plumbing
Electrical: New Service - # of AMPS Addition/Alteration
Mechanical: Residential Non -Residential
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets
_ Replacement A— New
Fire Sprinkler/Alarm Pool
Change of Service Temporary Pole
(Duct Layout & Energy Calc. Required)
# of Water & Sewer Lines # of Gas Lines
Plumbing Repair - Residential or Commercial
Occupancy Type: Residential _>�— Commercial Industrial Total Square Footage:
Construction Type: _ _ # of Stories: _ 9- # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: [� i 1 �j �q(AAttach Proof of Ownership & Legal Description)
Owners Name & Address: l i��
�� CI Qi d, 1 i"y����
Phone:
Contractor Name &Address: -Ti'r�
I ` I, _ State icense Number:
Phone& Fax: �`{�� `t� CM11l /� t� � �� Contact Person: , Phone:�i(3���
Bonding Company:
Address:
Mortgage Lender:
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 pen -nit 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 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 verificaC wthaiF'will notify the ownero'the p perry of the requir r nts of J IoriAa Len Nw, FS 713.
Signature of Owner/Agent IF D6 Sinature of C•�ry}on ra toorr/4Aprge�nt to
H c "c �JIY PU I:Scax;i Amn
* � PrCot gentamePrint O& I/ �DON«D10 /41
* ,
0EXPIRES: July 16�
1
s
11
Sig ary- e o o a ate S �C'ptPA�aryE13widEGRAVE Date
MY COMMISSION # DD 184280
WIRES: November 12, 200E
cad' .BondedTh� Budget to r
Owner/Agent is Personally Known to Me or �Co} Tactor/Agent is t' ersonatilyvpinfifi to e or
Produced ID 'T' Produced ID �C -^ \\,0 [0 �0 -
APPLICATION APPROVED BY
Special Conditions:
.D�
Zoning: 'L O � Utilities:
(initial '& Date) (Initial & Date)
FD:
(Initial & Date) (Initial & Date)
1U-05-EU1j5 1.5: Eb HHHUN 1NUUS I KitS iNC HRCaE1
MARYANNE WNMj CLERK OF CIRCUIT MW
MINGLE CQLINTY
NOTICE OF COMMENCTPMT:NjBK 05934 FIG 0073
CLERK'S #t 21e' 05171535
Permit No. T. WW*01051 5 011-06115
State of Florida. REM- RDINR FUS 10.0
County of Seminole REWRI O BY L McKinley -
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 property and street address if available)
_ e
LA R - ..... _-�'_.�'..� ............
PR_ l_.._... S ...._.... - -.. __.... __.._.__......--
2_ General description of i
4
5.
6 -
Uwner information
Interest in property -.
e. Name and address of fee simple titleholder (if other than Owner)
Contractor
a. Naune and address
b. Phone number
Surety CERTIFIED COPY
a_ Name and address
b. Phone number Fax number VL
�n COURT
C. Amount of bond
S OAUC�L
FLORIDA
Lender
6.
a. Name and address .. _._ 0R - - -
b_ Phone number _ Fax number J
7. Persons within the State of Florida designated by Owner tipon whom notices or other documents may be served as
CCS 5
provided by Section 713.13(1)(a)7., Florida Statutes: A
a. Name and address
b_ Phone number _
8. In addition to himself or herself, Owner designates
Fax number
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 year from the date of re g unless a different
date is specified)
Signature of Owner
Swam to< o aftttme and s ' cribed before me this 2 day of _ — , 20�, by
Personally Known/
'°�� p �dOR 'Produced identification _
Type o��Idep4 fica�HEi & t�Pg6A , -
* * W COMMISSION t DD 300610
EXPIRES: July 16,2M
T1iIS INSTRUMENT PRE RED BY:
�f1TFOF FVPBonded T'hru Budget Notary Services
Signature of Notary Publi State , f 141oricia NAME
CoTrfilission Exp'
ADDR.y