HomeMy WebLinkAbout705 Mattie StPermit /t :y'I1Ja4t„a
JbbA(ldress: %D MAIT I E
CITY Or S,lNrOnl) I riLMIT APPLICATION':!`
Date:
SANo
Description of WOI'T(: e - t., I(- vu 1� f /
Clistoric District: Zoning: Value of Work- S �{ ---
Permit Type: Building Nectrical Mechanical Plumbing rire Sprinkler/Alarm r Pogl•^^_-_
Electrical: New Service — It of AMPS Addition/Alteration Change o�. Servicc Temporary Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout S-, Energy Ca1G,•Rcquired)
Plumbing/ New Commercial: 1t of rixtures it of Water & Sewer Lincs If of Gas Lincs
Plumbing/New Residential: 11 of Water Closets Plumbing Repair— Residential or Commercial
Occupancy Type: Residential Commercial industrial 'total Squarc rootage:
Construction Tyne: fl of Storics: ft of Dwelling Units: Flood Zone: (rrMA torn require(', for outer than X)
,u-..-.•-�:-,��,.`-:.sem,•.-�-.
Parcel 1t: (Attach Proof of Ownership & Legal Description)
Owners Name & Address: L-1 9P_ADD .T_LLA-, _56Lk12170PJ —705 HxTVtP_ ---..._._.
F► 32-1-11� Phare: ._._._.. --
Contractor N:une &''Address: `Ar2 6G) CK (Zoo t N _..._._......._-.-._
�o o f:2E N (A J Sfk+-3 CC 1�' t l 32l'1 State License Number: VCiii 0 77– 1
Phone & rax: Contact Person:—_.._.__..... --
ponding
Address:
NIorl�a! l`
Address:
Architect)
Address:
Application is hereby made to obtain a permit to do the work and installations as indicated. i certify that no work or installation has corin•Icncvi prism 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, 1-IEATER.S, TANKS, and
AIR CONDITIONERS, etc.
OWNER'S AFFIDAVIT: I certify that :Ill of the foregoing; infornvition is accurate and that all work will be dont in compliance lvith all applicabic. lay s rrgtrl.'aing
construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE Or COMMENCEMENT MAI' RTSUi:T IJ\y YOUR. P YTNG
TWiCE FOR TMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTATN rINANCiNG, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFOI'- RLCORDiNG YOUR NOTICE Or COMMENCEMENT.
Nn'hIt (: Irl addition to the rcquirenu:nu: of this pcnuit, there Imly be additional w!;II ictions applicable to Ihi:; properly that play be found in (he public records of
this cot nity, and there may be additional permits required from other govenuncnCll entitles such :e: water nlulagenu:nt distracts, stale :II!cnr.lcs, or federal agencies.
Acceptance O
fPlor
wrler/Agent Dau: nal ofC T —
n.•:..r n,,.,le /Agent's :tine P It onnagor
of or,Iry_ :u�'A_ 451�?:ftK
_/Fury t-;Onj piston CC985428
,Ft Expires December 09 2004
Ohrnc to :M,: ur
3 67-
AITLICA•TION APPROVED BY: Illdg:
r:atare
i Il%1hV, rs
'A gClll
s Nanny .
Ile
Date
Q MY Comma ton CC98s418
1
'boa rae Expire 2 4
Con:,actol/A Pen;onaii. n to ,�M or
(Initial X.. Dahl
speci:d lonililiunS:------- --------------------------'---
(Initial Date) (lititial L D^_ir J
POWER OF ATTORNEY
Date: �b4
1, Andrew J. (Andy) Adcock do hereby authorize Ruben Birch
To pull the Reroof permit for %Q rj Mkm o S ( sAN �D zD .p"j
(type of permit) (address)
i
N
=OW Rk Linda A Keeling
My CM.Msm CC985428
or a Expires December 09 2004
Stamp
(Personally known --t-" me or driver license' # , of State of Florida, County of
�a "� day of I�z , 2004.
�_ P�flRYANNI` MiIR ,CLERK OF CIRCUIT COURT
SEMINOLE COUNTY
BK 054F1 FiG 1093
gDv �� NL' t l S4 f ECLERK' S 41 004146045 : 1,
ssA1�, Fo j n -37--71,`foucj:- 0r, C01�.i\,i - NC�%i�'IET'ikDRDED 09/20,V2004 01:39.32 PN ;.
- ,aia t.
permit No. RSCfiWO BY L McKinley
SuItc ofPloricla ,
Coullty of Sc[11illole
llcrcU �ivc:; 110L'1GG'Lllat II11prOVCUlCIlI ti'lill be I11:lctC to ccr;lin 1'C;11 prol)CfLy, ,11X1 ill accord'a11ce tihrilll
Sllc ualacrsi�nccl y L
Cllapt'cr 713, l'loridi, St'atacs, t�hc followilig illfor111"ltioll ploviciccl in alis :\loticc of Colnmcucc[ncnt
:: ss if :l�railablc e
1. .
UC,;,,L,ioil of pro �crty:�lcral cicscriptiall of dl l l} ":Is ct ;Icl —)
2, General dcscriPtioll of iroprovcnlcnt: ____•� I�o_a_��
Owilor illformatioll
a..
-N -will; and -,clress
b. 111tcl-CSt iu P1'ol�crty
C. Name alld ;id(lrc ss of fcc sitllplc titicllold
4. Contractor / y
a. rtalllc ��(l/la aclar
b. P11o11C 11Ulllbcl'
5. Surety
a, Nzillic and address
b, PhOn'11bCr /y
c, A.111oullt of bond
G, Lcndcr
a. N;1111C ally addreSsl
b. '1'110110llunlbcr
7. ),'Sons wialill tllc State: of Florida (Icsigir.LC
Provided by SCCLion 71?
;1, ,.N3111C 3I1C1 addrCS'S
I. other 111:111 0%1.111cr)
T�a;; nunlbcr
7 �D C/fJ
munbcr
].';1;� Illltl7.bCr wba `
by p,;[lcr allot; .rl1o111 notices or other doculllcllt-,; I'llay be scl-vcd as
tatutcs:
l';IX Illllllber Of
b. • I)11011C 1111111bcr
a. addition to hi or llcrsCU 0 .,Ilcr dcSilgllat'cs Provided ill S
to receive 3 copy of tllc Lic[lor's Notice as ectlola
713_.13
Fax IlllillbCl' lfcrcllt
Zi. Pllollc nunlbcr ,
�x 1rat10t1 ClatC Of l]oC1CC Of GOIII 111C11CCIII crit (t11C C::pir<lttotl a3l'C 15 l yC;1r fr0111"V datC Of 1'CCoi'Clill(', l CS"
9 P
e is speciC►cd)
dat_
SiLuaCure of Owne�r,/� .
clay oC
la'A
20 0 .. by
XSworil t0 (01' a flrtll� t) aa.d s `bscc bcct bcfor 1110 ii
=odY a„•,^ Linda A Keeling
Personally ZCnowll OF, Produced fclentt kation__- � W , My CommissionCC985428
,. - •• n.,_ _�.. .I ego` dt Exp,r December 09 2004
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