HomeMy WebLinkAbout950 W 13 StPermit # : 0—IS�
Job Address:
Description of Work:
Historic District:
Zoning;
CITY OF SANFORD PERMIT APPLICA'T'ION
Date: e6 D
Value of Work:
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinlder/Alarm Pool
Electrical: New Service — # of AMPS Addition/Altcration 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 Corrunercial
Occupancy Type: Residential Commercial Industrial Total Square rootage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #:
Owners Name & Address:
(Attach Proof of Ownership & Legal Description)
Elrv�.c�-�S-1- PC, . [fie-�•+��I_� �...
-'�F7" Phone:
Contractor Name & Address mo Lc- 0-J1 a y �� �♦:' 3277(
State License umber:
G[C D ZZ So
Phone & Fax: ?✓?z -1330 3 Contact Person: CD Phone: 7 3ZZ
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Cngincer: 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 taws regulating construction in tris 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 per s verifipatio h I vii ify the ovine of the propc y of the require r f FI da Lien Law, - 3.
L 9 &
t e of Owner/A ent r DIte Sign: of actor/Agent Da
at tr g
4Printwner/ 1 enl's Na QPri nt t Age 's Name�Uof tary-Stator of rida D:rtd Signature of No tyL-,%- -of n a D
"",• e OFBBIE BLA
hey 491
('—o"' IISSION 91
#FebruaContractor/AI nt is'<o,�" Personally k0'0\yLr;I
ID eoo-3-NRT r t'
Y ed IDAFNEY FAYE ADCOC Produce
APPLICA
Special Conditions:
NOTARY PUBLIC, STATE OF FLORIDA
MY Comm. Expires DEC. 2, 2008
✓EDOOMAdt DD376609
(Initial & Date)
�g3
Utilities:
FD:
(Initial & Date) (Initial & Date)
POWER OF ATTORNEY
Date: d
I, Andrew T „(Andy) Adcock do hereby authorize Ruben Bi I
To pull the Reroof permit for Ci0
(type of permit) (address) �Z
,i
Si
otary
Stamp
1" DAFNEY FAYE ADCOCK
1 NOTARY PUBLIC, STATE OF FLORIDA
MYCdRIM, gxplros DEC. 2, 2008
Comm, # DDS16609
Persona ll kno me or driver license # , of State of Florida, County of
day of
77-0 CP `;
AFFIDAVIT
REG ROOF DRY -IN AND FLASHING INSPECTIONS
Company: CoC.LPclol License #: C.C.I.d 7-7-S0
soya
Project Information
Owner: FAZt0Iz,C� A'LVV�DLF_ Permit #:
name c
a(4T' 40-0 . Subdivision:
address
SLI - �!Lo (obi Lot #:
phone
I, L affiant, hereby affirm that I am the duly licensed
contractor of record for the above referenced permit, that all the foregoing inform -tion 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 FLO A I
COUNTY OF �,
9
This instrument was acknowledged before me this _
above referenced individual,
duly licensed contractor with '�,T Z.e.
he/she was authorized to execute this document. He/
produced
WITNESS my hand and seal this
DAFNEY FAYE ADCOCK
t 11 NOTARY PUBLIC, STATE OF FLORIDA
MY Comm. Expired DEC. 2, 2008
COMM, # OD316009
day of Sin`20 by the
, who acknowledged that he/she is a
owledged that
;he is ' er personally kno to me or
as va ' ideni1 n.
day of , 20
Notary Publ c
�. foo Statc of Florida
itNo.
NOTICE OF COMMENCEMENT
Tax Folio No. (PID)
County of Seminole
The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with Chaptcr
713, Florida Statutes, the following information is provided in this Notice of Commencement.
DESCRIPTION OF
description of the property and street address)
GENERAL DESCRIPTION OF IMPROVEMENT �oo
OWNER. INFORMATION----- (� ` f
Name and address Ala — �i l�`�"�
Interest in property (Fee Simple, Partnership, etc.) f)A
NAME AND ADDRESS OF FEE SIMPLE TITLE HOLDER -9F OTIIER TI -IAN OWNER)
CONTRACTOR
N d addr s C O CHIC
SURETY (Bonding Company) =
Name and address t Q;ERTIFIED COPS
�n viNNE MORSE
Amount of Bond CLf p r F CIR l IT"101
LENDER (1
Name and address v r
EPDn (tLiRK
##
I'crsops within the State of Florida designated by Owner upon whom notice or other documents may be s ed provided
by Section 713.13(lxa)7., Florida Statutes:
Name and address up In fdi �'c 11�R
d' t��ncJJJ
•+«**#++++«##«#+4#4*4#«44##«##++#+k#Y�**+«�h«#JR4#*«*«*'M+«#***+*+t4***«+4**#+*««++«+,++**«#+#4k+«#+
In addition to, himself, Owner designates of
to receive a copy of the Lienor's Notice as
provided in Section 713.13(1)(b), Florida Statutes. r ,z
+«+**#«*#+*#4##4##*+#+#«+4+#+«##4#*#4**#44#+#*#4*###*#**##*+#*+#*#*«*+*+*##*+«##*#**#**###+4 loom " s
Expiration Date of Notice of Commencement L
(Thc expiration date is 1 Year from date of recording_ unlecc a diffemnt data iC ,uwr:ifed 1 '°' 00 7rt
Signature of Owncr �o,��Y,w*r CHARLES H. SMITH oa 0— r r;+ 11-i
* MY COMMISSION M DD 087676
Sworn to and subscribed before me this Day ofW—�'Qs� t EXPIRES: March 29,2006
T /
r6 OF F��4 Bonded Thru Eudget Notary Services `✓` r t
My Commission Expires:
Notary Public.r '
Thrcgoing instrument was acknowledged before me this day of ]9 by �+
(name of person ack-aowlcdgcdy. who is personally known to
me or who has produced (type of identification) as identification
and who did / did not take an oath> —t