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CITY OF SANFORD PERMIT APPLICATION
Permit #
Job Address: /o /vWI cm Si' Sa,
Description of Work: z e- too f " 51
Historic District: Zoning:
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: # of Stories:
Parcel #:
Owners Name & Address: ry
10fo W &^-S).
Contractor Name & Address:
Phone & Fax: -us
Bonding Company:
Address:
Mortgage Lender: .
Address:
Architect/Engineer:
Address:
Date: 4 - ?.or
7
Value of Work: $
N
qr oo - 00
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)
Attach Proof of Ownership & Legal Description)
ki•+s
1 1 V 71 Phone:
q State License Number:C'CC 18
n
Contact Person: R t Cl Y h G rttrl4n A Phone —6`I
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: 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 verification that I ' 1 notify the owner of the property of the requirements '0-Flo`rida ien Law, FS 713,
Signa of O er/Agent Date `W9 of Contractor/Agen Date
i
JM44.nt Owner/is NAffiA f Print_Contractor/Agent's Name
A MAAy os
ignatureofN o ' .,1pM%OM Date
o nFe QPIqs. N f DpMW2
Bonded 1*1N* 23
pet No '
OwneAgent is P ona y Known to r
Produced ID Z • 7' 7
APPLICATION APPROVED BY: Bldg:
Initial & Date)
Special Conditions:
Zoning:
J P.W CGRAW1014 # DD 185491
February 25, 2W7
ontrdetor/Agerst is:a'd?aeotoaNg Q"a
ely • seal-%
Utilities:
I / y/1
Date
Me or
3U./H o
FD:
Initial & Date) (Initial & Date) (Initial & Date)
6SS
AFFIDAVIT
REGARDING ROOF DRY -IN AND FLASHING INSPECTIONS
Company: A 0-12<P6 41Q
r r
f Z., C C
Owner: Mg r6, 6- s
name
address
0-7 32-z - 09 ¢
phone
License M CCC O-S--73 FS % Project
Information Permit #:
0 7 Subdivision:
Lot
M I, /
o,,t,-,r M, CoL- = - , affiant, hereby affirm that I am the duly licensed contractor
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:
sipature
eDAFni
Alf, C 7 L' printed
name STATE
OF FLO COUNTY
OF This
instrument was acknowledged before me this day of , 200K by the above
referenced individual,. Nnh r m C.o-Q--- , who acknowledged that he/she is a duly
licensed contractor withCU,1 & , and who acknowledged that he/
she was authorized to execute this document. He/she is either personally known to me or produced
as valid identification. WITNESS
my hand and seal this L/ day of 200 K Notary
Public DEBBIE
BLANTON IDMYCOMMISSIONkDD188491EXPIRES:
February 25, 2007 1-
000.3-NOTARY FL D;otrry Discount Assoc. Co.
Permit Dumber
Parcel Identification Number
Prepared by: •r. I11 z r p e
IL
to:
Wox vogQ 3
37- -7 30.
NOTICE OF COMMENCEMENT
State of ar 4
Se sure you record the Notice of Commencement (ifpermitisover $2500.09) at ofticial'Records, 401 S. Rosalind Ave before calling for final inspection &
oturnincopytotheyBuildingDivision: We mustl ' '' I
have it n file before you can get final inspection.
MARYANNE MORSEL CLERK OF CIRCUIT COURTSEMINOLECOUNTY
BK 05603 PS 0231
CLERKIS # 2005019236
RECORDED 02/03/2005 03:27:17 PM
RECORDING FEES 10.00
RECORDED BY 1 holden
CERTIFIED` COPY
MARYAtfflE MORSE,t
CkER 9FjCIRCUIT COURT''•
P'uTY CL FtK ekOUntyOfSCm:/I ode ,
03 2005 , c, The undersigned hereby gives notice that improvemcnt(s) will be made to certain rca.l ro a' p p My,.?nd iiniaccorda e' with Chaptcr 713, Florida Statutes, the following information is provided in this Notice Of Commencetment.
1. Description of property (legal description of the propeny, and street address if available)
7/
Il? c • l st
General description of improvcment(s)
Re- - (-oof
i. wner information
Name /12' f uP,; ^ s Telephone Number /l07 ?L 2- 0 7 V y
address lv/o W, /6 sr' Fax Number
Ss., Fred, F/ 3077f Interest in Property:
Fee Simple Title Holder (if other than the owner shown above)
Name Telephone Number
Address Fax Number
5. Contractor
f w4te1, rd0 c
StG e P game All
Address $07`` 3
7
Telephone Number (` 17 6 ><6- 4/05j
rr H ' F 327'3d
Fax Number
6. Surcty (if any)
Name Telephone Number
Address Fax Number
Amount of bond S
Lender (if any) _
Name Telephone Number
Address Fax Number
B. Persons within the State of Florida designated by Owner upon whom notices or other documents may be
served as provided by §713.13(l)(a)7., Florida Statutes.
Name Telephone Number
Address Fax Number
9. In addition to himself or herself, Owner designates the following to receive a copy of.the Lienor's Notice as
provided in §713.13(1)(b), Florida Statutes.
Name Telephone Number
Address Fax Number
0. Expiration date of notice of commencement (the expiration date is one year from the date of recordingunlessadifferentdateis
specified):
Date Signed
and subscri me this
Signature of Vwncr jNote: Ifer §713.13(1)(g), "owner
must sign ...and no one else maybe permitted to sign in
his or her stead." -
day o.20'__ 4by J
who is ff_.
as identification
known tue LTIc O
v R—
kea — S" .
MY COMMISSION N DD105102 EVIRES
April 2Z 2006
SONDEDiHRUiROYFAIN INSURANCEINC