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HomeMy WebLinkAbout104 Anderson AveCITY OF SANFORD PERMIT APPLICATION Permit # : Ln- Job Address: / 0 Description of Work: Historic District: Zoning: Date: Value of Work: $ Permit Type: Building __ Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool Electrical: New Service — # of AMPS Mechanical: Residential Non -Residential Plumbing/ New Commercial: # of Fixtures Plumbing/New Residential: # of Water Closets Occupancy Type: Residential Commercial Addition/Alteration Change of Service Temporary Pole _ Replacement New (Duct Layout & Energy Cale. Required) of Water & Sewer Lines # of Gas Lines Plumbing Repair — Residential or Commercial _ Industrial Total Square Footage: Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X) Parcel #: Owners Name & Address: Contractor Name & Address: Attach Proof of Ownership & Legal Description) Phone: State License Number: Phone & Fax: Bonding Company. Contact Person: Phone: 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 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: hi 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 will notify the owner of the property of the requirements rida w, FS 713. Signature of Owner/Agent D to Signa e of Contractor/Agent Date Print Owner/Agent's Name (}t Prin Contractor/Agent's Name dos - Signature of Notary -State of Florida Date Signature otarfate oflTo3fdd Owner/ Agent is _ Personally Known to Me or Produced ID APPLICATION APPROVED BY: Bldg: Zoning: Initial & Date) Special Conditions: Utilities: Initial & Date) DEBBIE BLANTON MY COW46SION # DD 188491 EXPIRES: Febrijn v 9..R gnm FD: Initial & Date) (Initial & Date) s9"' i PERMIT ADDRESS CITY OF SANFORD, FLORIDA APPLICATION FOR BUILDING PERMIT J 'P, 5csoAl441 &"/4dPERMIT NUMBER j Total Contract Price of J % QD D Total Sq. Ft. Describe Work ' Z ja Type of Construction Number of Stories Number of Dwellings _ Occupancy: Residential Commercial ood Przne (YES) (NO) Zoning Industrial LEGAL DESCRIPTION (please attac printout from Seminole County) TAX I.D. NUMBER OWNER , PHONE NUMBER ADDRESS H P CITY STATE ZIP TITLE HOLDER (IF OTHER THAN OWNER) ADDRESS CITY STATE ZIP BONDING COMPANY ADDRESS CITY STATE ZIP ARCHITECT ADDRESS CITY STATE ZIP MORTGAGE LENDER ADDRESS CITY STATE ZIP CONTRACTOR ' h PHONE NUMBER ADDRESS ( S G ST. LICENSE NUMBER CITY STATE ZIP 3 2 R S 9 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, PLUMBING, MECHANICAL, SIGNS, POOLS, ETC. OWNER' S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating Construction and zoning. A COPY OF THE RECORDED COPY OF THE NOTICE OF COMMENCEMENT WILL BE POSTED ON THE JOB SITE WITH PERMITS NO LATER THAN SEVEN (7) DAYS AFTER THE PERMIT HAS BEEN ISSUED. FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOU PAYING TWICE FOR THE 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 WILL NOTIFY THE OWNER OF THE PROPERTY OF THE REQUIREMENTS OF EL.DRIDA LIEN LAW, FS713. 6 3 ' b Z! C ( D O i b ey rr O O h S ,, Signat of Owner/Agent & Date Signature of Contractor & Date 0 w < c z U Type or Print ner/Agent Name Type or Print Contractor's Name a a Signature Notary & Date Signature of Notary & Date ~' p 0 1 (Official Seal) PDLeiLANCs Notary Public, State of Florida My Comm. expires nr, 112006 ° z a 9onded thru Ashton Agency, Inc, (800 451-4854 ro a 3 O E x ro o Z ri H UN I ro w a o u o o a)>1 Z w. F Application Approved BY: FEES: Building Open Space PERMIT VALIDATION: CHECK Radon Road Impact Date: Police Fire Application CASH DATE BY ORIGINAL ( BUILDING) YELLOW (CUSTOMER) PINK (COUNTY TAX OFFICE) GOLD (CO. ADMIN) 0 a C n rr D a N v THIS APPLICATION USED FOR WORK VALUED. $2500.00 OR MORE AFFIDAVIT REGARDING ROOF DRY -IN AND FLASHING INSPECTIONS Company: , ay f License #: Project Information Owner: ' -eLl p Permit #: name r>,4 ,A5L2" Subdivision: address V oz % V Lot #: phone I, & P ,/ , 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: dz signature printed name STATE OF FLO A COUNTY OF This instrument was acknowledged befigrp me this day of 265 , by the above referenced individual, 1 C , who acknowledged that he/she is a duly licensed contractor with ' , 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 r day of Notary Public Permit Number I loll it Ill 11111 II oil 11 lit II oil 1111111 oil II Ill 11 Ill 11 Ill I IN Parcel Identification Number 3119 315 Z 5 0 r0000Y0 Prepared by-T_)J c_ _e"E60c_ Return to: Brite Top Roofing P.O. Box 590325 Orlando, FL 32859 NOTICE OF COMMENCEMENT State of Florida County of 5;P14,f , l.e OP MARYANNE MORSE, CLERK OF CIRCUIT COURT SEMINOLE COUNTY DK 05622 FAG 1639, CLERK'S # 2005030287 RECORDED 02/22/2005 0209:42 PM RECORDING FEES 10.00 RECORDED BY t holden CERTIFIED COPY MARYANNE MORSETEKFCIRCUITCOURT The undersigned hereby gives notice that improvement(s)will be made to certain real ro a 14 d accordanegYgpprty, with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1. 2. 3. 4. 5. 6. 7. Description of prope (legal description of the property, and street address if available) I9--3/-SzS-09bo--00vc General description of improvement(s) /V,, o/ (,. yt,'o yt OetLks P-C, leg 16 / PC. 97 Owner information Name 7: i; . ®77 Telephone Number 3 0,2 Address %d t7 P. Fax Number ! S a 7 7.® Interest in Property: 0 yy;P !; Fee Simp a rt1e Holder (if other an the owner shown above) Name N/A Telephone Number Address Fax Number I Contractor Name Brite Top Roofing Address P.O. Box 590325 Orlando, FL 32859 Surety (if any) Name N/A Address Lender (if any) Name N/A Address Telephone Number 407-895-1551 Fax Number 407-895-1320 Telephone Number Fax Number Amount of bond $ Telephone Number Fax Number 8. Persons within the State of 'Florida designated by Owner upon whom notices or other documents may be served as provided by §713.13(1)(a)7., Florida Statutes. Name N/A 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 N/A Telephone Number Address Fax Number 10. Expiration date of notice of commencement (the expiration d is one year from the date of recording unless a different date is specified): Id Date Signed Signature o wrierote: per §711.13(1)(g), "owner must sign ...and no one else may be permitted to sign in his or leer stead.", 0 ,t-,P4 L, c P.,rp " ®©- g a? -5-7- 070 - O Sworn to and subscribed be fore me thi ` day o tsr vq , 20 KS by who is personally known to me OR produced as identification. ] WANDA L. LEBLANC Signature of Notary ( to ial seal must appear below) Notary Public, State of Florida Form Revised: 3/ 04Fshtony comm. expires Apr. 21, 2006 No. DD 110286 Agency, inc. (800)451-4854