HomeMy WebLinkAbout110 N Hampton CtCITY OF SANFORD PERMIT APPLICATION
Permit #: ()S ' 1
nr
Date: Ja.n • -? . ao
Job Address: 11 0 N Ral,vvLQ+o to Sar-d-Drd . F L
Description of Work:
Historic District: Zoning: Value of Work: SL `W7q • JS
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/Alteration 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 Commercial
Occupancy Type: Residenti al
L
Commercial Industrial Total Square Footage:
Construction Type: is,-C{ c # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: 0--t— Q U " rS 1 _ 5 0 a —
Owners Name & Address: ftnw r4-ii'1! 7
C.X> W U (Attach Proof of Ownership & Legal
3T M
r
Contractor Name & Address: "Q.rr C 5 I t1 in el (D7 tP'7 H o f r7l r PaJd r
Oy (it na o FL 6:t$ 0-11 OL State License Number:
Pbone & Fax: NC7 — 3 — S3 y *s F' yow//L" s Contact Person: Lin r Phone:
Bondine Comnanv:
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. 1 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. 1 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 it is ver'fication t t I will notify the owner of the pr
hv. &' 1/ go
wne Agent_ Dale
P' t w A g6nt's Name
y
Signature ofN ry-State of Florida Date
BETTY-ANN KELLY
MY COMMISSION 11 DD 029121
Owner/Ag t i rsonalt"ITkbrAof005
Produc 'RNP
APPLICATION APPROVED BY: Bldg:
Initial & Date)
Special Conditions:
Zoning:
of Florida Lien Law, FS 713.
SignatuMil
tractor/Agent Date
La", bf r__ -
Print Cont ctor/Agent's Name ,
Contrar r
P
Utilities:
Initial &
Date) BETTY-
ANN KELLY MY
COMMISSION N DE) 029121 i
EXPIRES: May 24, 2005 FD:
Initial &
Date) (Initial & Date)
e-7
POWER OF ATTORNEY
i
Date: O
I hereby name and appoint 1 r ('«ccna
C44ojc(.' to be my lawful attorney in fact to act
for me and apply to the e-1
Building Department for a
ufi
permit for work to be
performed at a location described as:
Section Township
Subdivision
and to sign my name and do all thi
Range Lot
ew .rs_
Ad&= of Job)
gs necessary to this appointment.
or " nwm of mtif ed ommdor
Block
I
The foregoing instrument was acknowledged before me this " 1 day of -:5-AtJ
i
By c.y/V /V t rl cn
Who > pamnally known to me ho produced
As identification and who did take oath.
State of Florida
nn ,
I
Countv of tJiiQ l2Gi p _
Notary Publico0range County, iorida
A •"., BETTY AI I IDLY t
MY COMMISSION / DD 02912, li
s ,mot EXPIRES: May 24, 2005 P,
a i dF - BoiMW Thru BUdpal NWary Sonwso
Permit Number
Parcel Identification Number 07- cAO-31-j60V " 0 00-
Prepared By: t-lari-id'c7qq
r .
t9-7 V,-1 HoffPcV- 7W C-
u,lando, F- aa aa
Return to:
Ccrityac-4-D"',
NOTICE OF COMMENCEMENT
State of -F i (W i a
County of A Serf ii n6lC
MARYANNE ON, CLERK W CIRCUIT MIRT
SEMIM LE COlUIM
BK 05579 PS 1657-
CLERK'S * 2005006990
RECORDED 41/13/eM 1&2100 AN
Rk' WINS FEES VL W
RECORDED BY L McKinley
The undersigned hereby gives notice that improvement(s) will be made to certain real properly, 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 property, and street address If available)
L-66i LC1T W 6A"IN1-11-- 1V 1ST F-eP-PrT
110 N • A4ckrY-'"fi G-U- CERTIFIED COPY
2. General description of improvement(s)
r E-r (. h Y' Y
c1t-1-rricL c MARYANNE MME
3. Owner Information
CLERK'OF CIRCUIT COURT
Name fttn -i,EtsE Telephone Number SEMIN LE COUNTY, FLORIDA
Address 110 )u . i-W-rn pl'R Fax Number
t i7 ,,Cf r r-G ,5-). Interest in Property BY.
P CLERK
4. Fee Simple Title Holder (if other than owner shown above) ^
Name Telephone Number
Address Fax Number
2005
Contract
Name /}f ja./111G Si(J1 r1, Telephone Number
Address &
r
Z U17 H61fnC M a Fax Number
1•-
6. Surety (if any)
Name Telephone Number
Address Fax Number
Amount of bond $
7. Lender (if any)
Name
Address
Telephone Number
Fax Number
8. Persons within the State of Florida designated by Owner upon whom notices or other documents maybe
served as provided by Section T13.13(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 Liences Notice as
provided in Section T13.13(1)(b), Florida Statutes.
Name Telephone Number
Address Fax Number
10. Expiration date of notice of commencement (the expiration date is 1 year from the data of recording unless a
different date is specified):
Date: igne f g gtnatule :Awn .[Note: p r Section 713.13(1)(g), "owner must
sign ... a o one else may be permitted to sign In his or her
stead.^)
Swom to and subFcribedt before me this day of uQ-q, 20 by
who is personally known to me OR
as Identification.
Form Revised: 3/98
W/L^ Wg v
Signature of ry (notarial seal to app below)
o•';:'°Bir BETTY-ANN KELLY _ 'I
MY COMMISSION N DO 029121
EXPIRES: May 24, 2005
00 Bonded Thru Budget Notary Services
AFFIDAVIT
REGARDING ROOF DRY -IN AND FLASHING INSPECTIONS
Company: Sf"btn1 G License M
6-7&7 4OFFrie e
09c.firi-b-0 FI 3z$zz.
Owner: ANY MCd:S*Lr
name
II o 1 l 4191f &; orl GT
address
S'•rlfvrZ'b 3 Zi7 :1
phone
Project Information
Permit #: O ff— 1 O 2 y-
Subdivision:
Lot M
I, 1 /4 1 b Pfl Q CC-7 2 , 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:
signature
r 11 P1c2cc
printed name
STATE OF FLO A
COUNTY OF
This instrument was acknowledged before me this day ofyqrl , 2001 by the above
referenced individual, tS -e-r c. , who acknowledged that he/she is a duly
licensed contractor with 1 ate' , Sr• d ; n r , and who acknowledged that he/
she was authorized to execute this document. He/she is either personally known to me or produced
L_ e o- LP(a 3) O e as valid identification. WITNESS
my hand and seal this _ day of , , 200 kA"
2_t blic
P';
IE BLANTON EY,
Rtiit:S: FAN" 5• 2007 1'e003-NUi,1FY tl nryy pp