HomeMy WebLinkAbout116 Long Leaf Pine CirCITY OF SANFORD PERMIT APPLICATION
l
Permit #
Job Address:
Description of Work:
Historic District:
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: Residential Commercial Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Bonding Company:
Address:
Mortgage Lender: _
Address:
Architect/Engineer
Address:
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 will notify the owner of the property of the requireme of Fl nda ' Laws, IFS 713.
Signature of Owner/Agent Date Signature of tractor/Agent Kite
c7
Print Owner/Agent's Name
Signature of Notary -State of Florida
Owner/Agent is _ Personally Known to Me or
Produced ID
APPLICATION APPROVED BY:
Special Conditions:
F
Date
J J , Zoning:
Date)
Prin ontrac r/Ag rt's Name %
31JUJG J
gnature of Notary -State of Florida Date
X DEBBIE 13LANTON
MY COMA4IS ,O,N #
Contractor gP ry=1 0 §Qf p
Prod els
nt AD Co Initial &
Date) Utilities
FD: Initial &
Date) (Initial & Date)
n
CITY OF SANFORD PERMIT APPLICATION
Permit No.: Date:
Job Address: _P& ,C.O NC 46 F E /A/C' CIR
r
S'AU FD kb FL . 1277-5 F
Permit Type: Building Electrical Mechanical Plumbing Fire Alarm/Sprinkler
Description of Work: s a m!a (,C /Cc- Ieco F 1/ SQs .
Additional Information for Electrical & Plumbing Permits
Electrical:—Addition/Alteration Change of Service Temporary Pole New AMP Service (# of AMPS )
Plumbing/Residential: Addition/Alteration New Construction (One Closet Plus Additional)
Plumbing/Commercial: Number. of Fixtures Number of Water & Sewer Drainage Lines Number of Gas Lines
Occupancy Type: "Residential Commercial Industrial Total Sq Ftg: Value of Work: $
Type ofC;:nstruction: Elrod 2;>+ne•-- ?i! :ber oi'Sta, _ Dwell.n.g LT3>+:
Parcel No.: /!•ao '30 --5-a 'Z- C 000 - 00,36 (Attach Proof of Ownership & Legal Description)
Owner/Address/Phone: /c- gay /4
Contractor/Address/Phone: 9 %(114-4 7) Ra AR I S
1e260 S'A9ATbQA ,LANE ,Q&86V/}. F4, 12M -State License Number: RC 0623/S/)4-1Contact
Person: RMAA• ,All ContactPhone & Fax Number: 67• 'S &lo' S992 Title
Holder (If other than Owner): Address:
onding
Company: Address: Mortgage_
Lender:_
hJQ_t1Sr1740n4Q W01' Address: P.
4 -8 a x- o It O 7 C /-yQEl . 3 G 3 d-3[ 1 U Architect/Engineer
Phone No.: Address: Fax
No.: d,.,.1'....
tin ; t,o.al..+Mp.n tn• ..l.ta;.. it to .7+. t_e r r! gtallatinn •s+ir P T rvrt;4'v l} n work 11c1t 071 irr'=^•-- •_ , _ - _ _ _. _ _ _ ^`'^?_- -- ^.. _ _ and -^-.-.. -_$
aS
i.._ _at_ _ . _ th _ o wo_ or rsta as 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 regords of this county, and there may be additional permits required from other governmental entities such as r 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 Florida Lien Law, FS 713. Y y. Signature
of
Owner/Agent - _._ - - -Date ignature of Contractor/Agent Date t C4
Q-
f- sha Print 9,
wner/A&nt s Name j _ - - - Print Contractor/Agent's Name Notary-Stafe
of to ' a Date Lynda PA.
Kavanaugh Commission # DD315993
Expires May
4, 2W8 8aided Troy
Fain • Inay .a Ina. 8OW8&7076 Owner/Agent
is Personally Known to Me or Produced ID
lti D fL Lre/ APPLICATION APPROVED
BY: Ioz C
S Si tore
of Notary -State of Florid Date Dana A.
Murray lY PVe% 0 Commission #
DD285482 Contractor/Agent
is Personally Known to Me or Produced ID
I/ Date:
Special
Conditions:
IVU i Aki Z
Permit Number`
Parcel Identification Numbera0 •O •3C- 0008 • 009 S
Prepared by: Ga 11 Mo r r 1 s I1111III 111111111oil 111111111111111 Il 111111N 11111 I111111111 1260 Saratoga
Ln, Geneva, Fl,
327.32 Return to:
D R and 6, Inc. 1260 Saratoga
Ln. Geneva, Fl,
32732 NOTICE OF
COMMENCEMENT State of
Fll 0 G 1. da County of
i Semi nn1P MARYANNE MORSE,
CLERK OF CIRCUIT COURT SEMINOLE COUNTY
BK 05664
FAG 1081 P_1zR
K I lql # ;2t7(215t)5 C)F,23 RECORDED 03/
29/2003 11130135 AN RECORDING FEES
10.00 RECORDED BY
t holden CERTIFIED COPY •"°
MARY NNE
MORE CLE K
0 CI UIT URT SEMI EORIDA
The undersigned.
hereby gives notice that improvement(s) will be made to certain real property; and. "" 6r ign°c with Chapter
713, Florida Statutes, the following information is provided in this Notice of Com nce in; Description
of
property (legal descri tion of the. property, and street address if availble) ou Z-Z-,
4 F /N /R . T 9Nja7)
c-x/ /.Akf--V AZR>aHy?,!3VBA9S l To2 2 3.
4
L
o
General description
of improvements) j7 ........... 3 ._
aaF 31 Q Owner information
Name /VR_
CSAL Pqzrls5VAL4 Telephone Number; Address //(o
L/P- A16-CIR.• Fax Number S'i41/
F1l , • 3277 Interest in Property: FeeaSimple Title,
Holder (if other.than owner shown above) Name . Telephone
Number= Address Fax
Number I Contractor
Name
D.
R Address1260 6.
Surety (
if any) Name Address
and
G,
Inc. Telephone Number, 407 327 5636 Number 407,
349 1398 Saratoga Ln
Geneva, Fl, 3 ffl Telephone Number
Fax Number
Amount of
bond $_ 7. Lender (
if any) o--2fo-
7 773 Name ' tZj (
S v u :i r g C J Telephone Number i Add res
s.(3 Y 30 110 Fax Number 06 Z7b I/7i 8. Persons
within he 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 Telephone
Number Address Fax
Number 9. In
addition to himself br tierseit, Owner designates the following to receive a copy of the Lienor's Notice as provided. in §
713.13(1)(b), Florida Statutes. Name 1,
Telephone Number Address Fax
Number 10. Expiration
date of notice of commencement (the expiration date is one year from the date of recording unless a
different date is specified): 3 Z `'
L---eD Date Signed
SIgnature of Owner Note: per §713.13(1)(g), "owner must sign ...
and no one else may be. permitted to sign in hiss or
her stead." Sworn to
and subacribed before me this day of C 9 Z aS by who is
t--- personally known to me OR as identification.
Notary (notarial
seaito Z), Lyndi !.111.
Kavanau`g`j Commisslan # DD315993
Expires May
4, 2008 Bonded Troy
Fain • Inwronoa, Ma a10NSIM8 below) Form
Revised:
3/98 F
AFFIDAVIT
REGARDING ROOF DRY -IN AND FLASHING INSPECTIONS
Company: p Y: h C License #: '&g go _
Project Information
Owner:
name
viz)
addrefs
7 s
phone
Permit #:
Subdivision: --'C_
Lot #:
I , 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:
A
signature
printed name
STATE OF FLO
COUNTY
This instrument was acknowledged before me this 30 day of , ZQO S by the
above referenced individual, I'G hQ cl !h d.-,' ,who acknowledged that he/she is a
duly licensed contractor with , and who acknowledged that
he/she was authorized to execute this document. He/zhe is either personally known to me or
produced Eh L., e-" S Im ) uS as valid identification.
WITNESS my hand and seal this 2 0 day of
DEBBIE BLANTON
MY cnMIUICCin. —
February 25, 2007
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