HomeMy WebLinkAbout1212 W 8 StCITY OF SANFORD PERMIT APPLICATION
Permit # 05 /0js
Job Address: 1,9
Description of Work:
Historic District: Zoni
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 Cl 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)
Parcel #:
Owners Name & Address:
dZ / d & f
Contractor Name &
Phone & Faxz
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
Attach Proof of Ownership & Legal Description)
Phone:
3 Sta is er: G '''
Contact Per Phone;7
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 u' is orida S 713.
Signature of Owner/Agent Date Signature of Contractor/Agent Date
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is _ Personally Known to Me or
Produced ID
APPLICATION APPROVED BY: Bldg:
Initial & Date)
Special Conditions:
s Name
nature of Notary -State of Florida
DEBBIE BLANTON
MY COMMISSION # DD 188491
8-lexpRAFS. ropol4vil ao"n
Zoning: Utilities:
Initial & Date) (initial & Date)
i— /y_ o si
Date
to a or
FD:
Initial & Date)
THIS rN RUM NT P809H F COMMENCEMMS CM"
CIMUIT MW
AK 055al PG e15A@
Permit
Florida=
010,
NAMJ _ M760'9
State of Fl• '' C -
III FMIi iO = _
ll
County of Seminole ' 3 BY D TWM
The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with
Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement.
of p erty: (legal description of the property and street address if available)
2. General description of improvement:
3. Owner information
a. Name and address ! %cZ / a l , I Y
L.3 '-L72
b. interest in property 14-,Yleit¢J
c. "Name and address of fee simple titleholder (if other than C-A=)
4. Contractor
a. - N " e and address "5:07C • / 'o F
L 63 b.
Phone numb r g _ 7'7 J4 d255-Fax number 9 0 4 - % 7 - 019s' 5.
Surety ¢v a.
Name and address W
b.
Phone number Fax number sc.. c.
Amount of bond c, • P c •• O 6.
Lender, a.
Name and address b.
Phone number Fax number 7.
Persons within the State of Florida designated by Owner upon whom notices or other d ments m y..be served as provided
by Section 713.13(1)(a)7., Florida Statutes: a.
Name and address /Y c ng,' b.
Phone number 8.
In addition to himself or herself, Owner designates 0
Fax
number of
to
receive a copy of the Lienor's Notice as provided in Section 713.
13(1)(b), Florida Statutes. a.
Phone number Fax number Expiration
date of notice of commencement (the expiration date is 1 year from the date of recording unless a different date
is specified) Si
ture of Owner Sworn
tpor affirm d) and subscribed before me this day of a4104 f , 20 D 9 , by Personally Known '
7'- OR Produced Identification Type of
entification Produced Signature of
Notary Public, State of Flori Commission Expires:
ALZADA WASHINGTON
9r° Notory
Public'- Stote of Florldo My Gommission
Expires Jon 4, 2007 Zr-Commission #
DID 156630 M Bonded
By Notionol Notory Assn.
J
AFFIDAVIT
R/EGARDING ROOF DRY -IN AND FLASHING INSPECTIONS
Company: (l/l.G t,Bte License #: C C_G- O 01;1_q D- 9'
Owner:
ame
address
phone
Project Information
Permit M 0 5 - S /
Subdivision:
Lot #:
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.
Contract 4 6 A
signature
printed name
STATE OF FLO
COUNTY OF
This instrument was acknowl ed before me this day of , 20O ,, by the
above referenced individual, _tom , who acknowledged that he/she is a
duly licensed contractor with ,-and-who-ackn edg d that
he/she was authorized to execute this document. He/she is e' er personally known to me or
produced as valid i en i ica ion.
WITNESS my hand and seal this ) 4 day of a,-- , 2CP
Notary Public