HomeMy WebLinkAbout174 Clear Lake CirI '
Permit # :
Job Address:
Description of Work' _
Historic District:
L
CITY OF SANFORD PERMIT APPLICATION
Zoning: value of worst: s (a tty•(
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/Alteration
Mechanical: Residential Non -Residential Replacement New
Change of Service Temporary Pole
Duct Layout & Energy Calc. Requited)
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: 2 // I
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X).
Parcel 0: 2 d j C — J - O DDD — 06S0 Attach Proof of Ownership & D icriptiou)
Own Name AAddress: Miek6r—1 Dea-«— CQom.d*Al 74
3 a 7S Phone: #&r? 313 5—oC /
Contractor Name & Address:
1 A
State License Number:
Phone & Fax: yO7 L O Contact Person: 6bN PARfO41 Phone: f1y;? reP-Fd % Bonding
Company: Address:
Mortgage
Leader: Address:
Architect/
Eegineer: 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 drat 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 1 will notify the owner of the property of the requirements of Florida Lim Law, FS 713. Signature
of Owner/Agent Date SigvdiN o04 char/Agenrot- Print Owner/
Agent's Name Prinj Coontractor/Agff nt's Name a %l
pM Jai ) r O.0 Signature of
Notary -State of Florida Date Si of Notajy-stjtc of Florid Owner/Agent
is _Personally Known to Me or Contractor/A n ersoth B N Produced ID _ Produc I W UL)
188491 c EXPIRES:
February 25, 20p7 APPLICATION APPROVED
BY: Bldg P, a ! J l Ding: t OTARv
Ft ^bta oi e . Initial & Date) (
Initial & Date) (Initial & Date) - —( ate) Special Conditions:
1 yr
5 INSTRUMENT PREPAREaBY:'
NAME: Building 8 Fire Inspection
ADDRESS: ' DrZ SEAEVOLE COUA TY 1101 East 1st Stree
S27— Q'7lj J=' j) ) %%/ TIt)RIDa'S N.aTI.lNnl aitH• Qanf ir1 C
NOTICE OF CO" --
State of Florida County of Seminole
Permit No. Tax Folio No. (PID)
The undersigne ti.he*y gives notice thaFu'-ripr. jcaieni will be made to certain real property, and in b%xnniance with Chapter
713, Florida Staivtes,'the following infonna%ca is vT--gde3 iil this lk-Te%cr, of Cornmencement.
DESCRIPTI(ONO F PROPERT 1 ("WtOP l.sscription of the property an address)
r ..i ca#C t L iGt—j f
I q (IPA Late. ,.'ir
Name and address f L I ckaeA ) l O-A e (. o L u a rt I ' 1 "1 C Le -co"
Interest in property (Fee Simple, Partnership, etc.) A 1/„ CERTIFIED COPY'
NAME AND ADDRESS OF FEE SIMPLE TITLE HOLDER. (IF OTHER V q-
lgY
CONTRALTO r'
Name d address,"
V, k G to Gcr±4 Q FL 3;)-7 1
SURETY (Bonding Company) 1 Its II III II III Bill 111111 W B N 11 IN 1191 RISEN Ills
Name and address
NRRYANNE: MURSE+ CLERK OF CIRCUIT COURT
Amount of Bond BK 05570 PS 0003
LENDER
Name and address
CLERK'S t# 2005002200
R11111iukv 01/05/2005 11 t3209 RM
REQ1 I IM Fas 1100.. j
Persons within the State of Florida designated by Owner upon whom notice or other documents may be served as provided by Section
713.13(1)(a)7., Florida Statutes:
Name and address
Persons within the State of Florida Designated by Owner upon whom notice or other documents may be served as
provided by Section 713.13(1)(a)7.,Florida Statutes:
Name and address: .
In addition to himself, Owner Designates of
To receive a copy of the Lienor's Notice as
Provided in Section 713.13(1)(b), Florida Statutes.
Expiration Date of Notice of Commencement
e expiration data is I from date of recur
MIME C HURD
W COMMISSION #tD0180915
P'RES• JAN 29 2007
unless a different date is specified.)
a^ Bonded Wough Adwolaoc t+oury Si ature of Owner -- - U
Sworn to and subscribed before me this Day o
My Commission Expires:
Notary Public
The foregoing instrument was acknowledged before me this day of Ody'by
Name of person acknowledged), who i onally own to a or who has
pro uced (Type of identification), as iden ' who did/did not take
and oath.
111897
LM=D POWER OF ATTORNEY
I hereby name and appoint Le e— —T-,
of 4)I1rti4V0 L-LL
Date: //bq
to be my lawful attorney
in fact to act for me and apply to C o S n vO for
a n C I permit for work to be performed
at a location described as: Section Township Range
Lot Block Subdivision wi lko 110 A 11, &F// -r
7'1 Clew- 1.o% Cre- FL .3.>773
C01
Address of Job)
4) i 'Y C/pg- / .,/C.
aer of Property and Address)
and to sign my name and do all things necessary to this appointment
1 1 w.
frype or PriqP Acknowledged:
of
Certified CoatractDr and License #) re
of Certified Contractor) Sworn
to and subscribed before me this F/
vfrel-7Day
of A.D. DC.?2 S Notary
Public, State of Florida BRY
Seal) 1AYCOMMISSION
4M 7Rf;...
EXPIRES: January 9, 20 06 9ondb wowyauditu„d„w,Uwa My CommissionExpires - NU