HomeMy WebLinkAbout1807 Palm Wayi
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Permit #:
Job Address: O w '
Description of Work: w/ AYa
Historic District: /U t; Zoning:
CITY OF SANFORD PERMIT APPLICATION
Date:
3 .i--7 71
3 -A~T (fr' a 0-f
Value of Work: S OQ
E&MV
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
Construction Type: of Stories: # of Dwelling Units:
Total Square Footage:
Flood Zone: (FEMA form required for other than X)
Parcel #: (Attach Proof of Ownership & Legal Description)
Owners Name & Address: lN7 6 /tr s
r
Phone:
Contractor Name & Address: r//} .v C( nr2C 1 5'c 2 L.Z:c
State License Number:
Phone & Fax: 40% — 212'3 --s S7 5- Contact Person: /G—o22c3S7`" "ell S l411`hone: 3 ?4, '96 4 O R'5-3 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 M
sverification that will notify the o er of the property of the requirements f Florida Lien law, FS 713. Gy/
6 S Signature
of Owner/Agent Oate (( Sign re of Contractor/Agent Date C-
Goa r l/ wner/
Agent's Name Print Contractor/Agents me Si
lure of Notary -State or F1oria Date f 10 llbrida Date rc 900t '
b
AgW soi&3 ; 4 mif
uo s ,1bM$t i APPLICATION APPROVED
BY: Bldg: Initial Special
Conditions:
AlYCOAfy# BXPIRE:
ISSIONDO
16480 S November12qn' Utilities: Initial &
Date) (
Initial & Date) to a
or aaer FD:
Initial &
Date)
r °`.NOTICE OF CONfMENCEMENT
W
z
Permit No. Tax Folio No.
State of Florida
County of Seminole
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.
Description of property: (legal description of the property and street address if available)
31 - 15 — 31 — sa3 — 16000 00 vo
2. General description of improvement: .
3. Owner information
a. Name and add
xa7 P01-
4 ELL C rJ M. GZ6 N 4-n-L Z—
b. Interest in property '
c. Name and address of fee simple titleholder (if other than Owner)
Contractor
a. Name and
170
b. Phone number 0
5. Surety
a. Name and address
L411
tp
S
Fax number
b. Phone number Fax number
c. Amount of bond _
bra Lender
a. Name and address /U p Al
08.
0
b. Phone number Fax number
Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as
provided by Section 713.13(1)(a)7., Florida Statutes:
a. Name and address
b. Phone number
In addition to himself or herself; Owner designates
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)
Signature of Owne
S}rn to (or affirmed) and subscribed before me this day of ...20 , by
f'f GW lPS bon z t-1 e- Z MRRYANNE Mqi Y
taxes ur "• __
Personally Known OR Produced Identification BKINGLE 8C G 0195
Type of Identification Produced I&L 12ri JC, CLERK'S # 2005011146
RECORDED 01/21/20A5 10s33t34 AM
00
i KWW Bt 01941ED COPY,
Signattdie of Notary Public, S Florida
MARYANNE MORSE_
Commission Expires, +I
CLERK OF CIRCUIT COURT-,
p ,., Lynda M. Kavanaugh SEMI C N Y. LOMDA
Commission # DD315993
Expires May 4, 2008 6Y
9orgw noy Nn • uwenw one e00C1ES701Y EAU- . CLIiK C
AN 2 1 2005.1
9