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CITY OF SANFORD PERMIT APPLICATION
Permit # : c151 O
E
Date:
e5JobAddress: / g3 C%i`L - , c lc
Description of Work: -21 ,4 K- 171UyCjC/ d!¢/>J E btgly ,A 5:4 Historic
District: Zoning: Value of Work: 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 Plumbing/
New Residential: # of Water Closets Occupancy
Type: Residential Commercial Construction
Type: # of Stories: Parcel #:
Owners
Name & Address: Contractor
Name & Address: of
Water & Sewer Lines # of Gas Lines Plumbing
Repair - Residential or Commercial Industrial
Total Square Footage: of
Dwelling Units: Flood Zone: (FEMA form required for other than X) Attach
Proof of Ownership & Legal Phone:
416) -2 j 9 nn -
i
State License Number: CGC- (3 a o 5 * Phone&
Fax: I _3 P ' 10 1 % Contact Person: A%K Phone: 7-707 Q(p73 / 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 3'!
tify the owner of the property of the requireme _ orida n I w, FS 7 Xr
Signaturelo
ter gent i
Date
Signature of ontrractor/Agent Date 8 X
f arc y G . USG Gv nl _)) /' /C o/% Prin
wner/Ag is Name Pri Contractor/ ent's Name 3-
3-05 Signature
of N - to 0 orida Date Signature of otary-State of Florida Date Y w Owner/
Agent is Personally Known to Me or ' Contractor/Agent is Personally Known to Me or °N QltlProduced
ID t LhL'b (o50%1 ) 57 11 / _ Produced m k (o (- o 5q(4(o 9t-((o50 APPLICATION
APPROVED BY: Bldg: Zoning: Utilities: FD: Initial &
Date) (Initial & Date) (Initial & Date) (Initial & Date) Special
Conditions:
MARYAIVNlr MORS- tj CLERK CLF CIRCUIT COURT
SEMINOL.E COUNTY
AK 05E,33 r G 0194
CLERK' S 0 E 0050-35,407
RECORDED VIV12V-5 08:24:03 AN
RECORDING FEES 10.00
Tax Folio No. RECORDED BY L McKinley
This instrument Prepared by:
Name:
Address: 2 S S1n—/b,_d RiIFiED Cd
Y, ! ov 3 Z77
MpRYt NNE MORSE
NOTICE OF COMMENCEMENT it -
CIRCUIT COURT
CON . FLORIDP.
STATE OF FLOP IDA
COUNTY OF 5'/ Vi.,VoL Y L RK
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. BAR 0 3 2005
I . Description of property: (legal description of property. and street address if available)
2. General description of improvement:
ON iier information:
Z
it. Name and Address: 1D39+
Lick.?,S.raL i E.(N. S Lvl j l 3L/
b. Interest in propert.
C. Names and address of fee simple titleholder i if other than owner)
fc
a
4 Contractor 7 % lCr Q. 3 yrzS SI Snret\
it.
Name and address: b.
Amount of bond 3 6
Lender (Name and Address) 7.
Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided
by section 713.13 ( l) (a) 7., Florida Statutes: (name and address) S.
In addition to himself, owner designates the following persons) to receive a cope of the Lienor's Notice as provided
in Section 713.13 ( l) (b), Florida Statutes: (name and address) 9.
Expiration date of notice of commencement (the expiration date is 1 year from the date of recording unless a different
date is specified): Sworn
and subscribed before /me this daN
of Sign, `
r of Notr :F w ria
Gross NolarN'
s Nance :• My CommissionDD293833 a
Expires February 24, 2008 1365o•
812-57-/77,-0 igna
ire o caner vc-
c<, L _ azl 4. j Owners
Naluc iJ->
Ll'y fIOk 01%LCLf Owners .
Address 6/
N k 3 773
a
AMERICAN ROOFING &
t
GENERAL MAINTENANCE INC.
3412 S. SANFORD AVE. 407-310-0733
SANFORD, FL 32773 321-356-6117
CCC1325645 321-356-4023
Date: 3 L3
I hereby name and appoint Ae- "/c A52r.4&-
of A,4e,,i can Raof-l—, to be my Attorney -in -Fact, to act for me and
apply to the 54g1710 2 Building Department for a permit for work to
be performed at the location described as:
Section Township
J J Raangeems Lot Block
Subdivision I -
I
dden 94 6 e 5
Owner of property and address)
and to sign my name and do all things necessary in this appointment.
Michael J. MacDonald, cccl325645
Signature o Contractor
The foregoing instrument was acknowled ed before me this 21" day of January, 2005
by Michael'J. MacDonald who is ersonally known to me/who produced
as identification and who did not take an oath.
State of Florida
Co ty of Seminole
Notary Puh c 63
i A/EGAN B. VANQEKNobwyPublic5MYComm - 2 of Florida
Commra
F At*$.B
Bonded By National Nola'
3008
rY Asen,
773
REGARDING ROOF DRY -IN AND FLASHINGS
INSPECTIONS_
COMPANY: L,1?Q -0v --
SUBDMSION:
PER1,M NO:
AFFtDAVI-r
LICENSE NO:
PROJVKF INFORMATION
ADDRESS:zxie-SiCl2 G
LOT:
C, fr ! u •, (?yl afliant, hereby affirm that I am the duly licensed contractor of record for the above reference
permit, that all o the foregoing infonnation;is true and accurate, and that the- dry -in, tlashings at the above referenced addressllot has
been installed in accordance with all applicable codes and standards.
CON7'RA!_`TOR; U'iel re
I'd ed name)
gnature)
STATE Of ILOR -1DA.
COUNTY OF 1/1M
This - stn,mcnt was acknowledg before me this day of 1 „?ej "" - G
J by the above referenced
lit ividual, who acknowledged that helshe is a duty licensed contractor with
iL'tJ_ and who acknowledged that hclshe-was authorized to -execute this document. Helshe is
either personally known tome _ or produced -_ _— _ as .valid identification_
WITNESS my hand and official seal this !V- da cif_-
1
otary Pu )li(: - -- -
Printed Name
M Commission.E4)1-fes:
Njifill rrAA@GAN 8. VANDEN BRINK d. rRrNotaryPublic - of E'On State myCommission #
DD113009
fi;oF,
v Bonded By National Notary Assn.