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CITY OF SANFORD PERMIT APPLICATION %
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Permit #: l k Date:
Job Address: 0' ..2zor!! /A 62"e— , /-G , q 2Z 3-
Description of Work: P iz o O iL
Historic District: Zoning: Value of Work: 0
Permit Type: Building electrical Mechanical Plumbing Fire Sprinkler/Alarrn Pool
Electrical: New Service — # of AMPS Addition/Altetation 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: 6 00
Construction Type: ('204' # of Stories: J # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: (Attacb Proof of ersbip & Legal Description)
Owners Name & Address: /a -tit .+ WA
Phone: 7
Contractor Name & Address: S
State License Number: C44-c / ?.a i 3 Z
Pbone & Fax: (&( ! 76 ! 1'Y Contact Persou: ^ C Phone:
Banding company:
Address:
Mortgage Lender:
Address:
Arebitect/Engineer. Pbone:
Address: Fax:
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 certify that no wort or instaIlation 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: 1 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 numdanwrit districts, state agencies, or federal agencies.
Acceptance of permit is verification that 1 willll notify the owner of the property of the requirements of 4./Lacw LUaw`,//A7l3.
gnature of Ow/Agent
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Sign of Co r Agent
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tractor/Agerrt's N7
3/o8/cam Date
Signature of Notary -State of Florida ip Notary Public State of Florida e
Notary Public State of des Connie S Gooley Connie
S Gooley My Commission DD373772 My
Commission D 73772 1
a
r` Expires 11/21/ZOpg e
16 Pei a or Contractor/Agent is._Personally Known to Me or Produced
ID APPLICATION
APPROVED BY: Blzw_ 4 _m I I.1mg' Initial &
Date) (Initial & Date) Special
Conditions: Utilities:
FD: initial &
Date) (Initial & Date)
asmot o
AFFIDAVIT
REGARDING ROOF DRY -IN AND FLASHING INSPECTIONS
Company: i ofr4e 2ti l License #: 4r
Project Information
Permit #:
Subdivision:/_
Lot #:
D wZ7r- affiant, hereby affirm that 1 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:
s
ter e,-
prin ed name
STATE OF FLORIDA
COUNTY OF
This instrument was acknowledged before me this 2 day of 200 S, by the
above referenced individual, , who acknowledged that he/she is a
duly licensed contractor with , and who acknowledged that
he/she was authorized to execute this document. He/she is either personally known to -me or
produced as valid identification.
WITNESS my hand and seal this day of 20 4 -7
X:J 1&' L-0,
Notary Public
00 Notary Public State of Florida
Connie S Gooler
A4Y Commission DD373772
p Expires 11/p11?p t
THIS IN TRUMENT P EPARED BYs
NAME
AODR. -L
3
MARYANNE MnRSF_, CLERK OF CIRCUIT COURT
SEMINOLE COUNTY
BK 05545 PG 10134
CLERK'S I1 2005041438
RECORDED 03/ 1112M 4/112108 PN
RECARDINS FEES 11LQ4 ,, L
REMRDI=D BY L McKinley.
q IFIM COPY
NOTICE OF COMMENCEMENT
CER'f MORSEMARYNNE
CLERK CIRCUIT fOR
LAIMnu COUNTY,
Permit No. Tax Folio No. '
State of Florida I.E
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.
1. Description of property: (lygal description ofthe propgrty and street address if available)
2. General description of improvement: Ic C
3. Owner information
a. Name and address ORR:W2
b. Interest in property /
c. Name and address of fee simple titleholder (if other than Owner)
4. Contractor
a. Name and address eo ,T--
b. Phone number Cp'7 5—,1 mac/ Fax number
5. Surety
a. Name and address
A
b. Phone number Fax number
c. Amount of bond
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 documents may be served as
provided by Section 713.13(1)(a)7., Florida Statutes:
a. Name and address
b. Phone number Fax number
8. In addition to himself or herself, Owner designates of
713.13(1)(b), Florida Statutes.
to receive a copy of the Lienor's Notice as provided in Section
a. Phone number Fax number
9. Expiration date of notice of commencement (the expiration date is 1 year from the date of recording unless a different
date is specified) ,
3 aS
Signature of Owner
G¢-h
S orn to (or affirmed) and subscribed before me this p day or -Ma (L , 20 O.S , by
Personally Known OR Produced Identification_
Type of Identification Producedi rs [-Ce. JUS I
E%
4, kFFNotary Pub:irm
te
of Florida Connie
S G SiaofNotaryPublic, State of Hod Commission
Ex Tres: tixl CommiDD373772PExpires 11l