HomeMy WebLinkAbout223 Pine Winds DrPcrinit I/
Job Address: a 3 I Nnc
Description of Work: - `• I - 00 F
IIlstoric District: 'lotting:
CI11'OFSANFURI)I'I;l'u ll'1'Al'1'I,lGA11tJr.r. .. r• :•I: ^'K:•;."..;t::'+' ;,t3;'"r:?•j'"i?'
Date; %
I ti Ds •ve x 3Z` T •` '.:.,.
Value of Work: S 5,7-0 ' a
1eti z- —:..:+anus
Permit Type: Building Ncctrical Mechanical 1'lunibing Fire Sprinkler/Alarn, Pogl•_•__
Electrical: New Service — It of AMPS Addilion/Alterntion Change of Service Tcmpor:iry Polc
C 1;ncr ,y G. l.. Required)
Mechanical: Residential Non-Rcsidcntial Replacenicnt New (Duct Layout ,
Plunibiart Ncw Connnercial: ll of Fixtures 11 of Watcr F.: Sewer Lines it of Gas Lines
Plunibing/Ncw Rcsidcntial• n of Walcr Closcu; Plumbing Repair— Rcsidcntial or Cotnmcrcial
Occnpancy'Typc: Rcsidcntial Commercial _Industrial 'Total Square Footare:
Construction Tyoc: 11 of Stol•ics: 11 of Dwelling Units: hlootl /.one: (Fi:MA form rcquircti for other than X)
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Pnree111: (
Attach Prooror Own Estill) .r, Legal Description)
Owners Name .L Address: A0 (--IZZ3 1 1 J 1+1 N
Gi gE-oCZ-Q`, Il 3Z-1-7In rl,one Q-7-
Contractor Nanic &''Address: '& 19C_a 0 I / ^
J C .-1..•-•..--•-•••_
00 P P2lC1 , /t, J r S { rp •l- 1 3Z-1? L/Sutic Liccnsc/N Unll>rr: lJ/S/ 0 2 `Z./.1-----.•---
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v3 J" Contact Person:-Ni` T'`C C 1'honr. ZZ'r7rJ b
I'1 onc.0 Fax: - -%- --_— -+•
11ondin'. Company:
Atld css:
Nlort; a-m Letider:
Address:
Archilecl/r•.n-inter:
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Address:
I as:
Application is hereby made to obtain a permit to do tic work and installations as indicaled. I cenify that no work or installation has ca:imence<i prior In the
issuance of a permit and that all work will be lxrfomxd to nxet standards of all laws regulating constniction in this jurisdiction. I understand that a scp.. c
permit must be secured for ELL•CTPUCAL \t%ORI'. PLWAIIING, SIGNS, WELLS, POUTS. FURNACCS. BOILERS. 1•I11ATEILS, TANKS, and
AIR CONDITIONERS. cic.
OWNER'S AFFIDAV 1T: I certify lint all of the foregoing; inrorritation is accurate and that all wort: will be done in compliance with all applicalrlc laws rrl n4ttingconstnictionandzoning. WARNING TO OWNER: YOUR FAILURRTO Rr;CORD A NOTICE OF COMMENCCTvIL-NT IAAY RESULT UNI FOUR PAVNGVICEFORIMPROVEMENTSTOYOUR1'P.Ol,r.k1Y. IF YOU INTEND 9'0 OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR. AN
ATTORNEY BE -FORE RrCORI)ING YOUR NOTICE OF COMmr-.NCr. -.N•r.
N(Z1'1(,li: tit addition lu the rcquirenlcul:: of rhi : pennii, there may be atlllitinnal Pc::rrictiun5 :glplicablc N This pruperty that nlay be ruuntl in the public rceonk of
this county, and thcrc may be additional pcnnits rcquircti from other 1; l,•cnmu:ntal r:ntities such a:: ,'te nLrrlaLcmcnl disttrcls, stoic al;cncrc:, or federal agtncits.
Acceptance of perinit iss verification dial I will notify the owner of dire pro, city or the
to pS
Sit, lature ul'Owrter/Agentul
2.LI lV 'LA O-IZI 2
Tint Ornlcr/Agent's :unc
Sirl atln•e ,rNutalyStatt II•I:Ivritla Dale tiita:aulrc of i:J:3ry$tatC of I lurida Uaic
DAFNEY FAYE ADCOCK
t •f .........• 1• NOTARY PLOUC, STATE OF FLORIDA
Owlicr/Agent MY Comm. Expires DEGAki2m
Produced 11) COMM. p DD3708OJZ 1'ra
APPLICATION APPROVED) 11Y: 111dg:
IIni;ial::: I) ai
Cia! L'Jndilil111s:—_—_----
1
Zolllllg;:
1400-3-NOTARY
L:: ::Ci: _
PMISIE GLAWDI' Ic ur
TES: February 25, 20b7
FL Noury o :c^ant A.. . Co.
FI).
POWER OF ATTORNEY
Date: oZ 10. jo
I, Andrew T (Andy) Adcock do hereby authorize Ruben Birch
To pull the Re r o o f _permit for Pt v\.-
type of permit) (a ress)
Signature
N Stamp
DAFNEY FAYE ADWCK
NOTARY PUBUC, $TATE OF FLORIDA
MY Comm. Expires DEC. 2, 2M
COMM, A DD37M
Personally k n to me or driver license #— , of State of Florida, County of
day of f e "--— A26e4- Z
o S
REGARDING ROOF DRY -IN AND FLASHINGS
INSPECTIONS.
AFFIDAVIT
COMPANY: O DO I, (7 LICENSE NO: C C C D Z S o
PROJECT INFORMATION
SUBDIVISION:
PERMIT NO:
ADDRESS: ZZ 3 P vt (S Q
LOT:
I, D want, hereby affirm that I am the duly licensed contractor of record for the above reference
permit, that all of the foregoing information is true and accurate, and that the dry -in, Aashings at the above referenced address/lot has
beentinstalled in accordance with all applicable codes and standards.
CONTRACTOR: l41") 4'-'e-D e
Printed nam
Sijinature)---
STATE OF FLORMA
COUNTY OF U1v0V1
This instrument was acknowledged before me this L day of ZVOG by the above referenced
individual, L„ V-4-0 e D , who acknowledged he is a duty licensed contractor with
G i"TZ D LLD P—", Dye , and who acknowledged tltL was authorized to execute this docume6t'.-Z 5she is
either personally known to me _for produced // as valid identification.
WITNESS my hand and official seal this day of
W N
No Pub 'c
QN>rram^ DAFNEY FAYE ADCOCK
NOTARY PUBLIC, STATE OF FLORIDA printed Name: k—/ P;&QEjMYComm. Expires DEC. 2, 2008 C . 9 COMM. 0 DD376609 My Commission Expires: IZ Z 2 • m
fFNr~l o K
DD r e.,ti -A . NOTICE OF COMMENCEMENT
Sa, rd
State of Florida
Countyo[Semiiiole -rat
ft3Z7
Permit No. Tax Folio No. (PID) E ' ORS
711e undersigned hereby gives notice that improvement will be made to certain realproperty.and in acco
V
713, Florida Statutes, the following information is provided in this Notice of CommencementMP C\t" DESCRIPTION
OF PROPERTY Legal description of the3 roperty P1d street,address) zZ3PitiI31K-3DS Z>iZ OL G-e%
1ki
GENERAL
DESCRIPTION OF AVl1'ROVEMENT OWNER
INFORMATION / Name
and ad f e L I IZ & j A e e i z
2 3 1 1 N t N3 (D Interest
in property (Fee Supple, Pattnership, etc.) D w N C 2 NAME
AND ADDRESS OF FEE SAMPLE TrME HOLDER (IF OTHER THAN OWNER) CONTRACTOR
Name
and address 4r-11D It D o D J--7r SURETY (
Bonding Company) Name
and address Amount
of Bond 1,
Z005 iBEI®
t'IA®iliN01E118 A A Id Ntpll OK
td5612 PSG 0951 LENDER
CLERK'S 0 2 4447 Name
and address QED 8e/11/m 88159see APO t}
INO
FEB 1.88 iitiititkitkin..
a..###k s#..##:...#..#it#itktt#i#kktiiiititt#i# D .
hms Persons
within the State of Florida designated by Owner upon whom notice or other documents may be served as provided bySection713.13(lXa)7., Florida Statutes: Name
and address tttiittikttkt#
ttiikiksklkti#t##loss•tki#ii#iiittki iitittiitiktksts#siiiaiisiisiitiis#ktti In
addition to himself, Owner designates of to
receive a copy of the Lienor's Notice as provided
in Section 713.13(I)(b), Florida Statutes. tittttikiikikk#
ktktiikiikit#ktk#ikkik#Rkk•ik#ikkiiii#ttti#kiii#ikit#ii#ktiiitk#itiiiikit##tt Expiration
Date of Notice of Commencement 0j
tn¢
unless a differmt lRte. ie lt,.if, , AFNEY
FAYE ADCOCK , NOTARY
PUBLIC, STATE OF FLORIDA MY
Comm. Expires DEC. 2, 2008 COMM.
M DD376M Stgnatlme of O"er Iwo
to ayd subsc)-iore e t is iU Day of o P
blic MY Commission
Expires: The fo/(
ygoing instrument was acknowledged before me this M day of '7 a f W a by P
EL-1 1V E CA tZ —1 t: 1Z (name of person acknowledged), wh =nic own
to
me or
who has produced(type of identifica ton as ation and whodid / did not take an oath>