HomeMy WebLinkAbout2626 Palmetto Ave (2)CITY OF SANFORD PERMIT APPLICATION
P•irmit # :_
Job Address:
0-6, — / 0
Description of Work:
Historic District:
y
n
Date: d / b c' /0 5—
4ve
Zoning:
Permit Type: Building Electrical
Electrical: New Service — # of AMPS
Mechanical: Residential Non -Residential
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets _
Occupancy Type: Residential Commercial
Construction Type: # of Stories:
Value of Work: $ `a2, 5vo
Mechanical Plumbing Fire Sprinkler/Alarm Pool
Addition/Alteration Change of Service Temporary Pole
Replacement New (Duct Layout & Energy Calc. Required)
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)
Parcel #: (Attach Proof of Own hip & Legal
rirrJ
Description)
LieOwnersName
e&
Address: ci 1 i !J S d" ` 2 (' 6 lime ' - d e }
Sa,., 1 . 64 3,9 % 3 Phone: 'ttr0 7 7 %S87
Contractor Name & Address: xkn. -;- So i%cG S
r Naze-1 ko-, - Av e D,- /4.. FG 3 y State License Number:
Phone & Fax: L/D L 7G - 7663 - Contact Person: Joe;'k"r ( / Phone: Y07-
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
this county, and there may be additional permits required from other govemmental entities such as water management districts, state agencies, or federal agent
Acceptance of p ' s
SWao
o g _N Print erg
of Florida
i/
owner of the property of the requireof sen lowr FS ra/
l
Date
Date o ignatureofCotor/Agent c
fe ,
Q1 c .
110/
05 Print
Con for/Agent's Name Z
s
ate
Signa reof Notary -State df Florida Date V 7
v Owner/
Agent
is _ Personally Known to Me or Produced ID
r PLICATION
APPROVED BY: Bldg (Zb 1114105 Zoning: Initial & Date)
Special Conditions:
Contractor/Agent
is Perso lly Known to Me or_ 1 Produced IDF (i= 1:) 1 %{}- S (3 'd-(S' V Utilities: FD:
Initial & Date) (
initial & Date) (Initial & Date) 00 r
1 a,-
JOE RAYUS
HOME IMPROVEMENT SERVICES
2225 HAZEL HURST AVE.
ORLANDO FL, 32804
407-767-7663
CCCO58227
I, Joe Rayl do hereby give Keith Davis permission to obtain a permit for
2626 Palmetto Ave in Sanford Fl, 32773. _
F
Sworn to and subscribed before me this day of ^ 20 (>5
by ;snr 12G1.1.1 who is personally known to me or
produced as identification.
Signature of Notary (notarial seal to appear below)
KATIE CASTELLI
Notary Public, State of Florida
My comm. exp. Dec.13, 2008
Comm. No. DD 378876
Permit Number;`
Parcel Identification Number,
Prepared by:
4/
Return to:
NOTICE OF COMMENCEMENT
State of
County
MRWW OW, CLERK OF CIRCUIT WAT
SENINDLE COIW
RK 0155583 FAG 17818
CLERK'S 0 ElbW5 078143
RECORDED 0111412M 01:37%31 RN
RECORDING FEES 1DLeO
RECORDED BY D Thomas
The undersigned hereby gives notice that improvement(s) 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 (legal description of the property, and street address if available)
2. General description of improvement(s)
A_..... .._.....___.._.. _
w„o,a,..,::er.:e,r,: m--u _.wit-r:ni-:..-M' :—T
3. Owner information
Name , ill . % /,,s f l`stCL, Telephone Number, 00,1
Address ZCn (A c ! Fax Number
11 —7l Interest in Property:
4. Fee Simple Tit e'Holder (if other than owner shown above)
Name .
r
Telephone Number!
Address Fax Number
5. Contractor C/ 5 wit+.
Name 1 - IL z S /«zF /14;r: X, % Telephone Number , elO 17`
Address l i'lu </ Ice- Fax Number
Surety (if any)
Name Telephone Number
Address Fax Number
Amount of bond $
7. Lender (if any)
Name Telephone Number
Address Fax Number
8. Persons within the State of Florida designated by Owner upon whom notices or other documents may. be.
served as provided by §713.13(1)(a)7., Florida Statutes.
Name 14 /- Telephone Number
Address / Fax Number
9. In addition to himself or lierseit, Owner designates the following to receive a copy of the Lienor's Notice as
provided in §713.13(1)(b), Florida Statutes.
Name -~ Telephone Number
Address ; f 11 Fax Number
10. Expiration date of notice of commencement (the expiration date is one year from the date of recording
unless a different date is specified):
Date Signed
Sworn to
who is
as idei
me this nday of
to me OR
must sign ...and no one else may be permitted to sign in
his or her stead." evcl,S'Z - ;z Zc/ - 5-1- -
of Notary (notarial seal to appear
KATIE CASTELLI
Notary Public, State of Florida
My comm. exp. Dec. 13, 2008
Comm. No. DD 378876
Form Revised: 3/98
AFFIDAVIT
REGARDING ROOF DRY -IN AND FLASHING INSPECTIONS
Company: 1.4_ J . License #:
OPa2, name
address
phone
Project
Information Permit
M 0, /0 / -7 Subdivision:
Lot #:
I, ,
affiant, hereby affirm that I 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 auulicable codes and standards. i
ature e
P c- ( n_-,;S printed
name STATE
OF FLORIDA COUNTY
OF `S This
instrument was acknowledged before me this day of , 20Q< by the above
referenced individual, SgC1 . , who acknowledged that he/she is a duly licensed
contractor with F+Vv, ,R vl- , s _ , and who acknowledged that he/she
was authorized to execute this document. He/she is either per na y own to r' a or produced as
valid identification. WITNESS my
hand and seal this day of26) S Notary Public QD
MY EBBIE
BLMTON COMMISSION
k DO108491EXPIRES: Februar, 25, 2007 B^nnv FLNotory
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acourTM qsaoc Co.