HomeMy WebLinkAbout306 E 21 StPcrinit 0 : VJ — ^/ _add
Job Address:
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Description of Worlc: t, 1c_ vv ' a- Id t -
Historic District: Zoning: Value of 1Vorlc S
Permit Type: Auildinl; Mcetrical Mechanical Plumbing Fire Sprinkler/Alan» Pogl•i -
Electrical: New Service - li of AMPS Acid ition/Altcrntion Clhange of Service Tempor;iry Polc —;--•
Wchanical: Resicicn(ial Non -Residential I:eplacemcnt New (Duct Layout a' l;ncrgy Cili; Required)
Plumbing/ Ncw Conuncrcinl: 11 of Fixtures 11 of Walcr ace Sewer Lincs
Plumbing/Nciv Rcsidentink 11 of Vk''alcr Closcts
it of Gas Lincs
Plumbing Repair -Residential or Commercial
Occnpancy'17ypc: Rcsidential a Commercial _ Industrial
Construction Type: — 11 of Storics: Hof Dwcllinp Uni(s:
Total Square Poolaf;c: h
blood Zone: (FENIA form required for ottterthan X)
Parcel A•
O%Yncrs Name & Address:!V 7#
Altach Proorof Ownership 14 LcCni Dcscrip(ion)
r
Z 1 -N D tZ 1---?? 1
1'honc• Z " 7i- 12 1(7 _h
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Contractor Name & Address: ``Ci7C 20 1 —••..• •-_.__.._
Roo g-2 cA L SA-•C I 3z-1-7 L Stalc License \umber,
rht,ne &Fax: (.'Q-(- zj?jb-G%?j_j' 7 Contact Person:_ T COC _Phone. -4Zz-d
flnndin;; Conhpnlly: - /--A—
Address:
Mort, age Leader:
Address:
Architect/I:n'i lice":
Address.
Phone:
Application is hereby made to obtain a permit to do the stork and installations as indicated. I certify that no work or installation has commenceei prior In theissuanceofapermitandthatallworkwillbeperformncdtomeetstandardsofalllawsrcrulatiiirconstnuctioninthisjurisdiction. I understand that a scpantcpermitmustbesecuredforIiLECTRICALWOPJ:. PLUMBING, SIGNS, WELI..S, POOLS, FURNACF, 001LERS, HEATERS, TANKS, and
AIR CONDITIONERS, ctc.
OWN f R'S AFFIDAV T. I certify that all of the forcgoin1, infomiation is accurate and till all wort: will be done in compliance with all applirible law:: rrl ribdingconstructionandzoning. WARNING 1'0 OWNER: YOUR FAILURE'f0 RECORD A NO1'ICE OIT COMMENCEMENT IMAY RL•SULT IN YOURPAYWOTWICEFORIMPROVEMENTSTOYOURITOPER1Y. IF YOU INTEND 1.0 OBTAIN' FINANCING, CONSULT WITH YOUR LIE NDL•R OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
N(Zhlt, is b addition to the requircnvatl;: of hhi^ pennil, there maybe ad litimtnl r::aictions appheahle to "his properly That may be found in ilic public records ofthiscounty, and there may be additional permits required from oilier gtwermncl)1al entities such a:: watcr nt:uha4cnhcnt dist:•icts, staic al cncic::, or federal agmcics.
Acecptancc of pcnnit is vcrI t ttion that 1 ail(/tuafy :hc ottrer of tiu p:o;hcr;y of the rcquiremcn i'lo lien
Siynantrc of Otvtrer/Agent 1n tat rCoi ncclor/A,l unt 1e
Print tune / real'' arc I'rin: Contrrctar:\gcnt's arc
ID
t!$' 1 E ADCOCK 1 _ a' a Y'
u
SL u` 1)atc
Sirs { j i1RY PusUC, STATE•OF FLONVA ,
r MY Comm: Expires DEC. 2, 2008 DE?gIE BLANTON
COMM. # DD376609 PAY C0W %M:'SION # DD 188491
1 or on:., r/At::C'i RES: FI+p14iUygp,&I w,, h h•Ic or
t)tt•11 • A!,enl is " _ T t•8o ;i.n •s-•r?v.:) FL N*Wy Disewrdsex. ACO. _-- Produced
115 71Q JD-S%7M - -- - - Cc,
Lit, Al'
I'LIC:\TION AITKOVID) t1y: llld& lC "i";;: -- t' ::::i`>: — In.:
ia) .': Dale) (Imnal .l'• D_:: rlmuat:'•
1 t l (bnlial I)•rlt) ,
REGARDING ROOF DRY -IN AND FLASHINGS
INSPECTIONS.
AFFIDAVTr
COMPANY: 4&e4& 1200 ri h-Nf, LICENSE NO:
PROJECT INFORMATION
SUBDIVISION: ADDRESS: olo E. ZIP` i
Pa2, f .
PERMIT NO: LOT:
I, 1b DL, 4t>dDC4e_ , affiant, 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, fleshings at the above referenced addresstlot has
beentinstalled in accordance with all applicable codes and standards.
CONTRACTOR: AND t,7COcii
Printed n )
Signature)
STATE OF FLORIDA
COUNTY OF 4r4wL r. o
This
wo
ent was acknowledged before me this day of a w w N r Z a o S , by the above referenced
individual,f V-t'D COC. , who acknowledged that he/she is a dul licensed contractor with
r Low and who acknowledged that he/she was authorized to execute this document. He/she is
e' rsonall k own to me or produced as valid identification.
i
WITNESS my hand and official seal this day of 4M o. a.. Z o 0
No Pub is
DAFNEY FAYE ADCOCK
Printed Name: _`P't 7--N f/I cto a-tLNOTARYPUBUC, STATE OF FIORIDA
MY Comm. Expins DEC. Z, 2We My Commission Expires: COMM. N DD378809
POWER OF ATTORNEY
Date: I Z 7 D S
I, Andrew J. (Andy) Adcock do hereby authorize Ruben Birch /
To pull the R roof permit for 76G Z
S
5; Tt 4D
type of permit) (address)
DAFNEY FAYE ADCOCK4
NOTARY PUBLIC. 8TATE OF FLORIDA
s ; MY Comm. Expires DEC. 2 2ON
p '
4 COMM. N DD3766097n1NNr'
Stamp
Personally k wn to me or driver license # , of State of Florida, County of
2 I—
day of -J "- "". , 694•
Zoos
NOTICE OF COMMENCEMENT
County of Seminole
Soo 4
lvt
State of Florida
R -,57-7-1 (
retmn rvo. Tax Folio No. (PID)
The undersigned hereby gives notice that improvement will be made to certain real property, and in accordipce with Chapter
713, Florida Statutes, the following information is provided in this Notice ofCommencement.
DESCRIPTION OF PROPERTY (Legal description of the property and street address)
57 7 -1
GENERAL DESCRIPTION OF IMPROVEMENT
OWNER INFORMATION
Name and address
3 0 CC7 Z( 2FF
Interest in property (Fee Simple, Partnership, etc.) afi-
Les"A1*11`m
TAIff,L't H
NAME AND ADDRESS OF FEE SIMPLE TITLE HOLDEROF OTHER THAN OWNER)
CONTRACTOR
yNameandaddress
SURETY (Bonding Company)
Name and address
4-1
Amount of Bond
ID 9
LENDER WLn
Name and address p°e N
CD
0
tissttts4ssssiiiiiiiii##ti isitsiiiii#siiii#iisssiiis4ti#tii4ii#+issiiiii+t tis++++siiissss
Persons within the State of Florida designated by Owner upon wbom notice or other documents may be served as provided y
by Section 713.13(lXa)7., Florida Statutes:
Name and address L
Ch cs
to
stifi+f+iisiti#iiiliiiif#i#ii4i+Ysi#4t#i###isiiiti44i+4#iiii#4t#ii#sii##++i+i+i+++s++++++i+ "
In addition to himself, Owner designates of
to receive a copy of the Lienor's Notice as
provided in Section 713.13(l)(b), Florida Statutes. -
Expiration Date of Notice of Commencement !
The expiration date is 1 vear from date of recording unless adiiffe rnt dateieSri rA Vigc ZL
Signature of
Owner I ZOOS
ww „„ Sworn o
an subac ' ed re a this _ Day of w , lA_ y" ^y DAFNEY AYE ADCOCK NOTARY PUSL
0. STATE OF FLORIDA MY Comm,
E xplros DEC. 2, 2W8 My Commission
Expires: OMM M DD376609 Not4y Public
The foregoing
instrument wa6,acknowledged before me this! day of by _ A F'
T/ h - Cie ,Q M (name of person acknowledged), who is personally known to me or
wl`085 produ WIJ lie, (type of identification) as identification M and who
dt t not take an oath> GG o S12 -r,( 209 -