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Permit # :
Job Address: 4 D 6
Description of Work:
Historic District:
CITY OF SANFORD PERMIT APPLICATION
Date:
ryFoes 3 C--r7 f
Zoning: Value of Work: S i X/a 0o
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 # 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:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than 7Q
Parcel #: -so - $0 - 0 0 00 - $ Z40 (Attach Proof of Ownership & Legal Description)
Owners Name & Address: V D AV II 71 OS L U I S E X /Z/T La E
4101 &/. -EO -=d S7% VW FD ICV Se-7-7 / Phone:
Contractor Name & Address: 14/ / As DOI' /I1Ili //d . Z t7 3 0 S. CLM M) C L MK .
i>EC-rOnI A, FL 3 Z 7 L 5- State License Number: C CC -/ 3 Z 6 0 E
Phone & Fax: 3yd- / - 10619 Contact Person: 'mcl)EL Phone:
Boodine Comnaav:
Address:
Morteaee Lender:
Address:
Architect/Engineer: Phone:
Address: Fax:
Application is hereby made to obtain a pemvt 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
pemut 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 will noti a oNer
Sr re of Owner/Agent
L Yt l S • " t L4 Ne ( .
of the requirements of Florid ien w, FS 713.
OO
Signature of Contractor/Agen $ Date
Pri er/Agent's Na
TT <<
Pri ontractor/Agent's Name
VJ
gnature of No -State of Florida ate Signature f N -State of Florida
u tsn&W ")*a DEBBIE BLANTON
OYig"QO up tuvo MilesQDMY COMMISSION * DD 11it3491
Commission DD04116!!s EXPIRES: February 25, 2007
Owner/Agent is _ Persor ci%lm Auger 22 2000 Contra /Agmtsis TA Persog
Produced ID _ Pr
APPLICATION APPROVED BY: Bldg: Zoning: Utilities: FD:
Special Conditions:
Initial & (Initial & Date) (Initial & Date) (Initial & Date)
S
I Permit Number
Parcel idontNlcetion Numbwr 'l
Propored Dy: AM
wi6 c, 0[.a MILL .ba
J716C,-170 rJ A , FL 3Z•7z S
Returnto: llltbS X006,14 G /n/(' -
eO3O S. OL9 r(ILL-'j>4t.
PrL7101VA, (—L. ner?Lr
NOTICE OF COMMENCEMENT
State of Et Get 1-V A -
County of S
IIiIIIIII Iliilll111,,,,,,1,1111111111,1111111111„....
MARYANNE MORSE, CLERK OF CIRCUIT COURT
SEMINOLE COUNTY
BK.05602 PG 1760
CLERK'S # 2005019031
RECORDED 02/03/2005 12139;17 PM
RECORDING FEES 10.00
RECORDED BY t holden
The undersigned hereby gives notice that improvement(s) will be made to certain real property, and In accordance withChapter713, Florida Statutes, the following Infonnatlon is Inprovided this Notice of Commencement
I. Doscrtptlon of roperty; legal description of p orty, and street •aqreaa if available) LAG Go /s3 S id tro D 1+Et G4-tsyob • Zo sue. Sri ftM D 19
2. General dosFlpdon of Improvements)
r L 3 'Z -7-7 1
3. Owner Information CERTIFIED COPYr
Name L (J l5 6iQF-4 (.b Y/ V/A"O NITAone Number MARYANNE MOR. a; ly
Address y Gf'p
Fax Number
Interest in
CLERK OF CI ,CUIT COiIRT' +
L C UNT F IDA' Property4. Fee Slmpla ltle Holder (If oth3eh+o owner shown above)
SEMIN
rName
Address Telephone Number BFaxNumber
S. Contractor ( 00i/IJtjj1/c ES
Name 6
r, tY 4PWF`UVrtLERK '' -
41, 2 t7 S L i/ L t 9. Telephone NumberAddress
7 ELT UvJ fC I- 3 Z? ZrFnx Number
S. Surety of any) t
Name
Address Telephone Number
Fax Number
Amount of bond 1
7. Lender (If any)
Name
Telephone NumberAddress
Fax Number
S. Persons within the State of Florida designated by Owner upon whom notices or other documents may beservedasprovidedbySection713.13(a)7., Florida Statutes. Name
Telephone NumberAddress
Fax Number
9. In addition to himself or herself, Owner designates the following to receive a copy of the Lienor's Notice asprovidedinSection713.13(1)(b), Florida Statute*.
Telephone NumberAddress
Fax Number
10. Expiration date of notice Of commencement (the expiration date Is 1 year from the date of recording unless adiftrontdateisspecined):
Date 8lgnod— —' --- 0 8 gnature of Owner [Note: per Section 713.13(1)(g), "owner must
sign ...and no one else may be permitted to sign In his or her
stead.")
8wom to and subscribed before me this 3 day of -1: - , Z0QSL by
f ILA. --------
who Is —___ personally known to me OR —_
producedasIdentification.----
Form Revised: 3/98
of Notary (notyfel seal to appear below)
Ratlhd MCI
MY Cotrpni WM DDOs90lN{
n- Expltss AtrSust 22. 2008
AFFIDAVIT
REGARDING ROOF DRY -IN AND FLASHING INSPECTIONS
Company: /4114CS C0V)r11(6, INC
Z23a S. 0(;D MILL 'PC-
DELTQ n1A
License M C G C / 3 Z 6 0 6 Y
Project Information
Owner: —)&,I i d,4 eet ed l-015 j5CIZ I.V; Permit M nano
20T-
Subdivision: <AQF(/4Cb dec(6/475 address
Lot #: /
SZ • / 5.3 phone
I, '
4f, C11461- 4 l C.G S , 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 applicable codes and standards. Contractor- .
e zl_4 signature
6
e- -I ,I- E S printed
name STATE
OF FLORID COUNTY
OF This
instrument was acknowledged before me this 3 day of 20 oS ; by the above
referenced individual, 1f1C4%C-L eli L65 , who acknowledged that he/she is a duly
licensed contractor with - yZM5 go r Pt so G i r.) C . , and who acknowledged that he/
she was authorized to execute this document. He/she is either y sown to meor produced
as valid iden aam WITNESS
my hand and seal this day of F'4- k , 20 d Notary
Public DEBBIE
BLANTON MY
COMMEXION # DD IGM1 EXPIRES:
February25, 20W 1 8op-
3-N7ARY FL Not" Dmourd Assoc. Co.