HomeMy WebLinkAbout512 E 5 StPcrinit
Job Address: S lZ E
n.
42•
c
Description of Work: 2 200
Historic District: Zoning:
CI'I'YOFSANFUI%I)1'I:I:dII'1'Al'I'I,II;AIIVty :n: ttiK:,+i;t:•:r: ,•:r>;. yti n:
Datc• . ..w.r. `ice• `.Y ir•.• •: .lw •: R:a '1
Z S•, _ ZS ti e 3 —k --6
Value of Work: S 14(,Z0 •C
Permit Typc: 131iltting Mccirical Mcc}tnnical Plumbing; fire Sprinkler/Alarni Pogl• _
Electrical: New Service -11 of AIYIPS Addition/Al tcrntion Change of Scrvicc Tcmpot:iry Pole y
rncrgy C:i1G. Rcquinal) Wchanicnl:
Rcsidcntinl Non -Residential Rcplaccmcnt New Duct Ltt out Plumbing/
Nei• Commercinl: 11 of Fixtures 11 of Miter & Sewer Lincs 11 of Gas Lines PlumbinpjNct,'
Residential: fl of NA!alcr Closets Plumbing Repair- Residential or Colnmcrcial Occupancy
Typc: Residential Commercial _ Industrial Total Square rootage: Construction
Type: it of Storics: If of Divemnr Units: Flood Zone: (MVIA form required for other t11211 h) Parcel
It: Attach
Proor or Owncrship & Lcgal Description) r =
4-+ . - -r <t e Owncrs
Nantc & Address: e- I LL- k-IL`7 t tWk - - 1
a 3z"t I rhone• 140`7- 3zz- `7o.IQ Contractor
Name &•'Address: `A C Cif=LD 0 1 C2-—••.••_..__._....._ 00
N J L S) p •G I 3ZZ'7 L State I.iecnsc/N umber: G Z?_ 5-----..._. o1'
honc &Fax: -. i?iD -33j Contact I'crson:_; "COC _I'honc:-3z.g5r g Ilnndin,^,
Company: Ad0css:
Iorl,•
ag;c Lcnder: . Addr•
css: Architect/
rnl.inccr: 11
Address:
Application
is hereby made to obtain a permit to do the stork and installations as indicated. I cerify that no work or installation has commence!! prior a, the issuanceofapermitandthatallworkwillbeperformcdtomeetstandardsofalllawsregulatingconstructioninthisjurisdiction. I understand that a separate permitmustbesecuredforELECTRICALWORK, PLUM11ING, SIGNS, WELLS, POUTS. FUI%NACr-S. t001LEMS. 1•1L•ATERS. TANKS, and AIR
CONDITIONURS, cic. OWNER'
S AFFIDAV I'1': I ccrlify that all of the foregoing; infomtation is accuntc and that all wort: will be done in cornpliancc with all npplil;W;lc lays rt:l ithling constructionandzoning. WARNING TO OWNER: YOUR FAII.UitG TO RECORD A NOTICE OF COMMENCEMENT MAY Ru. uIT tIQ POUR PAYING TWICEFORIMPROVEMENTSTOYOUttPR01'EIt1Y. IF YOU INTEND 1'0 OBTAIN FINANCING, CONSULT WITH YOUR LENDER Olt AN ATI'
ORNEY BEFORE RECORDING YOUR NOTICE OFCOMI.4ENCf:!vtl-.IJT. NCZI_
I(,ai: In atldilion to the rcquircnvatt:: of this permit, Ihcrc n,ay he atlditinnal n:::!rictions applic:tole to thls prv{tcrly That nlay be ftnlnd in Ihr, public rcconit of this
county, and Iherc n,ay be additional permit:: rcquircd from other ; ,t crnn,cnl:d entities such a:: t:Ucr nunavincnl tlistricls, slab. al,;ensics, ur ft:dcral ag teics. . Acceptance
of pct'lnit is verification 1111 1 will notify the owner of tilt pro, c1;y of the rcgt .1" s r!-,on icn L1tt, FS 7 Signature
of Utvncr/Aj-,Ent Datc Sig; ]tore of Contnetor/A„ nl — Z
l l.L E2 EE B - tl. Print
ter gcnl ji ante 11rinu Contrrctar:\gcnt's Namc ( Sc,
t, ,r Florid, I)atcl mna my of of Florida Ogre UAFNEY
FAME DCOCK NOTARY
PUBLIC, 8 MY
Comm. E>r new it)
or APPLICATION
APIil'%OVI-'D BY: Illtl a:A 31 a/Dr•""in;;: tInitial
Dmc" p
cia! l'ondi ions: DEBBIE
BLANTO N, 198491.
1c r XP.
IRES:e9wety?9;'200T- 1.
600.3•NOTARY FL Notary Discount Assoc. Co. Inili'
11 ;: I)at l (Iiikial & Uate) (Initial & D21' 1
POWER OF ATTORNEY
Date: : Z- jjt>G
i
I, Andrew J. (Andy) Adcock do hereby authorize Ruben Birch
To pull the Reroof permit for IZ ES`( typc
of permit) (address) 37—
n iSignature
Stamp
f,....
ti DAFNEY FAYE ADCOCK NOTARY
MUC. STATE OF FLOFVDA MY
Oomm, Erplrss DEC. 2, 2= COMM. #
DD376M Personall
to me or driver license # , of State of Florida, County of Z7'
day of —low- sa
S
REGARDING ROOF DRY -IN AND FLASHINGS
INSPECTIONS.
AFFIDAVIT
COMPANY: eow- Roo-P-7 N(, LICENSE NO:
PROJECT INFORMATION
SUBDIVISION: ADDRESS:
r? E • C7
PERMIT NO: LOT:
N
I, LfO 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, flashings at the above referenced addresstlot has
beeninstalled in accordance with all applicable codes and standards.
CONTRACTOR: 4C
ted nam )
IZ7A
nature)
STATE OF FLO A
COUNTY OF
its.'- This instrument was acknowled ed before me this ZL day of ?ADS , by the above referenced
individual, Ocl- Dom- %4'0C0who acknowledged that he/she is a duly licensed contractor with 41'
7t --M o f and who acknowledged that he/she was authorized to execute this document. He/she is either
to me rl or produced as valid identification. WITNESS
my hand and official seal this ZZ'"L
wµ "
DAFNEY
FAY7FLORIDA 1 NOTARY PUBLIC, S3 MYComm. EllpinCOMM. 0 day
of 11,C — Notary
Pu 'c Printed
Name: 'PA'V-0 y My
Commission Expires: 1
Y-kW
g o 1Ar
State of Florida
NOTICE OF COMMENCEMENT
County of Seminole
CERT1f1EpLtdPermitNo. Tax Folio No. (PID) GpPY
37.-nf TLa undersigned hereby gives notice that improvement will be made to certain real property, and in accordanec li;1opt n IWOR$E
713, Florida Statutes, the following information is provided in this Notice of Commencement SEMINO(E IVIRCUI COURT
n ZOQS
GENERAL DESCRIPTION OF IMPROVEMENT iG L FC o 0
OWNER INFORMATION
Name and address Z 1 L Lr,- M`i7 E t-3 LL-
St'Z E. F'0 3
interest in property (Fee Simple, Partnership, etc.) a W "1;~
NAME AND ADDRESS OF FEE SIMPLE TITLE HOLDER.(IF OTHER THAN OWNER)
CONTRACTOR
Nfte and address
1n
SURETY (Bonding Company)
ININIM11M
Name and address
WAWM , CIRIXIIT COURT
Amount of Bond WIMLE NOW
BK 05662 FAG 0350
LENDER
Name and address REWDED a/f8/2M_®8v47v34 M
CLERK' S 0 200W5,a049524
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Persons within the State of Florida designated by Owner upon whom notice or other documents may be served as provided
by Section 713.13(lXa)7., Florida Statutes:
Name and address
ssssrassrstsRt+ssss++++#+sss#s+isssssssssrsi*issri#sssRssssisirsss+ss+s+ssi+RstssRRs++s++++s
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.
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d HtiY 1bDdEm(DK rdinse unlemc a different date in xn rifimi 1
NOTARY PUBLIC. STATE OF FLORIDA A
MY Comm. Expires DEC. 2, 2OD8
COMM. N DD376609
of Owner
ubsc ed h;cfjorec this Day of 49 Z S
My Commission Expires: Z z ZDO
S.-
The foregoing instrument was o ledged before a this day of Z01S
Z 1 L L E M of person aclmowledg wh '
me or who has produced (type of identification) as identification
and who did / did not take an oath