HomeMy WebLinkAbout623 Grovewood Ave (4)Permit # :
Job Address: b--
Description of Work:
Historic District:
1
CITY OF SANFORD PERMIT APPLICATION
Date: _
Jo tt-- oa P v e, 3o,4)4, T1 .
Ire- -
Zoning: Value of Work:
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/Altemtion 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
Plumbiug/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 X)
Pared p:
Owners Name & Address:
2-)1--) 7;-;
Contractor Name & Address:
Phone & Fax;
Bonding Company:
Address:
Mortgage
Address:
Architect
Address: -
Attacb Proof of own & Legal Desc
r1 CO IQ.t(t'11d1 k -
Phone: L4 C) 3 ) --h -
t o nJ S
State License Number:
Contact Person: Phone:
ran.
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 perfomred to meet standards of all laws regulating construction in this jurisdiction. 1 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 AFFIDAV 1T: 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. n
NOTICE: In addition to the requirements of this permit, there may be additional restrictions appli 1 thi that may be found in the public records of
this county, and there may be additional permits required from other governmental entities such a ement districts, state agencies, or federal agencies.
Acceptance of '
41isr7non
I will notify the owner of the property of the on en w, FS
7l3- Jul-o-3 4 os
Signa t Date Signature o Contract ent Date
P 16 rrL. 3,( C A Aqwq. I .-
Print er/Agent's Name Print Contractor/Agent's Name
LL 3-1v--o ` , , - r b Js
Signature o No -State of Florida Date Signature of Notes -tat rda Date
Owner/Agent is r' Pasonally Known to Me or Contractor/Agent is _ Personally Known to Me or
Produced ID _ Produced ID L y
APPLICATION APPROVED BY: Bldg:
Special Conditions:
Zoning:
Initial & Date) Initial & Date)
Utilities:
Initial & Date) (Initial & Date)
rRACEY MACHTOLFF P Lowery
Notary Public - States of Fkutda My Commission DD365450
B• •__ T>ccMYCamxnFiqiesNov30,ZD=i s, +d' E vaires October 24.2008
Commission 8 DD066167
Bonded By National Notary Ann.
POWER OF ATIrORNEX
Date: IG MAR, kO S
I hereby name and appoint M
of . . ' "iAj^ `t to be my lawful attorney
in fact to act for me and apply to the Cm Sow
Building Aegartnaemt fora ' coof N
for work to be performed at a location demn'bed as:
Section l b_ Township 74 Range 30 Lot Z3 block
Subdivision `, yEy tf w Vt iLI a ho• PwGAT G-
a CA,
and
to sip my name A -),
A Address
o1 JOb) I
Z
G,,,•o ALE Sit owner
of Property and Address) do
0 things necessary to this appo . CGG
g741 and
Cov"cWs Mixon Number 777
The
foregowg MM&U rent was acknowledged befi = we tbn _ 6 day of 20 d by .
Ck who
is pees m&y known to aWwho produced as
Mentification and who did not take oath. State
of Florida County
of N
Public, a County, Florida C-%
mj0p@"wwuDemU 24 Power ofAlto+w.TAoe Palls !
on MAIM
6
P Lowery a
MY Commission DD30MOO Vr-1d; Expires October 24. 2008 Seal
THIS INSTRUMENT PREPARED BY:
NAME: &daL4 j ,7 `...' Building & Fire Inspectior
ADDRESS: uJ SE uNOLE Coun n 1101 East 1 st Stret
C LORIMSINATURAt a10irf Sanford, FL 3277
State of Florida
Permit No.
NOTICE OF COMMENCEMENT.
County of Seminole
Tax Folio No. (PID) /O-o?v- 36 -505- 0,9o0 - 4a3o
The undersigned hereby gives notice that improvement 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.
DESCRIPTION OF PROPERTY (Legal description of the property and street address) .
koI-- c:2 3 (less ENV 334f) C3roye v / ew V;/(t$(. I5FAdQ ,Pep P8 -74 s -4
1p 3 Ciro u e-word. Aue-- . 'Y- -d Fl- 3alf- 3 ZOA
OWNER INFORMATION
Name and address P lVvT
Interest in property
1\E.Q
110
NAME AND ADDRESS OF FEE SIMPLE TITLE HOLDER. (IF OTHER THAN OWNER)
hurr
WAYW , CLERK OF CIMUIT MWCONTRACTOR` 5, smlffll.E mtom
Name and address Pp 901<
u '%
S
TAK 91`.16 PG 0376
lV 11V7 IL i4,C GL 3.7g 3 CLERK" 5 ;'t ,..
Aft;
L`3'9
SURETY (Bonding Company) REMIND FEES 11LIG
Name and address
RECWM BY D Thomas
Amount of Bond
LENDER
1N= d a .dyes
t y-00,au159 bbPnay 1 C. Persons
within the State of Florida designated by Owner upon .whom notice or other documents may be served as provided by Section 713.
13(1)(a)7., Florida Statutes: Name
and address Persons
within the State of Florida Designated by Owner upon whom notice or other documents may be served as provided
by Section 713.13(1)(a)7.,Florida Statutes: Name
and address: In
addition to himself, Owner Designates of To
receive a copy of the Lienor's Notice as Provided
in Section 713.13(1)(b), Florida Statutes. Expiration
Date of Notice of Commencement The
expiration date is 1 year from date of recording unless a different dates specified.) TRACUI
ACHTOLFF Notary
Puolic tt;ttB of Florida My
Con"W" Now 30, MM Commission
It DD068167 Notary
Public The
foregoing instrument i 6a
etik - Ski A C A 109
Day
of y
Commission Expires: I 5101 acknowledged
before me this day of PbDS by Name
of person acknowledged), who is personally known to me or who -has k
A--,- (Type of identification), as identification and who did/did not take producedner, Sa-,, A and
oath.
AFFIDAVIT
REGARDING ROOF DRY -IN AND FLASHING INSPECTIONS
1
Company: '4J ln-Ccll7ua ¢S,,ly License #: ' C 05 FS %112
Project Information
Owner: 14l&rl `i_`_X XY a
name
3dtye,,,),W A/e_
61 address
phone
Permit #• 0S'/ $7I
Subdivision:
Lot #: 2 3
I,g!V1,Mecord tor affiant, hereby affirm that I am the duly licensed
nhe 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.
4" 04AIRvesignature
printed narne
STATE OF FL O
COUNTY OF
This instrument was acknowled ed before me this 1(O day of r , 20 03!by the
above referenced individual, MBA. , who acknowledged that he/she is a
duly licensed contractor with (L-S and who acknowledged that
he/she was authorized to execute this document. He/she is either personally known to me or
produced as valid identification.
WITNESS my hand and seal this day of 206
Notary Public
DEBBIE BLANTONMYCOMRIISSION * DD 18W1EXPIRES: February 25, 2007ARYFLOryC'm Assoc. Co.