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Job Address:
Description of Work: 26 rc- OD
IIistoric District: 'toning:
CITYOFSANhURD
Date: a ZRI.
IZ
Valuc of Worlc: S
Pcrinit Typc: BtlildinS 131cctrical Mechanical Plumbing rirc Sprinkler/Alarm 1'onl•L._
Electrical: New Service —11 of AMPS Addition/Alteration Change of Scrvicc Tcmpor;;ryPole —r MccbanIcal:
Residential Non=Rcsiticntial RcplaccmC f cnt New (Duct Layout • ,ncrgy 01A... Required) P untbinr/
Ncw Conimcrcinl: 0 of Fixtures 0 of Water F- Scwcr Lines I/ of Gas Lines Plambinr/Ncw
Residential: 9of R!atcr Closcts Plumbing Repair— Itcsidcntial or Commercial Occupancy Typc:
Residential Commercial _ Industrial 'I'total Square Foota;;c: Construction Type: —
11 of Stor•ics: 0 of Divellinr Units: Flood Zolic: (FriMA form required for o(her tttsn X) Allach Prooror
Ownership .c: Legnl Description) Parccl 11:^
n.Owners Name
dt Address: (0!-Y4fL C D V ll - Pbonc: V'
C•'
AIA—s Contractor Ianu . n_/Q
07
CI r% I 3Z%7 L State (.icensc/\umber. lilts/ 2ZPbonc fi Fax:(,Q-7 ZjZj d —!i ?j?j• 3 Contact Person: D I ^ COC _Pbonc:(Inndin, Company:
Acickess:lort;
a;
c Lender:Address' Architect/
tin-(
veer: Address:lax'
Application
its
hereby made to obtain a permit to do Iltc work and installationr as indicated. Icerifythatnoworkorinstallationhascol:imcncuipriorInthe issuance ofapcmtitandthatallworkwillbeperfomxdtonxctstandardsofalllawsregulatingconstnctioninthisjurisdiction. Iunderstandthatascpantc permit mustbesecuredforI'LI:CI*RICAL WOPX.PLUM))INC. SIGNS, WE•LL.S, POOLS, FURNACES, BOILERS, HEATERS,1'ANK.S, and AIR CONDITIONL•
RS. ctc. OWNER'S
AFFID,AVI'I': I certify that all ofthe foregoing information is accunteand that all wor:: will be done in compliance with all applicable lat'n r(qtibtting construction andzoning. WARNING *1'0 OWNER: YOUR FAILURE'f0 RECORD A NOTICE OF COMMENCETvIENT;.SAY RESULT11`Il'OUI.I'A.YfNG TWICE FORTMPROVEMENTS'f0 YOUR PR01'ERIY. IF YOU INTE.•ND TO OC'1'AINFINANCING. CONSULT WITH YOUR LENDER Olt AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMEN'r. NN( LIC,
XF: Inaddition to the rcquircnxnls of Ihi:: permil, Ihcrc may In:atlllitional n:::n ictiuns a, plic:Iblc ro Ihi; properly Ihar may be fount) in !hc public records of this county,
and there may beadditional permit:: required from oter governnxnt:Il entities :'tell as w tontanngcmcnl districts, stair. agency ur ft.deral agencies. of isa
Lien Aeecplanec ofcnt * verification that I will notify the owner orlirc pruper;y of the requircl its 1:a •, 119 U
r / — Si^I •
uure or0%vllcr/Al;cnt Unlc J E
n
cr
Print inter/
agent's Nam 3)06Sirnaurrc
of Notary-StarrI:Iori'I. I):u('rm:r-.
Ic tr/ IFrr?nitF 1 ItMaI t7 I.•1e u DD 1SMI
EXP:;IES:
FeUruaryI.OW3•NOTARYI'I.Notary Discount A==. CO. ntaatv(Inlual;;
Da10 (Ins 7, Uat: f)t
rct/Areal isIn kur I'I'
I.IC':I'IONAI'I'ItUvl:l>11Y:t)Itlg:rini;ial :
I):ati It KOLOSKY1;
recia!
l"oxlit IExpiRr i12/28/2008 weot:ded
throupb tloo 132A2st)
Florida Notary Aiin.. Irtts s Nanu
ofofI lurir(
a Ualc Uatc
ti
POWER Or ATTORNEY
Date: o a
I, Andrc-w J. (Andy) Adcock do hereby authorize Ruben Birch
To pull the Re oof _permit for tA,--r4LI be
type of permit) (address)
SA-t_!s 1=o cz—r , t
Signature
N Stamp
n DAFNEY
n.
FAYE ADCOCK
NOTARY PUBLIC. STATE OF FLORIDA
My
COMM 4 rDD376609
e
Personally know o me or driver license # , of State of Florida, County of
day of a.- —, , i6@
2oom
REGARDING ROOF DRY -IN AND FLASHINGS
INSPECTIONS.
AFFIDAVIT
COMPANY: &Le, LICENSE NO: O Z Z D
PROJECT INFORMATION
SUBDIVISION:
PERMIT NO:
ADDRESS: D o q c A TAL, lu A
C-1 3Z7
LOT:
afliant, herebyaffirm that I am the duly licensed contractor of record for the above referenceY
permit, that all of the foregoing information is we and accurate, and that the dry -in, flashings at the above referenced address/lot has
beentinstalled in accordance with all applicable codes and standards.
CONTRACTOR:
4
tinted
bwlev
Signature)
STATE OF FLORIDA
COUNTY OF - t n D LE-
Lk —
Th' inst ent was ag/lnowledged before me this
individual, D-' 5 C'Oe+—,1 , who ac
E D F n A and who acknowled
eithe sons own to me or produced
WITNESS my hand and official seal this
y'i"
Icn
day of t- b'a '-- ?.O& S, by the above referenced
owledged thie is a duly licensed contractor with
ged th he was authorized to execute this documedl, is
as valid identification.
day of
NOU P blic
DAFNEY FAYE ADCOCK Printed Name: T2Ler Ap Dc%!
NOTARY PUBLIC, STATE OF FLORIDA My Commission Expires: Z Z Z•
MY Comm. Expins DEC. 2, 2008
COMM, N DD376000
hu rA'7
A0466 NOTICE OF COMMENCEMENT Q
Mate of Florida County
of Seminole P+(+
Permit No. Tax Folio No. (PID) 7be
undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 4r2__( 713, Florida Statutes, the following information is provided in this Notice of Commencement. 3
Z7 -7 DESCRIPTION OF PROPERTY (Legal description of the property and street address) jo
f4L-1 N tD EF-C:2 GENERAL
DESCRIPTION OF IMPROVEMENT 4X
GC G
OWNER
INFORMATION Name
andaddressC, , 2 lLL L ( Interest in
property (Fee Simple, Partnership, etc.) e, a..+ ^sue NAME AND
ADDRESS OF FEE SAMPLE TITLE HOLDER41F OTHER THAN OWNER) CONTRACTOR Name
and
address (O Roo io '
AP_E3Zc_+-( 54 - w ..mow r'> 1 _ 1 — -- SURETY (Bonding
Company) I Illi f111ip11 f8 1a 1 G) /A 1 ® Ri Name andaddressltsAmount of
Bond iT COURT 9011MLE CMUPJTY
LENDER 8K
6561.2 PG 0955 Name and
address CLERK• S riI 26ti 4451 f 0
s••ss••
ss•s••s•••sssss•ssss•••..••.•.••s•a....a•'sgy 1•oU 3 Persons within
the State of Florida designated by Owner upon whom notice or other documents may be served as provided by Section713.13(lxa)7., Florida Statutes: Name and
address swsssasssstssssssssss*sss•
s••r•s•s•ss•ss s•s ssssrsssssss+as+tssssssassssssssssssss+sssssss In addition
to himself, Owner designates of provided
in
Section xb), Florida Statutes 713.13( 1 to receive
a copy of the Lienor's Notice as s•ssss••
s••ss•ss•sssss••s•+••sssssssss•s•sssss•sss•ssssssssss•ss+ssss••sss••ss•ss•s••ss•••• Expiration Date
of Notice of Commencement The expiration
date is 1 year from date of recorditr¢ a di errnr Aare ;c ,ir;fini Signature of
Owner Sworn to
and subscribed fore me is Day ofp jJQ17J or My
Commission Expires: Notary Public
The f
oing en t was a owledged before me this day of L DYErl (nameofpersonaclmowledged), who is na1lY wn to an or
ho
di
id not a - (type of
ldentrtlCail n w.8.L.1,SOw91a and ho
di did not take an oath i4PIDY KOLOSKY Commission • DD0174M
Expires 12rM006
012a,11% bonded through t (tWo-
472 t) Florida Notary Assn., Inc.