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A
v t CITY OF SANFORD PERMIT APPLICATION iitt'+F ' :; .1" : i! • tt
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Permit # : Date:
Job Address: -
Description of Work: r e-..A D /i) n !f df /_ Df , _ i_ i r l Lim '
Historic District: Zoning: Value of Work:
Permit Type: Building —4-- 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 P— Commercial Industrial Total Square Footage:
Construction Type: t < C ,1 1 # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for miter than X)
Parcel #: (Attach Proof of Ownership & Legal Description)
Owners Name & Address:
Contractor ry to &
Phone & Fax: _U
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer
Address:
State License Number:
Contact Person: Phone:
Phone:
Fax:
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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. 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 AFFIDAVIT: 1 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 notify the owner of the property of the requirements of Florida Lien Law, FSA 13.
Signature of Owner/Agent
Print Owner/Agent's Name
Date
Signature of Notary -State of Florida Date
Owner/Agent is _ Personally Known to Me or
Produced ID —
Z) 4APPLICATIONAPPROVEDBY: Bldg: Zoning: 71Z
Initial e
Special Conditions:
Print
of Notary-Stat2*j'Florida
Contractor/Agent is VPe, nally Known
Produced I D
Utilities:
Initial & Date) (Initial & Date)
Date
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Seminole County Property Appraiser Get Information by Parcel Number Page 1 of 1
PARCEL DETAIL
J
Scmin ulc i cmi n t
opertv,,0rpp aua
Artiices
1 1111 t'. knrsl St.
At ,
hi-751k,
GENERAL
Parcelld: 32-19-31-515-0000-0080 Tax District: S11- SANFORD
Owner: MARONDA HOMES INC Exemptions: OF FLA
Address: 411 CENTRAL PARK DR
City,State,ZipCode: SANFORD FL 32771
Property Address: 116 PINEFIELD DR SANFORD 32771
Subdivision Name: CELERY LAKES PHASE 1
Dor: 00-VACANT RESIDENTIAL
SALES
Deed Date Book Page Amount Vac/Imp
Find Comparable Sales within this Subdivision
t <J Back C_> i
2004 WORKING VALUE SUMMARY
Value Method: Market
Number of Buildings: 0
Depreciated Bldg Value: 0
Depreciated EXFT Value: 0
Land Value (Market): 10,810
Land Value Ag: 0
Just/Market Value: 10,810
Assessed Value (SOH): 10,810
Exempt Value: 0
Taxable Value: 10,810
11
2003 VALUE SUMMARY
2003 Tax Bill Amount: 226
2003 Taxable Value: 10,810
DOES NOT INCLUDE NON -AD VALOREM
ASSESSMENTS
LAND LEGAL DESCRIPTION PLAT
Land Assess Method Frontage Depth Land Units Unit Price Land Value LOT 8 CELERY LAKES PHASE 1 PB 62 PGS 75 &
LOT 0 0 1.000 10,810.00 $10,810 76
NOTE: Assessed values shown are NOT certified values and therefore are subject to change before being finalized for ad valorem tax
If you recently purchased a homesteaded property your next year's property tax will be based on Just/Market value.
http://www.scpafl.org/pls/web/re_web. seminole_County_title?parcel=3219315150000O080&... 1 /7/2004
12/18/2003 12:43 4073024345
CUSTOMER NAME:
LINEAL FSE(: COUNTY: -
HEIGER TYPE OF FENCE STYLE
4 5 Cypress Stockade
UB []8 Chats Link PVC ETD on 80
Ultrawood Shadowy Box
Picket
BOARD SIZE RAIL SIZE GOOD SIDE
01J2 x 4 02 x 3 In
1 x 4 2 x 4 Rout
xG
WALK GOTES' QTY:.,_ OPENING:
ORNE OiMi: Orr: OPENING,
LINE POSTS: OTY: O.D.:
TERMINAL POST: M.' O.D.:
MF HAIL: QTY. 0.0.:
WIRE GAUGE: KX: KT:
FENCE T7 FOLLOW CONTOUR OF GROUND:
FENCE T3 BE, LEVEL:
REMOVE: EXISTING FENCE: YES NO
FENCE LINE TO SF CLEARED: YES NO
CORNER LOT: YES NO
PERMn' NE:Eow: YES No
OFFICE DEPOT 613 PAGE _ 02/ 03
p -%
CO1r 330 Dog Track Road a Longwood, FL 32750
407-331-0765 Phone - 407-331-0772 Fox
OR OATS:
HONE: HOME N
WORK At r
FAX 0
MAP PAGE— MOBILE #
i
HOUSE
FRONT
C W rlt Otraq wllt "On die cameo an, upm lmlueut. In daonrgrint wt ore mt RW to 10 Oe traced, bat under no cimumsteae" dam Clasrok Few aafuam MW mp rAbitipr eegoe ft F Mpergr lab or
in my wy ;purmule their aeenoey If pmp "pins canna ee Impr4l, it is teceafnleodad ohm the Comm Am du prppeay surveyed.
CbM. k Rrmr errl wtawr thy. ertpters1611f1y tta lace ft. undarmmd shier arA utilhiea. fat wry rpvinkicm m olhrar unmarked Wricd lames w ulieUr.
Foot billim. will In bred on etr at bet= of ftch+$ Cwto. Paynern b due at Mx gme d co"ledem of aodt said a 6nonor thwp of I I/j%pa mandl ahe11 ee *Wied 1e ill lemme not god In fallaid" 10 dirge of CgmwNun. All moeMal w 11 fltyndn d11 nrep My er t lOwle Tkon son ostnnem is teaelod In M RIshl of stem and wmml it Xwvd to C ov de Rau» to tha curvy of nnnpa nietu
pQ rho tennl of the eonanet. At euattlns saver to ptfy oU Illuntst and arty Coon lat'WMA In the coltteUae of Ms debt
wilco amps mesa to a hlm f11s aeger to (kale ®rut w a a imilla a wort shtedy balRm, or eo seoept loom lj ooareercd Ibr. Aoyo aPte ee m prly Stlly .Gafddatrd dtenretea a! a arno equal ro 31'ts d
lOIIR eoettrlct price. pros ant ar malaiab awd 1+1x. ahgrJy furrodrcJ aR iapryareM.
Cusupw avaume+lull raptnribilily A* ublt+rriryl hwwwrem assmiat iAnappr ova{ fM tha trpt and tptAt nn M tease. CrM.'ro ruaCellA3 3 Cr Woos M C a
Wood react rdatehats set "P0 rai11 on ltYmv. WaM f&w. has a amdency to #Ank and warp in hot. humid wesou and swop tape will appear bef-tree bode. Craelte m dm woo are a enmmrm and
aceeMd wruneaee.
I HAVE REIM AND UNDIERSTANOT14E ABOVE CLAUSE:
APPFWW AND 4VEPMPM MVICIMER
CONACT AMOUNT: $ DOWN
PAYMENT: $ r BALANCE
DUE owe
UPON
COMPLETION $ TV
06 OXF.
CAU.ED MStgti.
R Pourer
C4. s Tblt
hwo Co. c «
rw 10
Gas
Ce.— s f.
QUOTE VALID OR 30 DAYS
C L
Telephones_)_
Who Authorized/referred
Insurance Co.
Insured's. Employer
Fax . Telephone(___ Fax
Referral #
Insured's Name Insured's DOB
Insured's ID/SSN GroupName/#
Relationship of Pt to insured Phone # to verify insurance s/W
Effective date of coverage _ Deduct amount Satisfied?
Co -Payment or Percentage Pre -Existing Clause?
Is Allergy evaluation, testing. and treatment in MD office covered?
Is SKIN testing covered?(CPT 95024/95004)
Is RAST testing covered?(CPT 86003)
Are Allergy Injections covered?(CPT 95117) Vials?(CPT 95155)
What company does the patient get Nebulizer Machine from?
Lab Can we bill lab work? or must be billed by lab
Flu INJ? Needs Dictation? (all managed care)
Authorization needed? Is authorization required for each visit Expires
Insurance Mailing Address
Approved Not Approved Verified by_ Date
PREPARED BY:
WAYNE VON DREELE
4005 Maronda Way
Sanford, Florida 32771
ATC# 03-14461
KT* 58042 CFD/DAID
this SpedA to y 19eed Made the 29th day of December
MARONDA HOMES, INC. OF FLORIDA
A.D, 20 03 by
a corporation existing under the laws of the State of Florida, and having its principal place of business at
11.01 N. KELLER ROAD, SUITE F, ORLANDO, FLORIDA S2810
hereinafter called the grantor to ROBEItT G ADOLDisir said ELIZABE',A'1d B. ADOLPHE, husband
whose post officeaddress is
and wife'
hereinafter called the grantee; 1042 AlvinA Lane Oviedo, Florida 32765
Wherever used herein the tame "grantor' nod "grontee' inchtdn n1t the parties to this instrumeatand the
hetre, egol represebmivee and nssitme of lodivichtnle, rind the nucceesora and nseigw of corporations) itnt5sQt1.
That a grantor, for and in consideration of the sum of $10.00 and other valuable considerations,
receipt whereof is hereby acknowledged, by these presents does grant, bargain, sell, alien, remise,
release, convey and confirm unto the grantee, all that certain land situate in Seminole County,
Florida, viz: LOT
8, CELERY LAKES, PHASE 1, according to the Plat thereof as Recorded in
Plat Book 62, Pages 75 and 76, inclusive, of the Public Records of Seminole County,
Florida. SUBJECT
TO covenants, restrtictions, easements of record and. taxes for the current year.. PARCEL
IDENTIFICATION NUMBER: 32-19-31-515-0000-0080 Byf
r with all the tenements, hereditaments and appurtenances thereto belonging or in anywise appertaining, J1®
in t® 'Hold the same in fee simple forever. d
the grantor hereby covenants with said grantee that. it is lawfully seized ofsaid land in fee simple; that
it has good right and lawful authority to sell and convey said land; that it hereby full warrants the title to
said land and will defend the same against the lawful claims of all persons claiming by, through or under the
said grantor. In
10IRRESS bhtrtPf the grantor has caused these presents to be CORPORATE
SEAL) executed in its name, and its corporate seal to be hereunto affixed, by its proper officers
thereunto duly authorized the day and year first above written.. A'
rTEST:.................................................... ........ ..... MARONDA .HOMES, INC : OF FLORIDA. , , .. Secretary
Signed,
sealed and delivered in the presence of. By .....
Lt..... ......................:...,.... WITNESS:....... _ _.....
D.`.............. TOM GREENAWALT, Vice_ President WITNESS:
D COLL Sr
1ATEOF FLORIDA COUNTY
OF SEMINOLE I
HEREBY CERTIFY that on this day, before me, an officer duly authorized in the State and County a
fbresaid to take acknowledgements, personally appeared TOM GREENAWALT, known to me to be the VICE
PRESIDENT ofMARONDA HOMES, INC. OF FLORIDA, a Florida Corporation, on behalf ofthe corporation.
He is personally known to me. WITNESS
my hand and official seal in the County and State last aforesaid this 29th dfly
of December , A.D. 20 03 Cynthia
F. Davis DM82431
EMES NTHIA F. DAVIS NOTARY PUBLIC ; MYcoMMISStQEfqFebruary
3, 2007 02/03/07 uur+
ncon•iautBorFw+ata"crcat MY COMMISSION EXPIRES IDD 182431 MY
COMMISSION NUMBER: I®
01/05/2004 17:20 4073024345 OFFICE DEPOT 613 PAGE 03/03
11V, VV I 1. L
vLV1.1 LVV.4 '•JT1Ili 111r1I%V11Vr1 11U111LU Maronda
Homes Inc+ 40'
n 475.9112 Fax: (ao7) 475-9115 1101
N. Keller Rd., Suits F. Orlando, inxida. 32810. Date:
AeceMker 6j 1 1
I•
ADDENDUM
TO CONTPLACT do
he This
Addendum to contract for Pt aso between Robert G Et 3
regarding the BuyetsandMarondaHome$ Inc., of Florida, Seller dated May 27,10re B following. property:
Lot #
8, Subdivision: Celery Lakes, Model: Arlington `K' 4 Bad Rooms, Series: AxericanA.
Street Address
Being: 116 pinefIeld Dave- Sanford FL. 32771. Is contribul
is
to
pa d1U pole
ATl oche
Buyer Witless
01/05/2004 17:20 4073024345 OFFICE DEPOT 613 PAGE 01/03
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