HomeMy WebLinkAbout1303 Persimmon AveCITY OF SANFORD PERMIT APPLICATION
Permit #
Job Address: 3 D t StttOM
Description of Work: 'e! ^ to
Historic District: Zoning:
Permit Type: Building Electrical
Electrical: New Service — # of AMPS
Mechanical: Residential Non -Residential
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential Commercial
Construction Type: # of Stories:
Date:
S
Value of Work:
06'
t
000-6D
Mechanical Plumbing Fire Sprinkler/Alarm Pool
Addition/Alteration Change of Service Temporary Pole
Replacement New (Duct Layout & Energy Calc. Required)
of Water & Sewer Lines # of Gas Lines
Plumbing Repair — Residential or Commercial
Industrial Total Square Footage.
of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel M %% (Attach Proof of Ownership & Legal Description)
Owners Name & Add ess: k4 q— i tr o Ili
03 L 39nione,
Contractor Name & Address: 1 t 4r1 O V %i OK 700 WOO 1 Flo
TiINsOKIT 1tIM45 Fp4' 327,0_ JN Slate License Numbe : CSC
Phone &Fax: 'T¢ Yy 1 a7— 6X C ntact Person`—wArk 4- t•e Phone:
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer: Phone:
Address: Fax:
Application is hereby made to obtain a pennit 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. I 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.
OTI E: 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 t is verification ilia 1 will not* the owner of the property of the requi ents of en Law, FS 713.
c
IS, wn g Date Signature of Contractor/Agent Date
QAAI-! L G(r ' e-
Prinnt'
a-
s Name Pt o ct Agent's Name
Signature of ary-State of Florida Date SignaturepLNotaryeS on a Date 11
gIE BLANTON Owner/
Agent is ` Personally Known to Me or Produced
Mir — APPLICATION
APPROVED BY: B Zoning: VVVVV (
Initial ate) _ _ _ (Initial & Dale) Special
Conditions: Notary
Public - State Of FlOflaa My
Commission Expires Jon A 2007 Cornmbsion
f DDI56630 Bonded
By National Notary Assn. t7E9
t +
SION # DD 188491 F.:.:
iF'._?•: Fabrucry 25, 2C07 Agent
is P _ t-/to.Wn.to.Me`o ccd•
IU"'r Utilities:
FD: Initial &
Date) (Initial & Date) d
AFFIDAVIT
REGARDING ROOF DRY -IN AND FLASHING INSPECTIONS
Company: &t/k aKApq Irio al&,License #:C6 7 T
7d A,,. //.-e
F t'7 t•ts,c l'r SDr :ti s 7d1
Project Information
Owner: t[6tt y- vyrz' /fV Tit /ytv Permit #:
name
uo3 Jcryt'&,~K Atte `40A0 Subdivision:
address
Y#7- `llS- S33 o Lot #:
phone
I, eqed4 eg'ft-&VA , 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:
I
signature
printed name
STATE OF FLORID
COUNTY OF
This instrument was acknowledged before me this day of , 20 the
above referenced individual A l/ I , who ackn lodged that he/she is a
duly licensed contractor with , and w o_ackno ededgeed that
he/she was authorized to execute this document. He/she is ' lrer peLGonally known tower'
produced as val-MiTen iTicatlon.
WITNESS my hand and seal this day of , 2001,o
Notary Public
r BLANTON
T"+^: Z 4# DD188491
ooruary25,207
iDlc:auMA.00c.C..
THIS INSTRUMENT PREPARED BY:
r.L.. .
NAME MARYMW MORSEL CLERK OF CIRCUIT COURT
700 ! NOTICE OF COMMENCEMENT SEMINDME COUNTY
ADDR. so • BK 06066 FFG 0164
Permit No_ A Tax fbl oW S 0 ZOID6000409
State of Florida ">~'T RECORDED
County of Seminole RECORDING FEES 10.00
RECORDED BY L McKinley
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 addres if available) 2.
General description of improvement: 3.
Owner information a.
Name and address ' 94 V14e, b.
Interest in property /0017g) c.
Name and address of fee simple titleholder (if other than Owner) 4.
Contractor a.
Name and address 700
ors r b.
Phone number Surety
a.
Name and address b.
Phone number _ c.
Amount of bond 6.
Lender a.
Name and address MiIFIED"
COPY, MARYANNE
MORSE Fax
number -CLERK OF QIRCUIT COURT b.
Phone number Fax number . - 7.
Persons within the State of Florida designated by Owner upon whom notices or other documents ma ' ed 6 provided
by Section 713.13(1)(a)7., Florida Statutes: F a.
Name and address b.
Phone number Fax nu ber 8.
In addition to himself or herself, Owner designates of 713.
13(1)(b), Florida Statutes. to
receive a copy of the Lienor's Notice as provided in Section a.
Phone number Fax number 9.
Expiration date of notice of commencement (the expiration date is 1 year from the -dateof recording tdifferk dateisspecified) r
Signature
of O er S
sr to r a ed)) a-n.dsubscribed before me this _ day of _, 20 iD 6 , by Personally
Known OR Produced Identification Type
of Identification Produced Commission
Expires: 1
arrP ei;•., tc- Puh"tC !!r e•
OF borNod3y hlut i F",`