HomeMy WebLinkAbout173 Wildwood Drr;
CITY OF SANFORD PERMIT APPLICATION
Permit # : 06- 1 ci, C Date:
Job Address: 1-7-3 2=? a
nn
Description of Work: pC - Qot'tx - lA /c In r vG Ie 5
Historic District: N Zoning: Value of Work: $ G?
Permit Type: Building X 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 Commercial Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for otber than X)
Parcel #: 10 - Z D - -?D - 5 O'L- Q 0 (Attach Proof of Ownersbip & Legal Description)
e
Owners Name & Address: 1 1 y1 P fyo, tn o ! eS Contractor Name &
Address: Phone: State
License
Number: Pbooe&Fax: -
3t3-41 8> ContaccttPerrson: (40i-]-3Q-4116%44'* Pbooe: Boodiog Company:
N i Address: Mortgage
Lender: % !
nr Address: Architect/
Eogineer:
NIA. Pbooe: Address: Fa::
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 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. 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 1 will notify the owner of the property of the requirements of Florida Lien Law, FS 713. o \I
t;yJot, A 1- 23 -a4, Pre -of
Owner/Agent Date Sig ure of Contractor/Agent Date Print Owner/
Agent's Name f Print Contractor/Agent's Name a=& d
241&.2 L--97-0 S&nature
of Notary-Sta ofFlorida Date Owner/Agent
is Personall own to Me j L/ Produced
ID)'?{x% ':53-''7V-0 S61hature orNotaiy-
StateOrFlorida Date Contractor/Agent
is personally Known to Me or Produced ID
APPLICATION APPROVED
BY: Bldg: O( 10/) Zoning: Utilities: FD: Initial & Date) (
Initial & Date) (Initial & Date) (Initial & Date) Special Conditions:
I JOHNSON MY COMMISSION #
DD493N2 MY COMMISSION # 004938M EXPIRES: Nov.
27,21109 ?orEXPIRES: Nov. 27.
2t1o9 4o7 ="160 Rwws
NOSY sw*mwm (407, 3960163 FlOAdt Nowt' Sovlmawn q#
AFFIDAVIT
REGARDING ROOF DRY -IN AND FLASHING INSPECTIONS
Company: 1 t` 1S Nfk ILa 5\_ License #: X CE D /
Project Information
Owner: Dn1 Y1P.1(VG QLI6 Permit #:
name
1-13 to Id1A_)on& brSan6t address
phone
Subdivision:)
6le, WOOOL Lot #: 31
I, /4l/ ,
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: ' signature
printed
name
STATE OF
FLORIDA COUNTY OF _
hM_, Q&) This instrument
was acknowledged before me this day of , 20 , by the above referenced
individual, F_Sl [1_ , who acknowledgeIt is a duly licensed
contractor with , 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 , 2006. 17 F,
407)
3WQ153JANICEL
JOHNSON MY COMMISSION
N DD493802 EXPIRES: Nov.
27,2W9 FWkI8 Notary
SWVI" C0m
AGENT LETTER TO REGISTER, SIGN, AND PICKUP
PERMIT FORM
James R. Hill Qualifier's Name
CCC 055587 Certificate Number
Hills Metal Roof Systems Company Name
890 Carter Rd., Suite 120 Address
Winter Garden, FL 34787 City, State & Zip Code
I, hereby authorize the City of Sanford Building Department to issue permits in the name
of Hills Metal Roof Systems and for David Mercer to act on my behalf to register, sign
permits, pick up permits, and call inspections for my company.
I, certify that the above person, is employed by the firm and I understand that I am fully
responsible and liable for all acts performed under said permits.
je
61 Signature of Qualifier) Date
111
Signature of Authorized Agent)
State of Florida County of Orange
2 - 61- (;
Date
Subscribed and sworn to. before me, this _day, of t , 200.
Notary Public
Janice L. i6iffinson
My Commission expires 11-27-09
SEAL
la*'N JANICE L JOHNSON
MY COMMISSION A DD493602
0lF p EXPIRES: Nov.27.2009
407) 39"153 FWMe Nobly Swim corn
NOTICE OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION
PgRC-Ei.1D
PERMIT
STATE OF FLORIDA:
COUNTY OF :
SEA oc.
THE UNDERSIGNED hereby gives notice that improvements 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.
YI ilUh-il:, CLE!a W CIKUIT (-M-t
IIM)LE C[Miiilf
06113 Pg 17721 tlpg)
E RK v S 4 2W60 2f ib, + WWED
02I09/E006 12204:5 UNDING
FIEtS 10.00 limiI;
D NY H Bailey 1.
Legal description of property and streettaddress: I -67 ;Q> 23 Pas -
7 4- 'k, `. 2.
Description of improvement: Re - Rou -P col s k rct Ie5 3.
Owner(s) name and address: Ni i Interest
in property: ckzocc Name
and address of fee simple titleholder: V4
ontr as name and address: 0
0
5.
Surety: (Payment bond required by owner from contractor, if any) i, tPs r 4^ e Name
and address: Amount
of bond $ 6.
Lender's name and address: W.
7.
Persons within the state of Florida designated by Owner upon whom notices or other documents may be served as provided
by Section 713.13(1)(a)7., Florida Statutes, Name
and address: 8.
In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in
Section 713.13(1)(b), Florida Statutes. Name
and address: 9.
Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a different
date is specified) gTtureof
Owner Print Owner'
s Name-/ e Sworn to
and subscribed before me this 7 day of , 20 t2(,-. Notary Pu
Print Nota
Prepared by :.
Dw-c> Address: 3Z'.
7
My
commission
expires: % L27-0q 123.01-
52 PAGE 4 8/02 EXPIRES: Nw.
27.2009 FI«ias
Nowy Swvloacom