HomeMy WebLinkAbout2435 S Elm Ave (6)Permit #:
0 (0' k/
Job Address: Z 4 3 C5
Description of Work:
Historic District:
IV.IW
Zoning:
CITY OF SANFORD PERMIT APPLICATION
Date: _
Value of Work: S
mm
S
3'Z 1 I
Permit Type: Building 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 other than \)
Parcel M
Owners Name & Address:
Name &
Phone & Fax:
Bonding Company:
Address:
Mortgage Lender: .
Address:
Arcldtect/Engincer:
Address:
Attach Proof of owners)p'p & Legal Description)
4 3 5 Sown E_ul n
c
Phone: 4 D —i 67z O C
dress: Y_k_C:) L-o_,c_ f DO -1 NCB iSDO
0./ Q State License Nurnb r:
D 3 Contact Person: 7 i ir 7-tiT O(.ihone:
Phone:
Fax:
r
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: 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.
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 permit.% required from other governmental entities such as water management districts, state agencies, or fcde agencies.
Acceptance of permit is verification that I will notify the owner of the property of the requiremcylof
MY
Special Conditions:
Date +
1 o p
e llZ t 0 !pfFridaVDal
ona v-X71 WMM Me or
ry DEC. 2, 2008
g ssos
s Name
Signature of Notary -State of Florida. Date
0"Cg4DEBB:E BI.ANTON
Contract r/Agcnt.is1_EkcrionPl1yb u4ryvR%19I00a;'
Produvcd.ID ---. -
Utilities: FD:
Datc) -' (Initial & Date) (Initial & Date) (Initial & Date)
e
AFFIDAVIT
REG ING R OLDY-IN AND FLASHING INSPECTIONS
Company: °0 d o License MC L L D ZvS b
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Project Information
Owner: 00 't Permit M
name'
Subdivision: _
addrcss
atiy_1_
L on Lot M
phone
1
I, ffiapt, 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
r .
name
STATE OF FLO$DA
COUNTY OF S. Sly
1
This instrument was acknowledged efore me thi day of by the
above referenced individual; C.o who ackno ledged that he/::he is a
duly licensed contractor with and who acknowledged that
he/she was authorized to execute this document. a/she is eit one y known me or
produced as vali n.
WITNESS my hand and seal this day of
Notary
DAFNEY FAYE ADC CK
NOTARY PUBUC. B7ATE OF FLORIDA
MY Comm. Expires DEC. 2, 20os
COMM.•M DD376609
20 0
of Florida
NOTICE OF COMMENCEME a N q 111 11 M 11 ItGIMt 11M
County of Seminole
Permit No. Tax Folio No. (PID)
The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with (.::iaptcr
713, Florida Statutes, the following information is provided in this Notice of Commencement.
DESCRIPTION OF PROPS TY !,cgal description of the p operty and strc t address)
z 3S In t7-:C yu /P (d„n
GENERAL DESCRIPTION OF IMPROVEMENT
OWNER INFORMATION j ,
43S S.LMNrtc,rtd addre s '1 'e 0. .,i D 0
Interest in property (Fee Simple, Parthcrship, etc.)
NAME AND ADDRESS OF FEE SIMPLE TITLE HOLDER -OF OTI-IE•R T1dAN OWNER)
CONTRACTOR
C D . Name and address Op 1 /U
SURETY (Bonding Company)
Name and address
Amount of Bond
LENDER
Name and address
r**•ss**rr**r*****s*;r**•ss*rrrr**r*rrs***s*s*rrs*s*rrsrs*rs***
CLERf-' OF P1RCk1T CWT
s** *.**
Persons within the State of Florida designated by Owner upon whom notice or other doeudNL1t r6 .16j&cQjd L* •:ded
by Section 713.13(lxa)7., Florida Statutes:
Name and address
sssssssasss**•ss*s**ss**sr**s**s*ssss*s*s*sss*s*sssssssssss*sssssssssasr*ash*sr***rr *err
In addition to himself, Owner designates of
to receive a copy of the Licnor's Noticc w.
provided in Section 713.13(1)(b), Florida Statutes.
ssss*ssssss****sssss******ssss*s*ssss•ss**assass*srsssassss*•sssssssss*sssrsssrsrssrs*rsrs
Vxpi Datc of Notice of Commeaccmcat _
ofrccordinv1tcpircis __ lcca a difiernt date i xY ifir.l
Ntlt Ry p FAYE ADCO
Comm. IJBUC. S7A7E OF Fto IDAMy
Expires DEC. 2, an1COMM. N10;3706Oa I "Signature of Opmcr
Swo to d subs cd bcfor iu his Day of 't9 6
My Comm' ion Expires: f 7/
N to Pub tc
19-
The rc o' ' g g instrument was acknowledged before me this day of b
a ra p-v (name of pc n acknowled w is crsonally
me owho has produced _ _ _ _ _ _ (type of identification) as t cn
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and who did / did not take an oath>
POWER OF ATTORNEY
Date: a UCH
I
1, Andrc-nw J. (Andy) Adcock do hereby authorize
To pull the gerQot permit for t
type of permit) (address)
10,
IVUB
KAYLI ADCOCICL-10. ITATI Q
C.
FLORIDA
2 2M00", 4 DD37Notary \
j Stamp ZeErsognalljjknriver
license # of State of Florida, County of day of
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