HomeMy WebLinkAbout3999 W 1 St (3)R.
CITY OF SANFORD PERMIT APPLICATION
Permit # : Ob ' I S 3 Date: 2 I z d RECEIVED
Job Address:
Description of Work: i"o JL_AM .=fQ t G
Historic District: h-V . Zoning: pD
Permit Type: Building IC 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
S•iLi LDa LQfZ-1
Value of Work: S - ` 1?00
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
Industrial
Construction Type: # of Stories: # of Dwelling Units:
Parcel #: Zi3' l t '30.542 •VOW-CNy 4 0030
Owners Name & Address:
Plumbing Repair — Residential or Commercial
Total Square Footage: J
2 12006
Flood Zone: (FEMA form required for other than X)
Attach Proof of Ownership & Legal Description)
L- - P,014 I ngr L7r$W4-Q
5k r4ft fZ_Q - E_-L SK7'1/rI Phone: S 7 ) 3Z3 - 11 So
Contractor Name & Address: KAC Y-EE t^,oslo Q.J art& c-tJ -11D kpl Taos 07 > L
Art IL 6 1M D &j 2bE fl, 2Z-741State License Number. 1—'15C- OU '12 Phone &
Fax: Nol • I 23 • Q Contact Person: T)J i t2 fZ0t7D Pbon Bonding
Company: Address:
Mortgage
Leader: Address:
Architect/
Engineer. m+ t'iE C.ZJ Q• Add.:
V00 E• 17104E `ft , 5drfE ZOI . Fax: 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. 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 v ' ca tify the owner of the ro rty of the requirem 1 713. rgnature
of Owner/Agent' / tatel rgnat o Contractor/Agent / at o
Va h J S Q.,4 rbv S nt
Owner/Agent's Name Print Contractor/Agent's Name C
II Z ZI'L)CO Si
ure Date Signature o N 17{ tale o public State of F 0
ipnryablicStateofFloridaIn ' " Cnrist e Lumberry Christi? Lumberry t?
MY Commission DD415176 1:
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My
Commission DD415176 FRA4410fi
So Me or Contract 8 ProducedID
Produced ID EV6
APPLICATIONAPPROVEDBY: Bldg: Zoning: Utilities: Initial &
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Permit Number
PAR
Parcel Identification Number 28' lR •'So • S1Z•pCY.1p •op
Prepared by: •''r'12'000C)-4CY-10 Ct_
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R p FLmto: 32-74-1
NOTICE OF COMMENCEMENT.
State of Rorz4PA
County of 'Qe /A t No L.E
i Ml"I Li. M OF CIRWIT t NT
illll.E CWWY
06073 PG I L 99
RKI S * 2006003405
Wo 01/09/wm 11s02102 FA
WINS H--" 10.00
ft-V BY t holden
16
The undersigned hereby gives notice that improvement(s) 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.
1. Description of property Pagel description of the property, and street address if available)
15E5E 7'i '- I:2:>7- Cam_ c R-4 F-*ri oIV
ZVra \4 • ls[' S-r I SAN3V:'0ff t 32`r l
2. General description of Improvement(s) 1'emu e>fFee F30l Lv 1 t-Ac1
3. Owner information
Name t41AikTC%YL FRjFr--V--rlr=S Telephone Nu (40'1)323-1150
Address `f Woop P,,,,e," Gv/• Fax Number 'j7 323r'130q
SA F'oR-Pc l. 3,2771 Interest in Property: (Dvk3efZ,
4. Fee Simple Title Holder (if other than owner shown above)
Name Telephone Number
Address Fax Number
5. Contractor /Ar-Vjee 6F3-s1 Z.c--r,oN Ca
Name TelephoneNumb 4D'(323. 1 tso Address
Pp • i - 1 6 Fax Number 4C> 323 • 3 L-
hW-C !tie RoE t FL- 37-774'7 Surety (if any) Name
Telephone'Number Address
7 Fax Number Amount
of bond $ 7.
Lender (if,yy) Name
l7f 111 W Rf J Telephone Number C#7'3J0- 3z" Address
3.7 q 1 . l irSIR45r Fax Number q07 - 330 -3 Z6 7 vl"
F;XA, /11:::L 3Z77/ 8.
Persons within the State offlorida designated by Owner upon whom notices or other documents may be served
as provided by §713.13(1 xa)T.. Florida Statutes. Name
Telephone Number Address
Fax Number 9.
In addition to himself or herself. Owner designates the following to receive a copy of the Uenoes Notice as provided
in §713.13(1)(10-Florida Statutes. -- Name
Telephone Amber Address
Fax Number 10.
Expiration date of notice of commencement (the expiration date is one year from the date of recording unless
a different date is specified): 91ZA0_
r Date
Sign SWfieture of Owner dote: per §713.13(1xg).'owner must
sign ...and no one else may be permitted to sign in his
or her stead' mF
Sworn
to and subscribed before me this day of I by o &
f* V-pjaHavrAvus who
is_personally Imown to me OR --produced as
identification. Sig
ture f Notary (notarial to appear below) dp9EPM
N: NICMOM3 REM)
J AN 19 ZC @E °°a""' . Form
F%vWW: 3M ftn"e.liaoo.] . W