HomeMy WebLinkAbout505 E 3 St (2)CITY OF SANFORD PERMIT APPLICATION
Permit 9
Job Address: _
Description of Work: r "
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
n
Value of Work: S_t, -Sbc) 6
Mechanical Plumbing Fire Sprinkler/Alarm Pool
Addition/Alteration Change of Service Temporary Pole _
Replacement New (Duct Layout & Energy Calc. Reqyired)
of Water & Sewer Lines # of Gas Lines
Plumbing Repair - Residential or Commercial
Industrial Total Square Footage:
T
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #:
Owners Name & Address:
Contractor Name & Address:
Phone & Fax:
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
Attach Proof of Ownership & Legal Description)
Phone:
State License Number:
Contact Person: Phone:
Phone:
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. I understand that a separate
permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, and
AIR CONDITIONERS, etc.
I
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.
N TI : to 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 their may be additional permits required from other governmental entities such as water management districts, stale agencies, or federal agencies.
Acceptanc pe is verification that ill tify the wner of the property of the requirements of Florida Lien Law, FS "713.
Signature of o , /A Date Signature of Contractor/Agent Date
Print Ow r en ' Name Pnnt Contractor/Agent's Name
Signature of Nolt,a StsIe Date Signature of Notary -State of Florida
u _Nv
t ^` • 6r o y CCtrtl1i15510N It DD 1642BO
i vemoer 2,,t006EXPINES'+a ryker
Date
ent i, nA'.Lrh &kri li$ riown to Me r Contractor/Agent is _ Personally Known to Me or
roduced ID L _ Produced ID
APPLICATION APPROVED BY: Bldg: Zoning: Utilities: FD:
Initial ) (Initial & Date) (Initial &Date) (Initial & Date)
Special Conditions:
I Iasi :a+:auasirwu i iiW IQiU191Y tfii l7
THIS INSTRUMENT PREPARED BY: HARVOWMRSE,11ERK UF CIRWIT COIW
NAM iE j , ICE OF COMMENCEMENT SENIM)LE LUWY
Pcwnilit NDDR. Tax fftki'o.' S 0 20(-910509
State of Florida - pR ,
County of Seminole T REC()F;DINb FEES 10. G0 '
1 s F19
R1cDl W- DY t holdrm
The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with
Chapter 7i 3, Florida Statutes, the following information is provided in this Notice of Commencement.
Description of property: (legal description of the pto rty and street address if available)
r. 3
D General description of improvement:
3. Owner information
a. Name and address Qt`
b. Interest in property tJ —
J c. Name and address of fee simple titleholder (if other than Owner)
I
4.
S.
6.
Contractor
a. Name and address
b. Phone number _
Surety
a. Name and address
b. Phone number _
c. Amount of bond
Lender
a. Name and address
Fax number
Fax number
b. Phone number Fax number
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:
a. Name and address
b. Phone number
8. In addition to himself or herself, Owner designates
Fax number
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 date of
recor7'
s a different
date is specified)
ignature Owner
wom to (or affirmed )`an ubscribed before me this _ day of Yti , 20 O 1p , by
KY o copy
Personally Known OR Produced Identification MARYANNE MORSE
Type of Identification Produced zZ ta,,, F C R U T CGURCLERK
p • 1Y fl0 OA
SEMI t
E GI.F+R
Lure o c, of Florida
Commission Expires: Ci F AAFGRANIF 20 20
Y C0MhIIS510N # DD 1642V
EXPIRES No aTber 12, 200b
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