HomeMy WebLinkAbout655 Fucton StC_ Z 11 ti .
t •
e y Permit #
Job Address:
Description of Work:
Historic District:
CITY OF SANFORD PERMIT APPLICATION
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/Alteration Change of Service TFinporary Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Call:. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
I
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 1)
Parcel #:
Owners Name & Address:
Address:
Phone & Fax:
Bonding Company:
Address:
Mortgage Lender:
Address:
Arcldlect/Engincer:
Address:
Attach Proof of Ownership & Legal Description)
Phone: a - 3 t - 3
v
oa
St tc License umber:
i D Contact Person: Phone: iZ
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 separatepermitmustbesecuredforELECTRICALWORK, PLUMBING, SIGNS, WIiL1.S, 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 RESUL•1' IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND -TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER Olt 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 Ileac may be -Wonal permits required from other governmental entities such as water management districts, state agencies, or federal agencies.
Acceptance of permit is if ion that I will notify the owner of the property of the
Prin,05Ag 's Name
Signature f NoW-Slatr}of FI rida Dite
j °', DAF FAME ADCOCK
APPLICATION APPROVED BY:
Special Conditions:
Lien Law, ham/ 13.
tY
of Notary -State 'o rde Da
Ue lt BL:ANTON
0 911 MY C0' ,*W"S10N # DD 180491
cXF iF.C3: February 25, =D7
r/Agcnt•is,Ti,R7 11crsonally,Known to Me.or
uced'ID" --
Zoning: Utilities:
1 tc) (Initial & Date)
A'Z_
FD:
Initial & Date) (Initial & Date)
REGARDING ROOF DRY -IN AND FLASHINGS
INSPECTIONS.
AFFIDAVIT
N0: COMPANY: o LICENSE
SUBDIVISION:
PERMIT NO:
PROJECT INFORMATION
ADDRESS: Io S;1",-T"l .
Z"1
LOT:
I, C tcf4ffiant, hereby affirm that I am the duly licensed contractor of record for the above reference
permit, that all of the foregoing information is true and accurate, and that the dry -in, flashings at the above referenced address/lot has
been installed in accordance with all applicable codes and standards.
CONTRACTOR:
Printed e
Signature)
STATE OF'FLORID (
w
COUNTY OF
S-t
This insttpment was acknowledged before me this day of Zoe (i , by the above referenced
indi id 1, +.. o who ac owledged that heAhe is a duly licensed contractor with
a and who acknowledged that he/she was authorized to exedute this document. He/she is
either to me ti,-- or produced as valid identification.
WITNESS my hand and official seal this day of Z o0
No bH
Printed Name:
V.
My Commission Expires: r&o
POWER Or ATTORNEY
Date: c 1 Db
i
I, Andrew J. (Andy) Adcock do hereby' authorize,U.,
To pull the Reroof permit for
typc of pennit) (addr s)
jgnature
EAFNEY FAYEADCOCKARY PUBLIC. STATE OF FLORIDA•COMM
Expires DEC. 2, 2008 COMM. #
DD376609 Notary'
V 1 ' Stamp r$
onally known me or driver license # , of State of Florida, County of yT
day
of , , 2-G84. Zo
o%
NOTICE OF COMMENCEMENT
1 County of Seminole
Permit No. + Tax Folio No. (PID)
Z--n (
State of Florida
711e 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 address)
NAME AND ADDRESS OF FEE SIMPLE TITLE HOLDER.(IF OTHER TI•lAN OWNER)
1111111 of 111111111111119
CONTRACTOR
Name and address
1111111101111111111111
MARYANNE MORSE, CLERK OF CIRCUIT CtiURT
SEMINOLE COUNTY
I
706
SURETY (Bonding Company) I RECORDED 02/02/2006 09107:32 AM
Name and address RECORDING FEES 10.00
RECIIRDFD AY D Thomas
Amount of Bond
LENDER '
Name and addrew A .! / 7;Z / 2 -S '-
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Persons within the State of Florida designated by Owner upon whom notice or other documents may be served as provided
by Section 713.13(lxa)7., Florida Statutes:
Name and address ;
I
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In addition to himself, Owner designates of
to receive a copy of the Licnor's Notice as
provided in Section 713.13(1)(b), Florida Statutes.
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Expiration Date of Notice of Commencement
t6RFNEY4fn&5 f recording unlec a d' t dates is sr if..i 1
NOTARY PUBLIC, STATE OF FLORIDA
i
MY Comm. Expires DEC. 2, 2006
COMM 0 DD37660 /`S1 c'ofOwncr
4 I_ —
I subsc bed bcfo me this ay of Z coo
3 I I
My Commission Expires: + (Z Z O
N to ub c
zoe (oThefortoineatwasacknowledgedbeforemethisdayof
idcntfiffication
name of person admowlcdgc , who '
me or who has produced I (type of identificatio
and who did / did not take an oath
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