HomeMy WebLinkAbout810 Escambia DrCITY OF SANFORD PERMIT APPLICATION
Permit #
Job Address: Sit) _-
Description of Work: t2e_epO _Lt
Iistoric District: Zoni
1G,Sa ,2c-,,A, A4
S
Date:
A
Value of Work: $
5(IZ
7
mmo
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 Comtercial Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than x)
Parcel M
J1 G (
Attach Proof ofOwnership & Lo escriptiou) O
rs Name & t\ddress: : t(,O L't,VL-V%, , 0 ( 0 S C Am ",,l /a— r y
t.I, Phonc: Y 0 3 LZ — I Contractor
Na&! & J rD G OO -g O— Phone &
Fax: ' Bonding
Company: Address:
Mortgage
Lender: Address:
Architect/)
ngincer: Address:
State
License Number: E C- L D Z Z1::,p 1 / Contact
Person: (-," Ans 7 CaLDG Phone: T 3 ZZ S 2S 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. 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.publie 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 I will notify the owner of the property of the L_
D6 ignature
of Owner/Agent Date Print
O 1 er/ it's Nay ' KJ
Si
nalr re of ary-Statdio Flo -ida ate Owner/
Agent is _ Personally Known to Me or. Produced
ID Special
Y.
YE A t( B
TATE- rr
MY Comm, Expires D RA.
Ee"", COMM. # DD37 litrons:
Zoning:
of
F)diri'da IL.en Law, FS s
Name Signature
of Notary -State of Florida. Date Contractor/
Agent is Produced
ID Utilities:
Initial &
Date) Personally
Known to Me or Al
FD:
Initial &
Date) (Initial & Date) a
goo, -.-a
State of Florida
1D r 0 Permit No.
NOTICE OF COMMIINCFMENT
County of Seminole
Tax Folio No. (PID)
3Z"1 "j 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 PROPERTY (Legal description of the perty an street address)
O 1 C) CS C U- v v t c `J . Q v J-a r
GENERAL DESCRIPTION OF IMPROVEMENT -f<P Koo
OWNER INFORMATION
pNcandadcss2C'' e-x tti O 10 c'- Q
Interest in pro rty (Fee Siml4lc, Partnership, etc.) `a t,-->
NAME AND ADDRESS OF FEE SIMPLE TITLE IiOLDER-GF OTI-IER THAN OWNER)
CCONTRACTOR n
N dad ss t 0 r N
SURETY (Bonding Company)
1 '1`t1 'fWlkt L1i uiii. RT Ok Nameandaddress ,`, " Amount
of Bond _ k 1 113 Pit; 111"t tlpg) LENDER
1f4Qyjlh,
tl l 9t8:`ith tev4La+t. 1 Name
and address REUMOB FWi M 00 R1_
D:IR1i - 1 LAY H Bailey Pcrsops
within the Statc of Florida designated by Owner upon whom notice or other documents maybe served as pro-, idcd by
Section 713.13(lxa)7., Florida Statutes: Name
and address In
addition to• himself, Owner designates of pQ to
receive a copy of the Lienor's Notice x O IR provided
in Section 713.13(1)(b), Florida Statutes.', Expiration
Date of Notice of Commencement ptration
n atet tc of recording Iccc a ctiffcmnt date i m cr if,t,l 7A RY
EY PUBLIC, STATENOTARY
OF FLORIDAMYComm.
Expires DEC. 2, 2 corm. # CI378609
Signature of Owner Swo t
and ubs cd bcfo c this Day of e fig- aoo p 0 00My
Commiss
on Expires: Z u Notary bli
The f
rc oing mstruracnit was acknowledged before me this day of lO 1-9 ic name
of
on acknowledg o is perkno ; m to me or
who has produced (type of dcntilication and who
did / did not take an oath>
POWER OF ATTORNEY
Date: vZ Cp 0 Lp
I, _Clnslrs.NAdcocl< do hereby authorizeU To
pull the R e r o o f permit for S ( 0 S C a'v,,- t o IJ type
of permit) (add ess) Signa
o.... •;,,,,
DAFNEY
FAY NOTgpypDE11C3TATEOFFIOIDE ADCOCK
MYComm.R3X
A
Co EII
IVI plresDEC. 2, 20p8 DD376609 NotaStamp
ersonally k
wn to or driver license # , of State of Florida, County of day of
P)p i694 zv Lv
AFFIDAVIT
REG ING ROOF DRY- N AND FLASHING INSPECTIONS
Company: oC G o License #: C C L 0
Project Information
Owner: Permit #:
name
4 address
3vi
011 3Z , C Z
phone
Subdivision:
Lot #:
i C_v Gt4 affiant, hereby affirm that I am the duly licensed
contractor of record for the above referenced permit, that all the foregoing information s true
and accurate, and that the dry -in, flashings at the above referenced address or lot has been
installed in accordance with the applicable co s and standards.
Contractor:
signature
name
STATE OF FLOR A
I _
COUNTY OF
This instrument was acknowledged before me this day of b O'jby the
above referenced individual, o , who ac owledged that 1e/she is a
duly licensed contractor with S`t a oZc, cknowl ;Aged that he/
she was authorized to execute this documen . H /she is e' e-r personal o me or produced
as valid identi ica io . WITNESS
my hand and seal this day of DAFNEY
FAYE ADCOCK i'
1A NOTARY PUBLIC, STATE OF FLORIDA j
MY Comm. Expires DEC. 2, 2008 pirp,
COMM. # DD376609