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Home My WebLink About1115 W 12 St (4)Parcel #: /+ (Attach Proof of Ownership & Legal Description) Owners Name & Address: � e Mtlwl l- G very Ck-,cf.� nI�_� Phone: Contractor Name & Address: 1 1>AW h -)70A R-Q� _ /r State License Number: Phone & Fax: d 0% Contact Person: t _ LriA Ce!AicArS Phone: Bonding Company: Address: Mortgage Lender: Address: Architect/Engineer: Address: 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. 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 permit is verification that 1 will notify the owner of the property of the requirements of FI ida Lie w, FS 713. Signature of Owner/Agent Date Signature of Contractor/Agent Date CHr;&wL, Aela.-As Print Owner/Agent's Name Print C r'Agen ' ame Signature of Notary -State of Florida Date Signature of Notary -State of FI Date, Owner/Agent is _ Personally Known to Me or Contractor/Agent is Personally Known to or _ Produced ID DAV/ / Produced ID M U' -52A—: 4fn Bldg: ` Zoning: (Initial & I te) APPLICATION APPROVED BY Spccial Conditions: Utilities: FD: (Initial & Date) (Initial & Date) (Initial & Date) r n jJ CITY OF SANFORD PERMIT APPLICATION Permit N: 0� Date: �I7/% - `` Job Address: T W Description of Work: NffloltSL S Fy- Historic District: Zoning: Value of Work: $ 1000 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 I # 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 X) Parcel #: /+ (Attach Proof of Ownership & Legal Description) Owners Name & Address: � e Mtlwl l- G very Ck-,cf.� nI�_� Phone: Contractor Name & Address: 1 1>AW h -)70A R-Q� _ /r State License Number: Phone & Fax: d 0% Contact Person: t _ LriA Ce!AicArS Phone: Bonding Company: Address: Mortgage Lender: Address: Architect/Engineer: Address: 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. 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 permit is verification that 1 will notify the owner of the property of the requirements of FI ida Lie w, FS 713. Signature of Owner/Agent Date Signature of Contractor/Agent Date CHr;&wL, Aela.-As Print Owner/Agent's Name Print C r'Agen ' ame Signature of Notary -State of Florida Date Signature of Notary -State of FI Date, Owner/Agent is _ Personally Known to Me or Contractor/Agent is Personally Known to or _ Produced ID DAV/ / Produced ID M U' -52A—: 4fn Bldg: ` Zoning: (Initial & I te) APPLICATION APPROVED BY Spccial Conditions: Utilities: FD: (Initial & Date) (Initial & Date) (Initial & Date) Release and Hold Harmless Letter of Authorization to Participate in the Seminole County Community Development Block Grant DemolitionlClearance Program SEM114OLE COUNTY GOVERNMENT PHONE.. (407) 665.7384 PLANKING AND DEVELOPMENT DEPARTMENT FAX: r(407) 666.7366 1101 EAST FIRST STREET DATE: 03121103 SANFORD, FL 32771 We, New Mount Calvary Church and Ricky Scott (name) Who reside at P) Box 1827 Sanford FL 32771 (address) Do hereby authorize Seminole County and its authorized employees and agents, to enter upon and demolish and .clear -structures -and -debris .frorw4he following. property: Parcel ID# 26--1SI-30-5AH-000.0 gm Len E 226.6 FT o f Lot 4 Robinson Sun= of an Addition to Sanford (legal deso.Aption of property), further described as Single-Farnily Single—Familyunit atil15 W 1 S1L Sanford, FL 32771 (street address) We represent that we are the legal owner(s) and hold title of the foregoing property and 'hat we have full authority and right to grant the permission given by this document. We also recognize and agree that funding for this program is entirely granted by the Community Block Grant (CDBG) and that We will release, indemnity and hold harmless Seminole County, the Board of County Commissioners, Officers, employees, and agents from and against E,ny and all liability, claims for personal injury or death, and loss or damage to any property of aly kind whatsoever arising out of or in any way connected with the permission given by this docurr ent. WITNESS: ig ed, sealed and delivered in our resence_ t Sig un: (Own@r—" Sig tore (Owner) DAIS& KI&MONFS w Print Nam naiure (viiiine Signature (Witness) Lehr, - Print , -Print m Print Name Si �y Signature (Witness) Print N e Print Name State of Florida, Seminole County The forego insVme t ac Howled ed before m Tis da of ' 3, by r Jcof� a�FJ a ,Name), o e Hall known to m or who p oduced (type of identification) as iden ification and who (did) (did not) take an oath. 7 (Si�nd) �W;eo ubic, in and for the County aSf Florida (So.31). RUBY N. MAKE c Nobry Public - strte of F.1ootla VVC- rriWM F*% Nov 14'2M5 '��' Commission st p) 471903 90nded By Nacional notary Aar,, AuthorizmAomsll l 15W12StCNVWVCWChL.elterofAvthcriz8tionForm9.doo 16 DEMOLITION Building Division Acknowledgement A. Permit Application B. State Forms C. State Statutes/Contractor Licensing Public Works Acknowledgement A. Sidewalk Closing B. Street Use/Closing 1. Walkways — Protection — Width 2. Barricades — Protection — Width 3. Fencing — Protection — Width - Height 4. Curb Protection/Sidewalk Protection/Street 5.. Storm Sewer Protection.. .C. -.Dust Control Police Department Acknowledgement A: Traffic. Control. . . B. Crowd'Control/Security Utility Department Acknowledgement A. Water, Sewer — Capped off, Sealed B. Water for Dust Control (Meter) Engineering & Planning Acknowledgement A. Historic District B. Zoning Issues Address of Job: Additional Comments: C<. 7-17-203 11:37AM FROM DEMOLITION Building Division Acknowledgensent A. Permit Application H. State Forms C. State Statutes/Contractor Licensing Public Works Acknowledgement A. Sidewalk Closing A. Street Use/Closing 1. Walkways — Protection — Width 2 Barricades -- Protection — Width 3. Fencing — Proteexion — Width - Height 4. Curb ProteCtion/Sidewi~lk Protection/Sti'm 5. Storm Saver Protection, C.: Dust CoattoF . , :... . • • .. ,: • .:. _ � . Police Departrneng Acknowledgement A, 7raffie.Control B. Crovi►d CottiroVSecuritSr . Utility Department Acknowledgement A. Water. Sewer Capped o$ Sewed B. Water for Dust Control (Meter) Engineering & Pian>aing Acknowkdgemeot A. Historic District B Zoning lsa= Address of Job: _ 111 _ �d L.L.+.,._..- --� Additional Comments' Post4 r Fax NOW 7671 TO 39dd ad Qa0dNVS W- I OPGZZOEL0d 9080 E00Z/8T/L0 DEMOLITION -Building Division Acknowledgement. A. Permit Application B. State Forms C. State Statutes/Contractor Licensing Public Works Acknowledgement A. Sidewalk Closing B. Street Use/Closing 1. Walkways — Protection — Width 2. Barricades — Protection — Width 3. Fencing — Protection — Width - Height 4. Curb Protection/Sidewalk Protection/Street 5.. Storm Sewer Protection. _ .,C..'Dust Control— Police ontrol Police Department Acknowledgement A: Traffic.. Control B. Crowd 'Coritrol/Security Utility Department Acknowledgement A. Water, Sewer — Capped off, Sealed B. Water for Dust Control (Meter) Engineering & Planning Acknowledgement A. Historic District B. Zoning Issues Address of Job: l I 1 r'— Zitional Comments: Y� I b n Ue 71 Xx163—vt'jo, � Cr�v� \,,, �1 d•.e ed1 �-v cc -p op— rt S S 4S - "a(paa 1 (0 2 o d -c, a �-_ �� 100-t�L.5� C DEMOLITION ` -Building Division Acknowledgement A. Permit Application B. State Forms C. State Statutes/Contractor Licensing Public Works Ac4nowledg ement Len A. Sidewalk Closing ' B. Street Use/Closing 1. Walkways — Protection — Width 2. Barricades — Protection — Width 3. Fencing — Protection — Width - Height 4. Curb Protection/Sidewalk Protection/Street 5.. Storm Sewer Protection, C. -.Dust Control Police Department Acknowledgement A: Traffic. Control :. . B. Crowd 'Coritrol/Security : Utility Department Acknowledgement A. Water, Sewer — Capped off, Sealed B. Water for Dust Control (Meter) Engineering & Planning Acknowledgement A. Historic District B. Zoning Issues Address of Job: 1 I' Additional Comments: DEMOLITION ` Building Division Acknowledgement A. Permit Application B. State Forms C. State Statutes/Contractor Licensing Public Works Acknowledgement A. Sidewalk Closing ' B. Street Use/Closing 1. Walkways — Protection — Width 2. Barricades — Protection — Width 3. Fencing — Protection — Width - Height 4. Curb Protection/Sidewalk Protection/Street 5.. Storm Sower Protection. ' :C. �.Dust.GontroP. Police Department Acknowledgement A: Traffic. Control. B. Crowd Control/Security Utility Department Acknowledgement A. Water, Sewer — Capped off, Sealed B. Water for Dust Control (Meter) Engineering & Planning Acknowledgement A. Historic District B. Zoning Issues Address of Job: Additional Comments: