HomeMy WebLinkAbout1401 W Seminole Blvd (9)PERMIT APPLICATION �n
Permit # : O -3 Date: 5-r �/ `03
ess:ly0 /✓QST OZ C-- 82 v ! 47VF01eA Fe - 3277/
_: l- of Work: te460r, ,e,�r N - .
Historic District: Zoning:
Permit Type: Building Electrical t" Mechanical Plumbing Fire Sprinkler/Alarm POQI .
Electrical: New Service - # of AMPS Addition/Alteration L/ Change of Service Tempor`lry Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy CaliK� Required)
F...
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 Commercial / Industrial Total Square Footage:
Construction Tyne: —3� # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: (Attach Proof of Ownership & Legal Description)
Owners Name & Address: C L N 1 je. cR G 1 O/volL %W e-
14101 �JFST �C/-ri/VQIC- 01- VD, SEftrFVRb 3.277/ Phone: 4p7 321 �/SOn e,7r /
Contractor Name &'Address: P/9/V EC 12 i C !/VC • _
r ! 3 Pi n/ N 4y,6 1yv1' 4 R-1ifly'rk, 3 4?fZ `I State License Number: DOU f 2 6 ry _
Phone & Fax: (KO 7 / 4'3 e 3 306F 'g0"l2177 Contact Person: ':)/ M G 2 D FF Phone�32 / 22 F • q73/
Bonding Company:
Address
Mortgage Lender:
Address:
Architect/Engineer: 9CN/N5V1t+Ii Eiy6EEe if-I/VG INC-* Phone: O-7 "L�___LL.�d',_
Address: 20/6 41-41-SFN RO4-0 09,-ANbo N. 32dO3 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 public records of
this county, and there may be additional pemrits required from other governmental entities such as water management districts state agencies, or federal agencies.
Acceptance of permit is verification that I -Mll notify the owner of the property of the
N &,,j � 05/13/03
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N Signature of Owner/Agent Date
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i? m Print Owner/Agent's Name
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U.n St, re of otary-State of Florida ate
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3 • U 8 Owner/Agent is X Personal]. Kno%%n to Me or
oN• �0 _ Produced ID
AN'LICAI ION APPROVED BY: Bldg:
tInitial R Date)
Spcxia! Conditions:
Zoning:
es of Floridaen Law
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Contract&�v,
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(Initial &, Date)
Agent
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�YPue`�': Commission4'1
63723
Expires: D, 2005
r°is I'cfs i�����vn to Me or bti.
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(Initial K Date) (Iu;tial &C Dat:
CERTIFIED COP, ---�
(MIS INSTRUMENT PREPARW in, MARYANNE MORSE
MORSE)NAME NOT'I�I✓ OF CONWENCENffi CLERK OF CIRCUIT COURT
Tax Folio No. SEMINOLE COUNTY, FLORIDA
Permit No./tDDR. /�l0 / 1,,Lr=S i S �r't r nio�� r3� UD . •
State of Florida PL
County of Sem_ 3 Z 7 7 I trr (`LERK
20 2003
The 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.
1. Description of property: (legal description
2. General description of improvement:
'M2 & CCS Vf OV-)
3. Owner information
a. Name and address
and street address
e-
zm%Y, car e.
b. Interest in property (Dsl vz.e
c. Name and address of fee simple titleholder (if other than Owner)
�c
4. Contractor
a. Name and address Pte\/
1,5'13 O( /N(�::: iL . 3 2.2f 41
b. Phone number y07) 113.--1306 Fax number yo ;' y 3 - YZ os
C
5. Surety inmullodmail 101i1i01111110 Howls®
a. Name and address
b. Phone number Fax im-z
c. Amount of bond Bit( X14A31 Gr, wr ! R
6. Lender f CLERK'S # 2003085276
a. Name and address QED 05/28/213 118:56:19 Ail
RECORDING FEES 6.08
b. Phone number Fax en
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
a. Name and address \ Q�0. u - I
b. Phone number 4CU-7 � Fax number
8. In addition to himself or herself, towner designates 'b1 o-nc C--Y)la of
C.Q\\,f0-1 FI �uc-\c t.- O%n D . to receive a copy of th ienor's Notice as provided in Section
713.13(1)(b), Florida Statizibs.
a. Phone number *--7 '-2>St I -4-7YZ Fax number �'� -`q 3C: D
9. Expiration date of notice of commencement (the expiration date is 1 year from the date of recording unless a different
date is specified)
'Signature of Owner
Swo to (or affirmed and subscribed before me this /q day of 20 03 , by
Personally Known OR Produced Identification
Type of Identification Produced
,u+r apt"t, Esta L. Orseno
My Commission DD069842
t ature of Notary Public, State of Florida �jd-F Expires January 23 2006
Commission Expires:
1\
PALM A%MERICALM
ELECTRIC INC.W
Contractors & Engineers
Sanford Building / Inspection Department
POWER OF ATTORNEY
May 12, 2003
m
I hereby appoint Kenneth Groff as my attorney in fact to sign my name to the electrical
permit for the power & data work (03110a Robot — Pharmacy) to be performed at 1401
West Seminole Blvd.
Signature of License holder hereby gives Appointee Power of Attorney to sign permit
only:
(Signature of License holder)
STATE OF TENNESSEE
County of Davidson
Personally appeared before me, the undersigned authority, Michael W. Campbell with
whom I have identified, who acknowledged that the foregoing instrument was executed
for the purpose therein contained.
My commission expires: JAnt, 0,6, 200(o
1300 FORT NEGLEY BLVD NASHVILLE, TENNESSEE 37203 P.O. BOX 40786 (37204-0786) 615-242-6336 FAX: 615-256-6155
WEBSITE ADDRESS: http://www.pae-inc.com
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