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HomeMy WebLinkAbout312 W 1 St (6)The undersigned hereby applies for a permit to install the following equipment: Owner's Name: r�V'51eirL /e S> B.eA/iG Address of Job:-rIg jr%C�7 A'I'esT��i2C-C-� /s���oeT ,�/,�-o,2r�� Mechanical Contractor: Residential Non -Residential V'**_ Amount Nature of Work: Z b %PW mil r Job Valuation: Application Fee: $10.00 TOTAL DUE: //b•GP By signing this application, I am stating that t am in compliance with City of Sanford Mechanical Code. -4 e/I t,T.v.✓ i%% iii✓ Applicant Signature State Ucense Number t .•, Il •.Rf \ fy i CITY OF SANFORD MECHANICAL PERMITAPPLICAT10N Permit Number.y /_?VC1/ Date: 6-1?3-0;5 The undersigned hereby applies for a permit to install the following equipment: Owner's Name: r�V'51eirL /e S> B.eA/iG Address of Job:-rIg jr%C�7 A'I'esT��i2C-C-� /s���oeT ,�/,�-o,2r�� Mechanical Contractor: Residential Non -Residential V'**_ Amount Nature of Work: Z b %PW mil r Job Valuation: Application Fee: $10.00 TOTAL DUE: //b•GP By signing this application, I am stating that t am in compliance with City of Sanford Mechanical Code. -4 e/I t,T.v.✓ i%% iii✓ Applicant Signature State Ucense Number 111897 LIMITED POWER OF ATTORNEY Date: GZ3-03 I hereby name and appoint /i/,P Z>/��zyo Of /Ile 4s� G►r �'oj✓>�i✓L ,e�o%� to be my lawful attorney in fact to act for me and apply to .5�.�02a for a /�%i,/�,✓law permit for work to be performed at a location described as: Section Township Range Lot Block Subdivision 0i (Address of Job) and Address) and to sign my name and do all things necessary to this appointment c/a .✓ ev ✓ - dA0,0 416 908 (Type or Prjq name of Certified Contractor and License #) (Signature of Certified Contractor) Acknowledged: Sworn to and subscribed before me this ZY Day of V ,f A.D. OOX Notary Public, State of Florida F KARLA IOOIh11SE (see) 01< wb► �.: jW Na a t My Commission Expires' rz 06/03/2003 TUE 10:10 FAA 1 1U7 acts 527.1 LassiLer-rare insurance IjUUi/UU2 ACdR, -CERTIFICATE OF LIABILITY INSURANCE We (MMIDWYTT7)09/12/2002 PRODUCER (407)629-3441 FAX (407) 539-0619 ` Lassiter -Ware InSuranCe of Orange/Seminole. Inc. PO Box 940159 Maitland, FL 32794-0159 THIS CERTIFICATE 0 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO- RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. _ INSURERS AFFORDING COVERAGE NAIC 0 IN3uREo Air Systems - Central Fla ivision nC DBA: Il Air Systems of Central Florida 830 Cherry St. Winter Park, FL 32799-4611 wsuRERA. FOCI CommerC a Insurance -Co. wmiii te: rens ortat on Insurance Co. ( ) IMEURP.RQ INBURGR0: INSURER L (:V V THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICI I THIS CERTIFICATE MAY DE ISSUCD OR ANY REOUIREMENT. MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEMIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CII 0 P N LOWEM! OF INSWJPQUCYNUMDpjt GENERALLABIITY GL0000860 09/15/2002 09/15/Z003EAGHOCCU s 500,0001 GAMAME TO KERT96i 10010001 rA X ODMMECL GENERAL UASILm MEDEBWryWWPro) 3 'S.0001 CLAMS MADX OCCUR PERSONAL a ADV INJURY s 500,00GENE Add Ins RAL AGGREGATE 3 11000,0001 RB-anket AGGREGATE APPLIES PERPRDDUCTS-CCM190PAOEf E 1.000 OOO pLIIM�yIT OLICY X JI'�CT M LOC AUTOMOBILE LIAELRY X ANY AUTO -7a0-o-09-65 09/15/2002 09/15/2003 COMStIVED SWAE LIMIT 3 ltiioa0.nq $00,00 W11LYII RY S A ALL OWNED AVMS aCHEDULEDAUTOS HIRFO AVITIS NON4YWHED AUTOS BODILY ILS 3 PROPERTY DAMAGE S Iry wwwo GARAGE UASUM AUTO ONLY - EA ACCIDENT 3 oTIIERTItAN EAAtx 3 AUTO ONLY: AGO S AWAITIO NO COVERAGE vzvs III nmu A N auw EACN OCCURREWA 3 AGGREr,ATE 3 OCCUR rj MAW MADE 3 NO COVERAGE 3 DFOUCTISI.E RETENTgN 33 WORKENCOMPVMTIONAND 6MPLOY1Rv Lu1RAM WCZ0541960Z5 09/15/Z002 09/15/2003 X E.L. EACH ACC:IDDIT 100.0001 B OFFICCERfUEMMMM ExU� E.L. OISWE • SOL EMPwYE 11 100 E.LDISEASE- POLICY UMIT 3 S00,000 Sye�� eaorlb�uneer 6PECIAL PROVIs1O m bduw oRIIER NO COVERAGE DESCRIPTION OF OPERATIONS t LOCATIONS / VENICLEB / EI uwcNs ADDED BT DMORBEMENT / SPECIAL PRIMMIGNII Seminole County Building Department 1011 E. 1st Street Sanford. FL 32771 ACORD 26 (2001108) SM MM ANY OF TNB AWN DESCRISED POLICIES BE CANCELLED WWOW TME EEUIIRA710M DA7ETMIERSOP.TW ISSUING INSUMR WILL EMPAVOR TO MAN. DAYS WRITTEN NOTCE TO THE CERNFlCATe HOMR NAMED TO "A LIFT. BUT PARUM TO MAIL SUCH NOTICE SMALL IMPOSE NO OBUGATIGN OR LAW" OF ANY KIND UPON THE INSURER ITS A099M OR REPI161111iTATNEE AVngRIM REPR80ENTATIV1 OACORD CORPORATION 1988 This Instrume Prepared By: Name / C6✓1f?�1l f-LOQ/J/J 3V Address 1ez1AV7WUfz Permit No. Tax Folio No 2S.11- 30 - SAC.- a06- c010 NOTICE OF COMMENCEMENT STATE OF /clot'/!1A COUNTY OF WAYW (ARSE, CLERK OF UNWIT MW SENINOLE alm" HK 04878 PS 10537 CLERK' S -�-+ V VW& REMRDED U/24/M ISMA4 AN REMNINS FEES LOS REGARDED 8Y N M YerVc s Use Only 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 of property, and street address if available) 2. General description of improvement: Ra-nc.f c -r CZ� /O �� �o�r7P *C, �3. Owner information: a. N me and address: , � Ci ,f-tL&,*IWSr-i HRST 7WL4 Broca SIZ N IST _V-. M02031 b. Interest in property: c. Name and address of fee simple titleholder (if other than owner): JUN 2 4 2001 4. Contractor: (Name and address) /;/,Q _<y '1Z , L J 30 l�,2� ST1G'�'>� /f�l �.���! — 'a'� s. surety Ctftl'WED C©�Y a. Name and address: MARYANNE MORSE CLERK OF CIRCUIT COU" b. Amount of bond S SEWnHpLE COUNTY. FLORIDA 6. Lender: (name and address) Kptt.ry CLERK 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: (name and address) 8. In addition to himself, Owner designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes: (name and address) 9. Expiration date of notice of commencement (the expiration date is 1 year from the date of recording unless a different date is specified) 5.wo_mt¢p(�, and su cribed before me by / zcjl�a 1.17-eaT who is personally known to me m viedueed- as identification, and who did V.I— take an oath, this ,,day of Signature of Nota c-c.tc-- Printed name of NotaryQ19 XPJA'5lf5 Commission NoJWiramn e SEAL: *Vd* My Commission CC9=77 -I M,•.•r' Expires June 23, 2004 �O cxke�, - , (Signature of Owner) Owners Name JKt,-WL C- Gc TL 10 Owners Address 312 IJ Is` C Seta 3Z17 ALL INFORMATION MUST BE TYPED OR PRINTED LEGIBLY TO COMPLY WITH RECORDING REQUIREMENTS Page 53