1506 Historic Goldsboro Blvd 09-366Application p
Job address
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CITY OF SANFORD PERMIT APPLICATION
Submittal Date:
k11 •ValueoflYork:S ff,`5 Ton
Parcel ID: Zoning: Historic District:
Description of Work: Square Square Footage:
.......................................................................................... ...............................
Permit Type: Building ❑ Electrical ❑ Mechanical ❑ Plumbing ❑ Fire Sprinkler /Alamt ❑ Pool ❑ Sign ❑
Electrical: New Service - r of AMPS AdditioniAlteration ❑ Change of Service ❑ Temporary- Pole ❑
Mechanical: Residential ❑ Non- Residential ❑ Replacement ❑ New ❑ (Duct Layout & Energy Calc. Required)
Plumbing' New Commercial:# of Fixtures K of Water & Seiner Lines 9 of Gas Lines
Plumbing(New Residential: n of Water Closets
Occupancy Type: Residential ❑ Commercial ❑ Industrial ❑
Plumbing Repair - Residential ❑ Commercial ❑
Occupancy Use Group(s):
;Construction Type. • . • • • nn. -.. It of Stories: - -... • • # of Dwelling. Units: • - • -. -Flood Zone : /. ��((]J • • form required) • • • • • ... .
/(Property Owner: /:-1 7:27. l� de, • •Contractor: • ?n �tXl/ _t __ !"
Address: % r V •3 Oil c -w3 c" Address: /-,)6 t- C
Phone: cT ``] Fzmail 1�- - ] 7 V • c 1 Phone:WZ7'- 33c -'C) /Mate License Number: C C. 1 1.1
Bonding Company: Mortgage Lender
Address:
Architect/Engineer:
Address:
Plan Review Contact Person:
Address:
Phone: Fax:
Phone:
Fax:
E -mail:
Application is hereby made to obtain a pemut to do the work and installations as indicated. I certify that no Fork 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. I[EATERS. TANKS, and
AIR CONDITIONERS. etc.
0%"i`4EK'S AFFIDAVfr: I certity that all of the foregoing intormation is accurate and that all work will be done in compliance with all applicable lags regulaung
consnucuon and zoning.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE.
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR
NOTICE OF COIvtMENCENfENT.
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 cotmty, 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 requirements of M Florida Lien Law-. FS 713.
4 .
Signature of Owner /Agent Date Sifriature of Contractor,'Ageni %— Date
/0 .
Print Owner /Agent's Name
1
gtj aturc of Notary-State of Florida Date
rr{7hFeor 2�
DEBBIE BLANT
O OMY COMMISSION # DD62
EXPIRES: February 25. _
oF O,,ner /A "e0 _,NOT erso. a
Produced ID
APPROVALS: ZONING:
Special Conditions:
Rev 0 7.0 7
UTIL: FD:
Print Contractor /Agent's Name
Signaiture of Notary -State of Florida Date
e F�f NIY COMMISSION DD629096
EXPIRES: February 25, 2011
H. Notary Discount Assoc. Co. N
1- 1301 -3- NOTARY �,£°�
Contractor/Agen 's' "``[rc:isb'iialiy MOw'n o�vife 0'o -`
Produced ID n) L==! d-� ` J O
ENG: BLDG: l
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Permit No. �
Tax Folio No. THIS IK`f RIR0'q,i l'1{ p[0,EU By-
NOTICE OF COMMENCEMENT -
NAME +
State of Florida ADDR.
County of Seminole Q 5 j--ce v�_
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 the property, and street address if available) f 5'0(r tl,.,l j
2. General description of improvement: i\ e', i---% (D
3. Owner information: Name: C
Address: i u `t
b. Interest in property: c- .�
c. Name and address of fee simple titleholder (if other than Owner): Name:
Address:
a4
NOV 12
r/.,
CERTIPED Co
'K 0, CIICtJIT I
CO ti1Y, r
C,
4. Contractor Name: RD n -t 1--0 r1 C1 S r -«_ n Phone number:
)c- Address: , i D- na o L'
S. Surety Name
-rl. t/ /n n /�i n ��► tt ttt� 1 l�Mf
Address:
b. Amount of bond: $ 1Fi13Yl11VIl+F PIl1Htil:, 0_1_111K Ili: 1314,t4 f l;tibll i-
6. Lender: Name:
Address:
ON OV091 b. Lender's phone number: CLERW l # ;-, )i 81)� ' r,
7.a. Persons within the State of Florida designated by Owner upon whom noticesl � c'c cat t �r� j.y`b '� &ed as
provided by Section 713.13(1)(a)7., Florida Statutes: Name:
Address: 1'r! € }! "t' !1 ily y ur j
8.a. In addition to himself or herself, Owner designates of to receive a copy of the
Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes.
b. Phone number of person or entity designated by owner:
9. Expiration date of notice of commencement (the expiration date is 1 year from the date of recording unless a different
date is specified)
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE E)TIRATION OF THE
NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I,
SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB
SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF
or Owner's Authorized Officer/Director/Partner/Manager
Signatory's Title/Office
The foregoing instrument was acknowledged before me this day of , (year) , by (name of person) as (type of
authority, ... e.g. officer, trustee, attorney in fact) for (name of party on behalf of whom instrtuneut wasrVecuted) .
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LH.1�'fo
90. 6
(SEAT..) _�i'` 27.20 i t
'��0` `ap FI. Not:ry Discc�c rwcc. Cc.
Signature of Notary Public ,. I_80U
.3 OTA i 1., f, L
Personally Known OR Produced Identification T yp e of Identification cation Produced
Verification pursuant to Section 92.525: Florida Statutes: Under penalties of perjury, I declare that I have read the foregoing and that
the facts stated in it are true to the best of my knowledge and"belief.
/gn�ture of Natural Person Signing Above
Rev. date 3/2008