143 Scott Dr 03-2685 HVAC3--0- 1-3n, v
CITY OF SANFORD PERMIT APPLICATION
i 'Permit # : 07:-:3 2,12- Date:
Job Address: LA - % N V e -2 c -LrA L_3 71 1
Description of Work: -7 G 3- x-1 \rra +ne )OC i A- iVT\ O W1'1- S 1 t'nt61
Historic District: Zoning: Value of Work: $ q L( VU
Permit Type: Building Electrical echanic y Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical Residential Non -Residential eplacement 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: Qsidential Commercial Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: ,3 ` " (1 , ` - Sa 1 -0 (-1 CX7 - L \-,-) o (Attacb Proof of Ownership & Legal Description)
Owners Name&Address: 9y-'AAA
Phone: iCU-1 3 a-6 L{ 9 0
Contractor Name &Address: 12\<,5' l Ya' lS I G CJ SGC K SL) '1 , y\
11 State License Number: ACCDL-1 \ 11.5
Phone & Fax: Contact Person: GN ILL i--) Phone: IAO-1"- l 4
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. 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 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 requireme ntsda Lien Law, FS 713.
a lo3SignatureofOwner/Agent Date Date
Print Owner/Agent's Name Contra r/Agent's Nghe
Signature of Notary -State of Florida Date Signatureof Notary- tate of Flo da ate PA S. TI ERNEY Notary
Public, Site of Florida My
comm. exp. June 24, 2004 Owner/
Agent is _ Personally Known to Me or Contractor/Agent is Personally Known to Me or Comm. No. CC945112 Produced
ID _ Produced ID APPLICATION
APPROVED BY: Bldg: Y/ r t t T W Zoning: Initial &
Date) Special
Conditions:_ Utilities:
FD: Initial &
Date) (Initial & Date) (Initial & Date) ' a
OF COMMENCEMENT
State of Florida
ounty of Seminole i
Permit No.
Tax Folio No. (PID) 1' a 'OI ITheundersignedherebygivesnoticethatimprovementwillbemadetocertainrealroepprty, and, in accordance with Chapte713, Florida Statutes, the following informatioxgs provided in this Notice of Commencement.
DESCRIP TIOlV OF PROPERTY (Legal description,of the property and street address) s..
r
I
GENERAL (DESCRIPTION OF MIPROVEMENT r
Name and address OLERK OF CIRCUIT 11RT
6E LE COU
Interest in property (Fee Simple, Partnership, etc_)
3 5 ? J
BEP r rr11 ..
ERO(
NAME
AND ADDRESS OF FEE SIMPLE TITLE IE[OLIDER.(IF.,4THER,THAN OWNER) CONTRACTOt
Name
and,address ARS/WATTS AIR CONDITIONING 660.
Jackson Ave., Winter Park, F1 32789 SL,
MTY 'Bonding Company) Name
and address I loll III III III 1111 it lili 11 III 11111 II IN Il oil Ill 11111 1111111 loll MARYANNE
MORSE, CLE Amountofz? zrd --- BK'
04970 PG 0857 LENDER
CLERK'S # 2003144aG3 Name
and address RECORDED 08/19/2003 10059415 AM RECORDING
FEES 6.00 Persons
within the'State of Florida designated by Owner upon whom notice or other documents may be served as provided bySection713.13(lxa)7., Florida Statutes: Name
and address In
addition to himself, Owner designates of
provided'
in Section 713.13 1 Florida Statutes. to receive a copy of the Lienor's Notice as Expiration (
Date of Notice of Commencement expiration
date is 1 year from date of recording unless a different date is specified. L
u U Jc cl-Sc, 1 LC,.}
crilti L 3 wnel Sworn
and subscribed before me this E-f Da
of DayPAULA $.
TIERNEY c(
c / Notary Public, State of Florida MyCommissionduoExpires: h NotaryPublic' rMY exn 4 24 2004 IComm. No. CC945112 The
foregoing instrument was acknowledged before me this day of a S name
of me
o has produced ( person acknow edged),' w o is ersolly
kno to and
who did d n take an oath>(type
Pf identi onen cation