1804 Rose Way - P18-002595 - Replace Sewer LineCITY OF
SkNFORD
FIRE DEPARTMENT
Job Address:
Building & Fire Prevention Division
PERMIT APPLICATION
Application No: I-a_:-9-
Documented Construction Value: $ 6?95, GYM
Historic District: Yes No
Parcel ID: Residential Commercial
Type of Work: New Addition 4Iteration R..RepairEl Demo Change of Use Move
Description of Work: / 7 p0j0fla Ce `, e, L(/
Plan Review Contact Person: Title:
Phone: Fax: Email:
City, State Zip:
Owner Information
Phone: Y 67_ p S- 4 o 0,0
Resident of property? : 1 1°
Contractor Information
Phone: Y027_ 5,5 $ 01
Street: q P' a % d A %Z %% Fax:
City, State Zip: (/i j /V fl'eaym e_yze State License No.: CfLZV76 T'
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
ArchitecVEngineer Information
Phone:
Fax:
E-mail:
Mortgage Lender:
Address:
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
COMMENCEMENT.
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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.
FBC 105.3 Shall be inscribed with the date of application and the code in effect as of that date: 6'" Edition (2017) Florida Building Code
Revised: August I, 2017 Permit Application
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 ofthis 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 Florida Lien Law, FS 713. '
The City of Sanford requires payment of a plan review fee at the time of permit submittal. A copy of the executed contract is required
in order to calculate a plan review charge and will be considered the estimated construction value of the job at the time of submittal.
The actual construction value will be figured based on the current ICC Valuation Table in effect at the time the permit is issued, in
accordance with local ordinance. Should calculated charges figured off the executed contract exceed the actual construction value,
credit will be applied to your permit fees when the permit is issued.
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.
C a/,A
Signature of Owner/Agent Date tgn ure of Contractor/Agent Date
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
Print Contractor/Agent's Name
S gnature of Notary -St e c lb ida D1
S tgcF 170646MYCOMMIS0., EXPIRES: Fabrue 25, 2010DoadeO7bNNOPub1cllndernAlenp..
Contractor/Agent is Personal!y Known to Me or
Produced ID Type of ID
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building Electrical Mechanical Plumbing[] Gas[] Roof
Construction Type: Occupancy Use:
Total Sq Ft of Bldg:
Flood Zone:
Min. Occupancy Load: # of Stories:
New Construction: Electric - # of Amps Plumbing - # of Fixtures,
Fire Sprinkler Permit: Yes No # of Heads
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
UTILITIES:
INJ13
Fire Alarm Permit: Yes No
WASTE WATER:
BUILDING:
Revised: August 1, 2017 Permit Application
l
ILIT111K LIKE, LLI
pwMs No , saRevIces
407-558-0982
P,O. Box #43
Gotha, FL 34734
pleplumbing@gmail.com
if * 0. 01567
License #CFC 1426458
Date:
BILL TO 11 P
STREET
6 e-L, STREET
CITY STATE ZIP / CITY STATE ZIP
HOME PHONE 10, WORK PHONE HOME PHONE WORK PHONE
QUANTITY ITEM 1' PART DESCRIPTION DESCRIPTION OF WORK
00
Pl 4/11
C' 4,
SSA C
TOTAL PARTS PARTS WARRANTY TECHNICIAN HELPER
All parts as recorded are warranted as
per manufacturer specifications. LABOR HRSA IHRS=
WORK ORDER # LABOR GUARANTEE CHARGES
The labor charge as recorded here TERMS DUE UPONCOMPLETION
AUTHORIZATION # relative to the equipment services as
noted is guaranteed for a period of 30 1 hereby accept the work performed as satisfactory and in compliance with any aforementioned
CHECK # days. estimate. The liability of Pat's Plumbing, for damages to the property if any, is limited to that caused OTHER
We do not, of course, guarantee other
parts that thosewe install. If repairs
by the sole negligence of the employees of Pat's Plumbing. In the event that at the discretion of
Pat's Plumbing I agree to pay all attorneys teesand costs incurred, ifany. I agree to pay $50.00
CHARGES
NET 30 DAYS 20 DAYS 15 DAYS safer become necessary do to other service charge for each returned check. I understand that any unpaid balances are due within 30 SALES
detective parts, theywill becharged days of invoice date, and are subject to finance charges as allowed by the slate law if delinquent. TAX
separately. TOTAL
MATERIAL
CREDIT CARD # TRAVEL TIME
TIME
TIME
r AUTHORIZED SIGNATURE
r
J
ABOVE ORDERED WORKHAS BEEN COMPLETED AN I ACKNOWLEDGE RECEIPT OF MY COPY. DEPARTED
EL XTIME
DATE
Iif_ MW.
GRANT MALOY SEMINOLE COUNTY
CLERK OF CIRCUIT COURT & COMPTROLLER
BKNOTICEOFCOMMENCEMENTCLERK'S :92018064940'
RECORDED 06/07/2018 01:31:26 PH
State of Florida RECORDING FEES $10.00
County of Seminole RECORDED BY ,ieckenro
Permit Number: Parcel ID Number: .51- 0/- 31y-0-3 0000 006 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. DESCRIPTION
OF PROPERTY: (Legal description of the property and street address if available) OWNER
INFORMATION: Address:
it 15T/ Fee
Simple Title Holder (if other than owner) Address:
CONTRACTOR:
Name,
lj Address
Q (f.7 Persons
within the State of Florida Designated by Owner upon whom notice or other documents may be served as
provided by Section 713.13(1)(b), Florida Statutes. Name:
Address:
In
addition to. himself, Owner Designates Of To
receive a copy of the Lienors Notice as Provided In Section
713.13(1)(b), Florida Statutes. Expiration
Date of Notice of Commencement (The expiration date Is 1 year from date of recording unless a differentdateisspecified) WARNING
TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION 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 COMMENCEMENT. Under
penspen3lfop ofpe ' , I declare that I h read the foregoing a t the facts stated in it are true to the
be o y kin edge a belief. X C
to owners Signature
OWWS Printed Name Florida Statute
713.13(1)(gr ' The owner must sign the rooks of commencement andnoon* etse may be permitted to sign In his or her stead.' e N State of
County of t The foregoing
Instrument was acknowledged before me this 'd.y of 20 • s by 1
GI' Lu t= Who is pe onally known to me = °Co tatement 2LyW *has
pFINIta dl Mtifl C ti [ type of Identification produced: _ v w S MY
COMMISSION
t FF tllibq$ T\ EXPIRES: February
25, 2019 , a Z r • • • • ponded
Thru IJolart Poblx Underwrilen: o. s O
v NotarySignature
Lj O Z0