112 Golfside Cir - BR17-003294 - FENCESXY
Of
Pudding & Fire Prevention DivisionNF'`--" `--' ttESIDENTIAZ X'ENC , PEXIMITAPPLICATION
FIRF DEPARTMENT
Application No: k
Documented Construction 'Value: $ .6 / 5v
Job Address: Historic District: Yes No
Plan Review Contact Person: Y o f11 0 jo, 9 91 Title: IY I T ' GlC1l21iC/ YZf
Phone: 7`' i `. "7"?} Fax: /'r Email: d RA1 `1 ;? QIYI//C, fit'
Residential Fence Information
Type of Fence: 'Wood Metal PVC/Vinyl [0 ' Tron Other
Fence Height: -f - Feet #i Gates: • ;-)- Total Linear Peet:
Additional Information:
Fences with a height of over 6 feet will require signed & sealed structural engineering**
Property Owner Information
Name Y t F11 J: I S Phone: t'( L' ' ` 1 / 0
Street: MK (YOL E 5110E 019, Resident of property? : G
city, Stfi, ite zip:
Fence Contractor Information
Name /. t, L46 7, Phone G' l r,
1'$
J2 2
Street: _ ((i wwr' tt ")4d -rr g 1L Fax:
City, State Zips (:l''!ti D J L
Please Note: The Building Department Floes notperform site inspections on Residential Pence
permits. A signed and notarized Fence Affidavit is required to be submitted along with this
permit application.. Please see the attached Fence Permit, Submittal Guidelines.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPE, RTY. 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.
Effective; August 1, 2017
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 ofpermit is verification that I will notify the owner of the property ofthe requirements of Florida Lien Law, FS 713.
The City ofSanford 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 witli all applicable laws regulating construction and zoning.
r, t, \l UU 1L
Sig io ire o Os per/Agent f Date
R N'V I 4 I
Print Owner/Age is Name
r-t
17
Signaturb of Notary-StareofFlorda Date
DOREEN E: MOAGAN
W COMMISSION I FF ta20638
s EXPIRES: January22,2020l7i.".11 bided Rru 14M Nob rySerr,:es
Owner/Agent isy
Personally
Known to Me or Produced
ID Type of ID kv
Signatdre
of on rac or/Agent ale Pri
ontractor/Ag it's Name Signature
of Notary -State of Florida Date 0; °:"
p, DOREEN E, MORGAN r *
My CO.' WISSM I FF 1320838 or
EXPIRES: January 22, 2020 rF';
toP 80a&dRX08 dg llarySeriko Conh•
actor/Agent is Personally 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: Total
Sq Ft of Bldg: Occupancy
Use: Min.
Occupancy Load: New
Construction: Electric - # of Amps Fir
a Sprinkler Permit: Yes No ## of _ Flood
Zone: . , . of
Stories: Plumbing - #
of Fixtures Fire
Alarm Permit: Yes No APPROVALS:
ZONING: 72 UTILITIES: WASTE WATER: ENGINEERING:
FIRE: BUILDING: COMMENTS:
O t to install approx. %5—linear feet of 6' high privacy
fence and 2.. gate(s) as shown on plan.
Fence shall be constructed with f
rlished side facing oijbivard. Revised:
June 30, 2015 Permit Application
Prepared by, and after tocording return to;
Berry J. Walker, Jr;, an employee of
Walker & Tudhope, P.A„
225 South Westmonte Drive, Suite 2040
Altamonte Springs, Florida 32714
Consideration: $170,000.00
File Number: FA 17-493
For official use by ClerWs offiee only
WARRANTY DEED
THIS 1NDENTURF; mado this September 29, 2017, bt t veeri JSM Group Inc., a Florida corporation as Trustee for Trust
015-2995, a Florida corporation; whose mailing address is; 9$32 Southern. Garden Circle, Altarnonto Springs, Florida 32714, party of
the first part, and Kevin And Harris and Sophia L. Gonles-Harris, whose mailing address is 1 l2 C3oifsrde Circle, arifor0, T 432173,.
party/parties of the second part,
WITNLr S S R T R
Firstparty, for and in consideration ofthe stun ofTg AND N011.00 DOLLARS ($10.00) and other valuable considerations,
receipt whererif is liercliy aciciioivledge 1, does hereby grant, bargain; sell, alieirs, temises, releases, conveys and confirms unto second
partylpnrtfes, biMtedtheir heirs and assigns, ewe following described property, towel
Lot 45 of MAYFAIR CLUB PEASE 1, According to the, Pat tl el ,of, 1s recorded in Plat.
i
Book 53, Pages 7 and 8,.ofthe Ptiblta Records of Seihinolo Cpunty, Florida.
1
Parcel ldentifi0aition140hilier; 04-20-30-$13-0600.-0956
Subject, however, to all.covenants, conditions, restrictions, reservations, lunitatfons, easements and to all applicable zoning -
ordinances andland restrictions and prohibitions imposed by governmental authorities, if any.
TOGETHER with all the tenements, hereditaments and appurtenances thereto belonging or in anywise appertahiing.
TO HAVE AND TO HOLD the same iri. fee simple forever,
AND tho party ofthe first partliereby covonants.with said Patty of the second parti that it is laN01. iy seized ofmid, land irk feasimple: that it has good right and lawful authority to sell and convey said land; that ithcrcby hilly.warrants tho title to sa 4.land and
will defend the same against the lawful elaimsf all persons claiming by, through or under the party of the first part..
DBED - Special WarrWy Deed -Corporate
Closers' Choice
IN WITNESS WHEREOF, first party has signed and sealed these present the date set forth above:
Signed, sealed and delivered in the presence of ,1SM Oiroup Inc., a Florida corporation as Trustee for Trust
15-2995
By
Witness signature Print Name: Sa msonMunshi
Title: President
errcj
Print tress name
Witness signature
A. Fe mind"
Print witness name
State of Florida
County of :Sem.tnole
THE FOREGOING INSTRUMENT was ackn4xvtodged. before rite this 29th day ofSeptember, M17 by Samson Munshi, President of
JSM Grotip:lnc.i a Florida earitoratian tss Tntstee for Trust t115-2995. (X ivho is personally aiow t to nie or (_ who has produced
as. identification.
Notary Public.
A Femandu
Print Notary Name
1
My Conuitission Uxpires.
Notary Seai
1+Atl:Rlt: A FFBNAA'D6GiAtl' l:0UA9$SiU,4 iFF 8160a3
l edpThNli tsryPib oUn NrtPRa
9867 S.Orange Blossom Trail
Orlando, FL 32837
Tel: 407.857.5770
Fax: 888.283.7012
Insured / Bonded
www.fencedirectfl.com
No. 22322
ESTIMATE 1 CONTRACT
Estimate Date: _ ' l AZT %%
Estimate Valid For ' Day:
Prepared By:
CUSTOMER INFORMAT1014:
Name: _A e,;n c (r; Contact #:y
CTvl s c C Alternate #:
Address: UL ` 1
Fax #:
Co 1 L V
qtthdivision:
Email:
FENCE INFO:
PVC (Vinyl) Aluminum Steel (Montage) Wood Chain Link
rvtl FlRes.[]Comm. Res.[]Comm. FI Res.00omm.
Total Linear Feed r
S
Fence Height
Style/Model b X 6 t7OVA -)
Fence to follow
Contour of Ground
Fence to Top Level
Removal & Disposal NO
Existing Fence ft N
Clearing of Fence YES No
Line Needed
Clearing to be o"Der Fence hied
done by
HOAApproval Req.
YES NO
N
Required
Y® NO
El
Post Caps:
Color: WvLH P
GATES:
Oft. Walk 2-
5ft. Walk
I
8ft. Double
10ft. Double
OTHER:
Type; Size: QIT
t j i 6''tlrtcr { I
Ic,4 r, t 1i.. --
t
IT
LJ
Estimate AmounII
bt co[xer[ix[9P[1'a'vraY9'xra eett[etacusaaY.tlWW hP i
FwceD'rectx SassistGraastmrn upon[oldest ind'ei[[s5yngµiEreamf ncelstobeerected,bAurdernodtwmsrancedoesFenceDiectassumv ugI.spau 7 t IhIt" tecorrmended UsatGta costom[rha:re U[xp opely susreyred. in pioc
Fence Died will assuta Ore respons Day AV matelzl w33 remah Utepropely of Fence bredtmUpaymentistecery ithPf, itght o! accessand rertroval is lNantodforlocetwrdorgramdcablesand [hitters. Fence Dlrwt is not responsible for any spdntders to tal v
unmarked bu[ied Unesthat may be cut or damaged d la
the
r,, py a0oraccess T
rnent Is a
corryxetion Uwork and afirs= charge of2'%perrrog shall he apigp toa8accounts [cot p td h1 witltit 7 days ofcomp 5onDaecthU. etirent ofrPaYmerd 4a theterms oflHs conbad Ttte custom, agrees to paya9heed and any cost "cured In Ure co'.octbn ofUds debtinoUdn9 aUomeys lees.
scost of matelots znd k6o[ ,'ready tur
UU» bufrerretr sesto aoxtfg sE a tobegitnoAcor complete vraf[ aiezdy be(pxr, atoaccept mattxLa'scoMfatted for, Ovya erg eestopay s iq dateddmages Wasun equal to 35°; of enkaconbaU pricepbr In
progress. WORTTO
CANCEL Per fielder znd f edaai Carsrrrttasumtes ins contact may be canrered bya'tftaUtatxmz<orN severInwrk+rgbymldnghtOf NVudlmsEtessday aria s.+gnn' g• orbI posbnarked no later than3 bushes days altar $nU• Customer assumes
cull responSWty for obtaining homeowners assoeiatlon approval for the type and location of fence. TWyayn lstman as aco thesentertalsaidarerwipadh
hFlhatirealghttoenfa toS eur PY ty rePyb
tuctonInfrd Acco[dng
to F1aSda'sconshuction Genlaw (secbats 713.t101-713.37,P odda statues), teapeepe wfroarerrared trrotteymay lack Ecrt. If
fou eon' Wa,s
or a subcontractorlads to passubcontrzctars ormateMs supp5xsor rtegects to make other I aaY rued pal wft ro paY)cor tabor, material, o< oU a services D at your con7acwra a stbcantrad% y ha:re lazed topa; topay
year 'actor. four contractor r fa
ako hay
a Ear on your prr r * TNs means tf a Een Isfled your property could t o so`d againYoe catusirucgon Eon
lawis comperr andAflrecwrxrtFJXWthat cotter zrera speaflcprobemans^s. YoJ cauu3 an N0710ETO PURCHASEOF14OOD FENCES Yloodfence
matel*.s are rough r[rTl cut oems. wood faeces has a tendency to ".( and warp Inhot. WA Mllterand small gips wN appeu betem boards. Cracks h the woodas a commonoccurence. Wood fence matedas tra v nowarranties. FORINTERNAL
SPECIAL NOTES: USE ONLY
Cr,nCf qi lie Installed:
Installer: U,,,
n t, ^n C k Locates #: w
e'q(- Locates Date:
7__ THIS CONTRACT
IS YOUR INVOICE. CV'jj% CONTRACT AMOUNT: $
2 DEPOSIT AMOUNT: $
b S U BALANCE DUE11_
SC) UPON MPLETION: $ APPRO 8
CCEPTEO BY: _ L)1s
dim CUSTOMER CONTRACT
DE 0' J -
11n/2017 SCPA Parcel View: 04-20-30-513-0000-0450
Property Record Card
Qn1dSo oaon CfA Parcel: 04-20-30-513-000"450 jiPPRIOwner. JSM GROUP INC TR
S[:FiNpIL-{1(NiY,flClfil7A
Property Address: 112 GOLFSIDE CIR SANFORD, FL 32773
Parcel Information E t r €, t Value Summary
j-------------
Owner S"ROtiP'taC"1'R"
L— Property Address 112 GOLFSIDE CIR SANFORD, FL 32773 J 4:
Mailing' 9532 SOUTHRN GARDEN CIR ALTAMONTE SPRINGS, FL 32714-
Subdivision Name I MAYFAIR CLUB PH 1 +
Tax District S1-SANFORD
DOR Use Code 01_SINGLE FAMILY
Exemptions
2018 Working 2017 Certified
Values Values
Valuation Method — 1 Cost/Marketi, Cost/Market
Number of Buildings 1 1
Depredated Bldg Value 176,600 166,458
Depreciated EXFT Vatue 9,000 9,350
Land Value (Market) 35,000 35,000
Land Value Ag i
Juswaa et Value " 220.600 210,808 f
Portability Adj I
Save Our Homes Adj 0 0
Amendment 1 Adj 0 0
P&G Adj 0 0
Assessed Value - 220,600 —
i
210,808--
J
Tax Amount without SOH: $4,014.10
2017 Tax Bill Amount $4,014.10
Tax Estimator
Save Our Homes Savings: $0.00
Does NOT INCLUDE Non Ad ValoremAssessments
Legal Description
LOT 45
MAYFAIR CLUB PH i
PB63PGS7&8
Taxes
Taxing Authority Assessment Value Exempt Values Taxable Value
rCounty General Fund — 220,600( 0 220,600
Schools 220,6001 0 220,600
City Sanford 220,600 1 0 220,600
SJWM(SaintJohns Water Management) 220,600 1; 0. 220,600
County Bonds 220,600 0 . 220,600
Sales
Description Date i Book Page Amount Qualifled 1Vaclimp
I I CERTIFICATE OF TITLE 6/1/2016 08709 0920 188,000 No Improved
SPECIAL WARRANTY DEED 9/1/1998 03739 1153 137,300 Yes . Improved
rind TOlitt7:; r:iIr, ,al?!`- i i
Land
i rMethod l Frontage Depth Its Units Price Land Value
LOT 1 35,000.00 35,000'
Building Information
Is BediBath count incorrect? Click Here,
Year Builtj # Description Actual/Effective !Fixtures Bed I Bath Base Area !Total SF j Living SF I Ext Wall i Adj Value Repl Value I Appendages i
I 1 SINGLE 1998 9 4 1,120 2,583 2,142 ` CB/STUCCO .
1111
176.600 $189,893 I Descriptlon Area l !'
I Ij FAMILY FINISH
hItp:#parceldetail.scpafl.org/PareelDetailInfo.aspx?PID=0420305 i 300000450 112
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to install a i`
t s `- -- pprox. AS_linear feet of 6' high s.,- _, _
privacy fence and 'Z gate(s) as shown on y'
sr ,. - f plan, Fence shall be constructed with 3J . ]_ L3Lt ?;F. I: finished side facing outward. 4
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ps://mall.google.com/mail/u/0/#inbox/15f5a3684438ba3O?proiector-1 ' ',1. • ili .
SCoft Randolph, Te-,,, Caj..jector Tax Receipt Orange. County, FloridaThislocalbusinesstaxreceiptisinadditiontoandnotinlieuofanyothertaxrequired. bylaw or municipal ordinance. Businesses are subject to regulation of zoning, health and otherlawfulauthorities. This receipt Is valid from October I through September 30 of receipt year. Delinquent penalty is added October 1,
2017 - EXPIRES 91301201.8
1815 INSTALL FENCING $30.00 1 EMPLOYEE- 3502 WHOLESALE
181.5-0613674
30.00 1 EMPLOYEE
TOTAL TAX 60.00
PREVIOUSLY PAID $50.00 RODRIGUEZ OANY PRESIDENT
TOTAL DUE $0.00
FENCE DIRECT INC
9867 S ORANGE BLOSSOM TRL #A
ORLANDO FL 32837
9867 S ORANGE BLOSSOM TRL -,A
U - CRLANDO, 32837
PAID:- S60.00 .. ac)99-C)0-?,7j384 7/12J2017. -7 . . ...... ... ..... scatf Randdiph,'TaXx L
I
OC;ag Bu. sin4.ts' —8 ax Roc-ipt Orangai Cbun - ty; .- F . lo - r - id' ---- a --'- This local business tax receipt is -in addition to and not in lieu of any othertax required by law or municipal ordinance- Businesses are subject to regulation of zoning, health and otherlawfulauthorities.. . This receipt is valid from October 1 through September 30 of receipt year. Delinquent penalty is added October 1.
2017 EXPIRES 913012018
1815 INSTALL FENCING $30.00 1 EMP jf, Z -' HOILESALE . .
1815-0613674
30.00 1 EMPLOYEE
TOTAL TAX $60.00
PREVIOUSLY PAID $60.00 RODRIGUEZ DANY PRESIDENTTOTALDUE $0.00
ENCE DIRECT INC
9867 8 ORANGE BLOSSOM TRL#A9867SORANGEBLOSSOMTRL -A ORLANDO FL 32837U - ORLANDO, 32837 INPAID:
S60,00 0099-00777384 7/12/2017 This
receipt is official when validated by the Tax Collector-
ACCO tom® CERTIFICATE OF LIABILITY INSURANCE FDATE(1.s1.VDDNYYY)
07/31/2017
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must he endorsed. It SUBROGATION IS WAIVED, Subject to
the terns anti conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder In lieu of such endorsements .
PRODUCER CONTACT John MaldonadoNAME:
PHONE I- NoEX ()- -X No): ACCORD INSURANCE GROUP
2133 W FAIRBANKS AVE E-MAIL 1@ grouohnaccord s.comADDRESS: p
INSURERS) AFFORDING COVERAGE NAIL 9
INSURER A: Federated National Insurance Co 10790WINTERPARKFL32789
INSURED INSURER a
INSURER CFENCEDIRECT, INC
INSURER D : 9867 S Orange Blossom Tr
INSURER E
INSURER F: Orlando FL 32824
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OFINSURANCE ADDL SUBR POLICY
NUMBER POLICY
EFF MI.
VDO POLICY
EXP M6UDD
LIMITS COMIdERCIAL
GENERAL LIABILITY EACH OCCURRENCE 1,000,000.00 CLAIh1S•
MADE ® OCCUR AGE
R PEMSESEa£otxur0enw 100,000.00_ MED
EXP (Anyone person) 5,000.0 PERSONAL
A ADV INJURY 1,000,000.00 AGL-0000028447-02 05/20/2017 05/20/2018 GENt
AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000.00 PRODUCTS-
COhIPlOPAGG 2,000,000.00 POLICY0PRO- LOC
JECTOTHER:
AUTOMOBILE
LIABILITY COh.l NED SINGLE LIMIT Ea
accident) BODILY
INJURY (Per person) ANYAUTOBODILY
INJURY (Per accident) ALLOWNEDSCHEDULEDAUTOS
AUTOS NON
OWNED HIREDAUTOS
AUTOS PPROPERR a DAMAGE UMBRELLA
LIAR HCLAIMS-MADE OCCUR
EACH OCCURRENCE AGGREGATE
EXCESSLIARDEO
RETENTIONS WORKERS
COMPENSATION AND
EMPLOYERS' LIABILITY YIN ANY
PROPRIETORIPARTNERIEXECUTNE STANTE
R E.
L. EACH ACCIDENT E.
L. DISEASE - EA EMPLOYE OFFICERIMEMBER
EXCLUDED? Mandatory
In NH) NIA
E.
L. DISEASE -POLICY LIb11T IF )}.S6
descnbe
under DESCRIPTION
OF OPERATIONS belay DESCRIPTION
OF OPERATIONS I LOCATIONSI VEHICLES (ACORD let, Additional Remarks Schedule, may bo attached if more space Is required) FENCE
ERECTION rrnTr
elf' AYC Lnt MV0 CAMCFI I A'rinM SHOULD
ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City
of Sanford ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED
REPRESENTATIVE 300
N. Park Ave. Sanford
FL 32771 019Ut$-
WU14 A(%UKO GvKYUKA I ION. All rignis reserven. ACORD
25 (2014101) The ACORD name and logo are registered marks of ACORD
CITY OF
SANFORD
FIRE DEPARTMENT
Building & Fire Prevention Division
RE, SIDE FENCE AFFIDAVIT
6 FEET OR LESS IN HEIGHT)
PERMITM / / ' c J ADDRESS: 122,
I ! m j r , HEREBY AFFIRM THAT ALL OF THE FOREGOING
INFORMATION IS TRUE AN ACC RATE. THE FENC VILL BE INSTALLED IN THE APPROVED LOCATION AS SHOWN ON THE APPROVED SITE
PLAN. THE FENCE WILL BE'NO HIGHER THAN 6 FEET, MEASURED FROM GRADE. TIME FINISHED SIDE OF THE FENCE IS REQUIRED TO FACE
OUT. IT IS THE HOMEOIVNER'S RESPONSIBILITY TO VERIFY THE FENCE IS PLACED WITHIN THE PROPERTY LINES AND ANY DISPUTES
BETWEEN ADJACENT HOMEOWNERS WILL BE A CIVIL MATTER. I UNDI3RSTAND THAT FAILURE TO PROPERLY FOLLOW THESE GUIDELINES
AND ADHERE TO ALL CITY CODES (SANFORD LAND DFVELOPMENT REGULATIONS, SCHEDULE F) COULD RESULT IN THE FENCE HAVING
TO BE REPLACED, RELOCATED OR REMOVED AT THE OWNER'S EXPENSE.
0 FENCE CONTRACTOR
13Y SIGNING THIS AFFIDAVIT, YOU ARE ACKNOWLEDGING YOU HAVE MADE TIME HOMEOWNER ANYARE OF THE FENCE AFFIDAVIT
STIPULATIONS AS STATED ON THIS DOCUMENT. '
I
COMPANY / CONTRACTOR: ! ' t / C. N " \ v
CONTRACTOR SIGNATURE: DATE
IIOMEOWNER (OWNEWBUILDER)
OWNER/BUILDERNAME:
OWNER/ BUILDER SIGNATURE:
PLEASE NOTE"
DATE:
THE BUILDING DEPARTMENT WILL NOT CONDUCT ANY INSPECTIONS ON RESIDENTIAL FENCES., THIS
AFFIDAVIT MUST BE PROVIDED, SIGNED AND NOTARIZED, AT THE TIME OF PERMIT SUBMITTAL AND WILL
SUFFICE AS THE FINAL INSPECTION APPROVAL FOR THE FENCR.
STATE OF FLORIDA COUNTY OP U ` rvC- `
Sworn to and Subscribed before me thisday of _A j Y 20 t by: A
N 1 I T i6, 164 jtl" Who is Q Personally Known to me or has f Produced (type of identification)
V" as identification. 1
Itrye 7
4SlgnfireofNotaryPublict, ter Pua DOREENE:MORGaN StateofFlorida o ; ...,t, W
GOIWISSI0N0 FF 9-MEXPIRES:
January 22, 2020 lJU1 l• j r I f V'tI 1 E'' % i F f°'eovnoP°
BaA dTTruBadgatt,'oarySenices Print/
Type/Stamp Name of
Notary Public Effective:
August.1,2017