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120 Towne Center Blvd - 99-002007 (1999) INTERIOR BUILDOUT DOCUMENTS
0vk SUBDIVISION: ZONE l /j CONTRACTOR ADDRESS PHONE # LOCATION OWNER Aj i ADDRESS " PHONE # i PLUMBING CONTRACTOR ADDRESS PHONE # ELECTRICAL CONTRACTOR i ADDRESS PHONE # MECHANICAL CONTRACTOR 19 02 ADDRESS PHONE # MISCELLANEOUS CONTRACTOR ADDRESS SEPTIC -TANK PERMIT NO. t S SOIL TEST -REQUIREMENTS ( FINISHED FLOOR ELEVATION REQUIREMENTS ARCHITECTURAL APPROVAL DATE PERMIT . # ( ( - ( LOT NO. JOB ° BLOCK: COSTS j SECTION: SQUARE FEET: FEES - 7 MODEL: STATE NO. ) / OCCUPANCY CLASS: l 'm FEE $ FEE $ FEE ** t INSPECTIONS ITYPEDATEOKREJECTBY FEES ENERGY SECT. EPI: CERTIFICATE OF OCCUPANCY 1 ISSUED # DATE: FINAL DATE I CERTIFICATEF 1OCCUPANCYOOCCUANC REQUEST FOR FINAL INSPECTION I NEW COMMERCIAL BUILDING**** DATE: (-Q '-:'509 i ADDRESS: CONTRACTOR/PROJECT NAME: , e 5 The Building Dept. Has prepared a certificate of occupancy for the above location and is requesting a final inspection by your department. After your inspection, please contact the Building Dept. To sign off on the C.O. or submit an addendum if it has been denied. Your prompt attention will be appreciated. Thank you. Engineering: (-' Fire Dept: Public Works: Utilities/Cross Connection: Zoning Department: BP200I10 CITY OFISANFORD 6/30/9 Application Names Inquiry 08:49:0 Application number . . . . . . 99 00002007 Property . . . . . . . . . . : 120 TOWNE CENTER BLVD CONTRACTORNameDUKESCRCTION & RENOVATION Contractor n r. Address 61 ALAFAYA BLVD STE 282 I Occ lic nbr . . : 99 15948 Phone . . . . . : 407 384-899' MAITLAND FL ; Zip . . . . . . : 32751 PROPERTY OWNER Name ACI INC-ORE—'MNDS Address 600 E COLONIAL DR ORLANDO FL Press Enter to continue. F3=Exit F12=Cancel Phone . . . . . : 407 423-760t Zip . . . . . . . 32803 Bottom I CERTIFICATE OF OCCUPANCY REQUEST FOR FINAL INSPECTION NEW COMMERCIAL BUILDING**** DATE: Cor30 a q ADDRESS: CONTRACTOR/PROJECT NAME: The Building Dept. Has prepared a certificate of occupancy for the above location and is requesting a final inspection by your department. After your inspection, please contact the Building Dept. To sign off on the C.O. or submit an addendum if it has been denied. Your prompt attention will be appreciated. Thank you. Engineering: Utilities/Cross Connection: e,-1 i Fire Dept: Zoning Department: i Public Works: C.O./C.C. CHECKLIST - UTILITIES fRequest Received sf//if.-i__To Utility In. spwor S./_3i1A9!!,:!a INITIALS DATE Utility Inspector's Final -_ TC-_-_ 1 rs z7 FDEP Clearance - Wnfla- --------- V14-_------ FDEP Clearance Sewer &A City Services Easements --------- ' Maintenance Bond (10% - 2rr) --------- NV __ _____ Other------- ---------------- -- ------ W a r Wo. *e- 00 y c1A s-'prN\-Aeec C C ne V ud 110- 130 Towesn a s,00 yla lgg Pz C`y pn j161'0 5 BP20OI10 CITY OFISANFORD Application Names Inquiryc Application number . . . . . : 99 00002007 Property . . . . . . . . . . : 120 TOWNE CENTER BLVD CONTRACTOR 6/30/9 08:49:0. Name . . S CONTRUCTION & RENOVATION Contractor n r . Address 61 ALAFAYA BLVD STE 282 Occ lic nbr . . : 99 15948 Phone . . . . . : 407 384-899' MAITLAND FL Zip . . . . . . : 32751 OPERTY O Name . . : A 0 NDS PRANER Address . : 600 E COLONIAL DR ORLANDO FL Phone . . . . . : 407 423-760( Zip . . . . . . . 32803 Press Enter to continue. Bottom F3= Exit F12=Cancel e, CERTIFICATE OF OCCUPANCY REQUEST FOR FINAL INSPECTION 9lVffiKeiyl1104261TO0*1100112Lelim DATE: (o 1301c+cj ADDRESS: nZ O CONTRACTOR/PROJECT NAME: The Building Dept. Has prepared a certificate of occupancy for the above location and is requesting a final inspection by your department. After your inspection, please contact the Building Dept. To sign off on the C.O. or submit an addendum if it has been denied. Your prompt attention will be appreciated. Thank you. Engineering: Fire Dept: l Public Works: Utilities/Cross Connection: Zoning Department: wlllel-e- K BP20OI10 CITY OF SANFORD 6/30/9' Application Names Inquiry 08:49:0: Application number . . . . . : 99 00002007 Property . . . . . . . . . . : 120 TOWNE CENTER BLVD CONTRACTOR Name DUKES CUR=TION & RENOVATION Contractor n r . Address 61 ALAFAYA BLVD STE 282 Occ lic nbr 99 15948 Phone . . . 407 384-899' MAITLAND FL Zip . . . . . . : 32751 PROPERTY OWNER Name A DS Address 600 E COLONIAL DR Phone . . . . . : 407 423-760( ORLANDO FL Zip . . . . . . : 32803 Press Enter to continue. Bottom F3=Exit F12=Cancel I CERTIFICATE OF OCCUPANCY REQUEST FOR FINAL INSPECTION NEW COMMERCIAL BUILDING**** DATE: Cp — 3 0--!1 5 ADDRESS: © Uc reP..j o CONTRACTOR/PROJECT NAME: The Building Dept. Has prepared a certificate of occupancy for the above location and is requesting a final inspection by your department. After your inspection, please contact the Building Dept. To sign off on the C.O. or submit an addendum if it has been denied. Your prompt attention will be appreciated. Thank you. Engineering: Fire Dept: Utilities/Cross Connection: Zoning Department: Public Works: P/I+ 0 Z' BP20OI10 CITY OF SANFORD Application Names Inquiry Application number . . . . . : 99 00002007 Property . . . . . . . . . . : 120 TOWNE CENTER BLVD CONTRACTOR 6/30/9 08:49:0. ame . . S C=RUCTION & RENOVATION Contractor n r . Address . : 61 ALAFAYA BLVD STE 282 Occ lic nbr • 99 15948 MAITLAND Name ACI IN70R=NDS Address 600 E COLONIAL DR ORLANDO Phone . . . . . 407 384-899' FL Zip . . . . . . 32751 PROPERTY OWNER Phone . . . . . : 407 423-760( FL Zip . . . . . . . 32803 Press Enter to continue. Bottom F3=Exit F12=Cancel CERTIFIED CopyNIARYA:NNE MORSECLERKOFCIRCUITCOURT Notice of Commencement SEMI OLE COU , F RIDAState. of Florida CtiunPermitNo.Tax Folio No. PED - '. _ERK The undersigned hereby gives notice that improvement will be made to certain real property, andinJ 1 accordance with Chapter 713. Florida Statues, the following informatiom is provided in this Notice of M c Commencement. j - n DESCRIPTION OF PROPERTY (legal description of the property and street address)_ LoTLi4(-I yNcv.T„_ rc.,r —PD t L3 SI PFS ._ 110 `I r r GENERAL DESCRIPTION OF IMPROVEMENT 1! :: ' - T -- a ' _ -.. . i '., ' I (•:.:. .: G r ri (!. O, R INFORMATION Name and address t Interest in property(Fee Simple, Partnership,etc) NAME AND ADDRESS OF FEE SIMPLE TITLE HOLDER (IF OTHER THAN OWNER) r CONTRACTOR rr' Nape and address J v t-+ N 'D . I.<- E 5 W 0 SURETY( BONDING CO) t- a c 'r ; Name and Address c I CJ' 1 c_ - Amount of Bond co LENDER o r Name and address C V Persons within the State of Florida designated by Owner upon whom notice or other documents maybe served as provided bySection713.13(1Xa)7.,Florida Statues: Name and address Expiration Date of Notice of Commencement o= The expiration date is 1 year from date of recording unless a different date is s ified.) mpr; in cc Signature of Owner e— -u.rrt Sworn to and subscribed before me this IZ Day of p i .19 r r— I AMy PazWANDA L PE7 ND j Commission Expires: Now Paabk State o1 FloC;7rida, N tary ublic 2 No. 763583 Bonded thru Ar{Iaron Agertcy, Inc. The foregoing instrument was acknowledge before me this IZ*% day of Apri 19' by Fr&NK L • Selxin!5 (name of person acknowledge), who is pe 1 o to me or who has produced THIS INSTRUMENT PREPARED BY: (type of identification) as identification and who did/did not take an oath. NAME i •t `• p . , ;: ; ADDR JUN-23-99 WED 01:39 PM COE JAX REALESTATE FAX:9042322484 PAGE 1 U.S. ARMY CORPS OF ENGINEERS FACSIMILE 'TRANSMITTAL SHEET TO: FROM; CITY OF SANFORA BUILDING DEPARI)dENf TINA B. CAUSF.Y FAX NUMBER: DATE: 407.550.5677 JUNE 25, 19" COMPANY: TOTALNO. OF PAGES INCLUDING COVER: 1 PHONE NUMBER: T SENDER'S REFERENCE NUMBER: RE: PERMIT # 99.2007 YOVR REFERENCL• NUMBER: 110 TOWN CENTER BOULEVARD ICJ URGENT ror Rvmw PLEASE COMMENT PLEASE REPLY PLEASE RECYCLE NOTES/COMMENTS: TO Whole it Mayconcem: We are requesting a pre -power at the bdding located atIxTown Center Boulevard, Sanford, Florida. As thetenant, we willnot occupy thepremises unta Certificate of Occupancy is issued You, 76a W. &aaags r G PHYLLIS M. GARFiELp NOTARY PUBLIC, STATE OF FLORIOA MYcommissionexpiresNov. 30, Z999 CommissionNo. CC4985z7 490 w 7 BAY STREET - jACTUONVILLE. FLORIDA PHONE: 904-232.1175 0 FAX: 904-232-2084 Seminole County Property Appraiser Database Information http://ntweb.scpa0.org:8080/owa/owa/seminole_county_titic?PARCEL=29193050400000040 r __j SEG-0INTYAssessed values shown are NOT certified values and therefore are subject to change before being finalized for ad valorem tax purposes. VALUE SUMMARY Value Method Market Number of Buildings I .......................................... 1 Depreciated Bldg Value 172,648 s Depreciated EXFT Value 25,300 Land Value (Market) 475,680 Land Value Ag 0 Market Value 673,628 Assessed Value (SOH) 673,628 Exempt Value 0 El ....... ...... Taxable Value F$673,628 1 of 2 4/8/99 2:32 PM Seminole County Property Appraiser Database Information http://ntweb.scpafl.org:8080/owa/owa/seminole_county_titic?PARCEL-29193050400000040 SALES INFORMATION Deed':! Date Book..Page Amount Vac/ImpI............... . . Find Comparable Sales within this Subdivision LEGAL DESCRIPTION LOT 4 ACI INCOME FUND PD PB 51 PGS 99 & 100 LAND INFORMATION Land Assess Method Frontage Kept]h[Land Units Unit Price Land Value Q...............-..........................................................., S....UARE FEET ............... 0.. 0............... 39,640..?..............12:OO.. 475,680 BUILDING INFORMATION Bid Num Bid Class Year'; Bit Fixtures Gross SF Heated SF Ext Wall Bid E Value C 1iN CONCRETE l 1998 € 0 : 7,191 01 BLOCK -STUCCO 172,648 :: $17STRUCTURE: MASONRY EXTRA FEATURE INFORMATION Description : Year Bit Units l EXFT Value :: Est. Cost New i:....................... ................... ASPHALT DRIVE 2 INCH " 1998 21900 $21,024 $21,900 WALKS CONC COMM 1998 2048 $2,995 $3,072 : BRICK WALL 1998 1. H.._ :.................. 168.. 819 $840 POLE LIGHT CONCRETE 1998 3 462 $462 New Search ] [ Find Comparable Sales within this Subdivision ] 2 of2 4/8/99 2:32 PM DEVELOPMENT FEE WORKSHEET CITY OF SANFORD UTILITY - ADMIN. P . 0. BOX 1788 SANFORD, FL 3:2772-1788 h}C Z IO2 T Project Name: V.S /`7/li7RRY /Fc,Qv;7 G C/I.7G —Date: cfk/bS Owner/Contact Person: ' Phone: Address: (/ 0 _7o. ,v4 CGiv7,64 Cr'Q Type of Development: 1) RESIDENTIAL Type of Units (single family or multi -family): Total Number of Units: Type of Utility Connection individual connections or central water meter & common sewer tap): Water Meter Size (3/4", 1", 2", etc.): REMARKS: 2) NON-RESIDENTIAL Type of Units (commercial, industrial, etc.): Total Number of Buildings.: Number of Fixture Units each building): Type of Utility Connection individual connections or central water meter & common sewer tap): 1 Water Meter Size (3/4" 1", 2", etc.) _ REMARKS: CONNECTION FEE CALCULATION: 1 N l c? 4 . ii : x a: a '+ a 1 p '• W# (i'2' /t7A 7 5- Name- - Signature - Date. REVISED 6 1J/ 417 TABLE 709.1 DRAINAGE FIXTURE UNITS FnR FIXTuaFc Arun nannnc 2) Equivalent Residential Connection (ERC) - 300 Gallons Per Day (Gp0) Residential - S650/Unit Single family structure, or multi -family unit 487.50/Unit containing three (3) bedrooms or more. Multi -family unit or Mobile home unit containinglessthanthree (3) bedrooms. (This category isbasedonjudgement/assumption, estimation that such family units on average require 751 - 225 GPDofthewaterandsewerserviceofanaverage single family unit.) - Commercial - S650/ERU Fixture unit schedule from Southern Plumbing Codewillbeused. One ERU will be charged for connection and up to twenty (2) fixture units. For projects having more than twenty (20) fixture units the Impact Fee will be determined byincrementsof251basedonmultiplesoffive (5) fixture units above the twenty (20) fixture unitbaseforthefirstERU. (Example: twenty-five25) fixture units will be rated as 1.25 cru: twenty-six (26) fixture units will be rated as 1.5ERU.) Sewer System Impact Fees Equivalent Residential Connections - 270 Gallons Per Day (GPD) Residential - 1700 Unit Single family structure, or multi -family unit 1275/Unit containing three (3) bedrooms or more. Multi -family unit or Mobile Home unit containinglessthanthree (3) bedrooms. (This category isbasedonjudgement/assumption/estimation that suchfamilyunitsonaveragerequire751ofwaterand sewer service of an average single family unit.) Commercial - Industrial Institutional 1700/ERU Fixture unit schedule from Southern Plumbing Codewillbeused. One ERU will be charged for connection and up to twenty (20) fixture units. ' For projects having more than twenty (20) fixture units the Impact Fee will be increments of 251basedonmultiplesoffive (5) fixture units above 1athetwenty (201 fixture unit base for the first'4ERU. (Example; twenty-five (25) fixture units:: will be rated as 1.25 ERU; twenty-six (26) fixtureunitswillberatedas1.5 ERU.) 3 2 N" SFwI:a. - SCr7 CC), FIXTURE TYPE DRAINAGE FIXTURE UNIT VALUE AS LOAD FACTORS MINIMUM SIZE OF TRAP (inches) Automatic clothes washers, commercial' 3 Automatic clothes washers, residential 2 2 Bathroom group consisting of water closet, lavatory, bidet and 6 2 ha(htub or shower 13atluuhb (with or without overhead shower or whirlpool 2 1 i/2attachments) _ Bidet 2 I1/4 • Combination sink and tray 2 11/2DentallavatoryI11/ 2 Dcmal unit or cuspidor Dishwashing machinc,c domestic I 2 11/4 11/ 4 Drinking fountain 1/2 I1/4Emergencyfloordrain2 Floor drains 2 2 Kitchen sink, domestic 2 11/2Kitchensink, domestic with food waste grinder and/or dishwasher 2 11/2Laundrytray (I or 2 compartments) 2 11/2Lavatory1k2 = Z 11/4Showercompartment, domestic 2 2Sink21)/zUrinalU4Footnote d Urinal, 1 gallon per flush or less 2c Footnote d Wash sink (circular or multiple) each set of faucets 2 S , 11/2Watercloset, flushometer tank, public or private 4c Footnote d Water closet, private installation 4 k- 2 = Footnote d Wa(cr closet, public installation 6 ' Footnote d For SI: I inch = 25.4 mm, I gallon = 3.785 L. For traps larger than 3 inches, use Table 709.2. O b A showerhead over a bathtub or whirlpool bathtub attachments does not incmue the drainage fixture unit value. , c Sec Sections 709.2 through 709.4 for methods of computing unit value of fixtures not listed in Table 709.1 or for rating of devices with intermittent flows. d Trap size shall be consistent with the fixture outlet size.. c For the purpose of computing loads on building drains and sewers, water closets or urinals shall not be rated at a lower drainage fixture unit unless the lower valuesareconfirmedbytesting. DRAINAGE FIXTURE UNITS FOR FIXTURE ORAINS OR TRAPS FIXTURE DRAIN OR TRAP SIZE inches) DRAINAGE FIXTURE UNIT VALUE 11/4 1 11/2 2 2 3 21/2 4 3 5 4 6 Standard Plumbing Code01997 1•or bl: I MC11= 23.4 min. CITY OF SANFORD FIRE DEPARTMENT 1303 South French Avenue Sanford, Florida 32771 407) 302-1091 (407) 302-1097 FAX Plans Review Sheet t Date: April 14, 1999 Business Address: 110 Towne Ctr. Cr. Occ. Chap. 26 Business Name: U.S. Military Recruiting Ph. Contractor: John Dukes Ph. (407) 423-8997 t. Reviewed [ ] Reviewed with comment [ X ] Rejected Reviewed by: Bart Wright, Fire Protection InspectorfjJJ1 Comment: 1.1 Application — alteration to existing business occupancy (ch. 27) 1.2 Mixed - N/A , S. 1.3 Special Definitions - N/A 1.4 Classification of Occupancy — Business ch. 26 1.5 Classification of Hazard of Contents - Ordinary 1.6 Minimum Construction — N/R 1.7 Occupant Load — 1/100 sq. ft. @ 2,000 sq. ft. = 20 persons (egress capacity) 2.2 Means of Egress Components - O.K. 2.3 Capacity of Egress - O.K. 2.4 Number of Exits - O.K. y4 A#z.2.5 Arrangement of Egress - O.K. 2.6 Travel Distance - O.K. 2.7 Discharge from Exits - O.K. 2.8 Illumination of Means of Egress - O.K. 2.9 Emergency Lighting - O.K.; will field verify a, CITY OF SANFORD FIRE DEPARTMENT 1303 South French Avenue Sanford, Florida 32771 407) 302-1091 (407) 302-1097 FAX Plans Review Sheet Date: April 14, 1999 Business Address: 110 Towne Ctr. Cr. Occ. Chap. 26 F Business Name: U.S. Military Recruiting Ph. Contractor: John Dukes Ph. (407) 423-8997 t:. Reviewed [ ] Reviewed with comment [ X ] Rejected Reviewed by: Ban Wright, Fire Protection Inspector t Comment: i. 1.1 Application — alteration to existing business occupancy (ch. 27) 1.2 Mixed - N/A , 1.3 Special Definitions - N/A 1.4 Classification of Occupancy — Business ch. 26 1.5 Classification of Hazard of Contents - Ordinary 1.6 Minimum Construction — N/R 1.7 Occupant Load — 1/100 sq. ft. @ 2,000 sq. ft. = 20 persons (egress capacity) 2.2 Means of Egress Components - O.K. 2.3 Capacity of Egress - O.K. 2.4 Number of Exits - O.K. 2.5 Arrangement of Egress - O.K. 2.6 Travel Distance - O.K. 2.7 Discharge from Exits - O.K. 2.8 Illumination of Means of Egress - O.K. 12.9 Emergency Lighting - O.K.; will field verify A7 CITY OF SANFORD Z0 ro FIRE DEPARTMENT N / FEES FOR SERVICES PHONE #: 407-302-1091 DATE: i PERMIT # 95- ;ou-i BUSINESS NAME: (J, 5- 17, WZVADDRESS: / /V G2. - PHONE NUMBER: ( ) aZ S ' -7boo CoA)r, . J 01411f 0UCC-S (4eD-0 3sst- 7 PLANS REVIEW BURN PERMIT TANK PERMIT COMMENTS: 9— TENT PERMIT REINSPECTION FIRE SYSTEM AMOUNT $/ D Fees must be paid to Sanford Building Department, 300 N. Park Avenue, Sanford, Florida. Phone # 330-5656. Proof of payment must be made to Sanford Fire Prevention before any further services can take place. i San ord Fire r vention I certify that the above information is true and correct and that I will comply with all applicable codes and ordinances of the City of Sanf lorida. A plicants Signature CITY OF SANFORD MECHANICAL APPLICATION PERMITNO. 13 DATE: 4/— .% - 7 S THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO INSTALL THE FOLLOWING MECHANICAL EQUIPMENT: OWNER' S NAME _A ADDRESS OF JOB 116 f o-rJL'2 81y CV MECHANICAL CONTRACTOR:AA rLo (Its- ydt4lul -QL RESIDENTIAL COMMERCIAL X Subject to rules and regulations of Sanford Mechanical Code Applicalign e By Signing this application I am stating that I am in c ' `fiance with Mechanical Code. Applicant Signature CAU S-77s States License# CITY OF SANFORD, FLORIDA APPLICATION FOR BUILDING PERMIT PERMIT ADDRESS 1/O nwA/E GEwTE/L BZVb PERMIT NUMBER 9(=_Cw l Total Contract Price of Job -_3Z, q-7 -L Total Sq. Ft. 2000 Describe Work 10te AVWT QV/(-D —0 vT Type of Construction COMPIE/Lt/A-L /cOAC"ri, Flood Prone (YES) Number of Stories / Number of Dwellings / Zoning Occupancy: Residential Commercial x Industrial LEGAL DESCRIPTION (please attach printout from Seminole County) TAX I.D. NUMBER Lq— /g• — 30 —fog/- d 000 — 00 N b OWNER .4 Gr X A/ Coy .II t7-b PHONE NUMBER 1-/Z3 — 7 600 ADDRESS (00 F', ?) 2 CITY 012t_.A-N SO ,D STATE F L. ZIP 37-8 O 3 TITLE HOLDER ADDRESS CITY IF OTHER THAN OWNER) BONDING COMPANY ADDRESS CITY ARCHITECT ADDRESS _ CITY MORTGAGE ADDRESS CITY LENDER STATE STATE STATE STATE ZIP ZIP ZIP ZIP CONTRACTOR J-014 M D V bC E 5 PHONE NUMBER 1/07-38 N_ 899 % ADDRESS 4G.41C/4,YA' WOODS , BLjj-D, _5M Z87 ST. LICENSE NUMBER CG'G0S'7-717 CITY DI//FiDG TATE ( ZIP 3 Z7 (S 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, PLUMBING, MECHANICAL, SIGNS, POOLS, ETC. OWNER' S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. A COPY OF THE RECORDED COPY OF THE NOTICE OF COMMENCEMENT WILL BE POSTED ON THE JOB SITE WITH PERMITS NO LATER THAN SEVEN (7) DAYS AFTER THE PERMIT HAS BEEN ISSUED. FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOU PAYING TWICE FOR THE 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 REQUIREMENTS OF L RIDA LIEN LAW, FS713. m O a w O H ei r.i Signature o Owner/Agent b Date tur of Contractor & Date M n r N r , sctri J. /ff/ C. DVfcE z Ile r P 'nt Z01W Ty e o Print ontr r me o O rot Signature of Tqotary & Date ignature of Notary & Date 0 Official Seal) WANDA L. PENLAND No" Pam, Skle of Floddo WANDA L. PENLAND MY comm. e0es J* 30, 2002 NW&q Pubes State of RMI& 7°0No. CC763583 MY oomm. Wkes July 30, 2002 ro BondedtivuAeMonAgency, Inc. 17 Bonded Vwu Ashtono CCll3583 q, Irte. o a C nrt Mra I c w 3 0 E X Z ? W - 4 ro w G O N O 10 N N 4J N a O N ?. z a F Application Appro d BY: O Date: 2 Z FEES: Building Radon Police Fire Open Space Road Impact pl'cation PERMIT VALIDATION: CHECK CASH DATE qW'qq.BY ORIGINAL ( BUILDING) YELLOW (CUSTOMER) PINK (COUNTY TAX OFFICE')"' -GOLD (CO. ADMIN) hl THIS APPLICATION USED FOR WORK VALUED $2500.00 OR MORE