8100 Cardinal Cove Cir - BC00-000687 (STONEBRIDGE LANDING) (DOCUMENTS) BLDG 108aC0 ULFCA -Ra
ZONE DATE (,'; 3
CONTRACTOR SOhn T &11 CLAM 4`SrA4' -2;0(v'
ADDRESS 111 &P CLA LLe &ia &t-L A -
PHONE # qb(L - -7n
LOCATION
OWNER
ADDRESS
PHONE #
D,( 39OPLUMBING CONTRACTOR
ADDRESS
PHONE #
SUBDIVISION:
ZC! (.I/IwID
j
PERMIT' # a (OP LOT NO.
BLOCK:
JOB Uf
5
SECTION:
COSTS T
SQUARE FEET:
FEE $ MODEL:
STATE NO.
FEE $22SLZ!!v
ELECTRICAL CONTRACTOR
V
h 0 - -212`ll FEE $ Yoto'
ADDRESS
PHONE #
G MECHANICAL CONTRACTOR La-L rSOri
kli ADDRESS
PHONE #
MISCELLANEOUS
CONTRACTOR ADDRESS
SEPTIC
TANK PERMIT NO. SOIL
TEST REQUIREMENTS 4 FINISHED
FLOOR ELEVATION
REQUIREMENTS ( ARCHITECTURAL
APPROVAL DATE: FEES
OCCUPANCY
CLASS: INSPECTIONS
I TYPEDATEOKREJECTBYFEES
ENERGY SECT. CERTIFICATE
OF OCCUPANCY ISSUED #
DATE: FINAL
DATE EPI:
CERTIFICATE OF OCCUPANCY
REQUEST FOR FINAL INSPECTION
NEW RESIDENTIAL/APARTMENT BUILDING****
DATE: Ili I
ADDRESS: `dl
CONTRACTOR/PROJECT NAME: Wu,-a+La,12R; Q.
E
The Building Dept. Has prepared a certificate of occupancy for theabovelocationandisrequestingafinalinspectionbyyourdepartment. After your inspection, please contact the BuildingDept. To sign off on the C.O. or submit an addendum if it hasbeendenied. Your prompt attention will be appreciated. Thankyou.
Engineering: a Department:
Public Works: Zoning Department:
Utilities/Cross Connection:
CERTIFICATE OF OCCUPANCY
REQUEST FOR FINAL INSPECTION
NEW RESIDENTIAL/APARTMENT BUILDING****
DATE: 312-cI() l
ADDRESS: `dl
CONTRACTOR/PROJECT NAME:
b
The Building Dept. Has prepared a. certificate of occupancy for theabovelocationandisrequestingafinalinspectionbyyourdepartment. After your inspection, please contact the BuildingDept. To sign off on the C.O. or submit an addendum if it hasbeendenied. Your prompt attention will be appreciated. Thankyou.
Engineering:
Public Works: f3''""` s.T • .
Utilities/Cross Connection:
Fire Department:
Zoning Department:
f (e.a.s e--
ne- r/ 4o 4-,-s For p ropiZ (1 2.
CERTIFICATE OF OCCUPANCY
REQUEST FOR FINAL INSPECTION
NEW RESIDENTIAL/APARTMENT BUILDING****
DATE: 312-CIo 1
ADDRESS:
CONTRACTOR/PROJECT NAME:
1-1
The Building Dept. Has prepared a, certificate of occupancy for theabovelocationandisrequestingafinalinspectionbyyourdepartment. After your inspection, please contact the BuildingDept. To sign off on the C.O. or submit an addendum if it hasbeendenied. Your prompt attention will be appreciated. Thankyou.
Engineering: Fire Department:
Public Works: Zoning Department:
Utilities/Cross Connection: 3
P p FL E
C.O./C.C. CHECKLIST -. UTIUTIES DEFT.
P S C- U) Keq,'s1 Received Utility inspector -
5 , l S p o 1141TIALS DATE
NP, bEU FEC
P 'Idoo PO-00-6VI
Sce kec# 4 )A
utility inspectors Final __________
FDEP Clearonce - Woter----------
FDEP Cleorance - Sewer- ----------
City Services Easements- ____---___
Mointenonce Bond (10% - 1yr) __ __--,-.
Cf -
f---------
1 r+.
r *f"I i; t 41s4
y 1 .
it
CERTIFICATE OF OCCUPANCY
REQUEST FOR FINAL INSPECTION
NEW RESIDENTIAL/APARTMENT BUILDING
DATE: IZCII 1
ADDRESS: `dl
CONTRACTOR/PROJECT NAME:
The Building Dept. Has prepared a certificate of occupancy for theabovelocationandisrequestingafinalinspectionbyyourdepartment. After your inspection, please contact the BuildingDept. To sign off on the C.O. or submit an addendum if it hasbeendenied. Your prompt attention will be appreciated. Thankyou.
Engineering: Fire Department:
Public Works: Zoning Department:
Utilities/Cross Connection:
C.O./C.C. CHE KUST —. UTILITIES DEPT.
Request Received _ 3 zl i--- To Utility inspector
RNITCS DATE
Utility Inspector's Final _ S?_%
FDEP Clearance Water ---------- ----------
FDEP Clearance - Sewer __________ _________
City Services Easemnts__________ ----------
Maintenonce Bond 00%, - 1yr) __________ __________
r" nor
A r
CERTIFICATE OF OCCUPANCY
REQUEST FOR FINAL INSPECTION
NEW RESIDENTIAL/APARTMENT BUILDING****
DATE: 312-CIo 1
ADDRESS: 3L
CONTRACTOR/PROJECT NAME: W e; 1-1
The Building Dept. Has prepared a certificate of occupancy for theabovelocationandisrequestingafinalinspectionbyyourdepartment. After your inspection, please contact the BuildingDept. To sign off on the C.O. or submit an addendum if it hasbeendenied. Your prompt attention will be appreciated. Thankyou.
Engineering: Fire Department:
3 2 1v1
Public Works: Zoning Department:
Utilities/Cross Connection:
Sanford Fire Department
Fire Prevention Division
Certificate of Completion
DATE: March 21, 2001
ADDRESS: 8100 Cardinal Cove Cir
CONTRACTOR / PROJECT NAME: Westlake Apts.
The above noted location and/or project has received a final inspection from the Fire
Prevention Division for the items listed below. Compliance with current requirements
for Life Safety Systems and/or codes have been satisfied and inspected. There may be
other requirements, by other city departments, which may be necessary to be completed
to meet the requirements for a Certificate of Occupancy, which is to be issued by the
Community Development Department Building Division.
X ] BUILDING FINAL
X ] FIRE ALARM FINAL
HOOD FINAL (No suppression system)
HOOD FIRE SUPPRESSION SYSTEM FINAL
UNDERGROUND FIRELINE FINAL
SPRINKLER SYSTEM FINAL
PAINT BOOTH FINAL
PAINT BOOTH SUPPRESSION SYSTEM
INSPECTED BY: T. L. Robles
TITLE: Fire Protection Inspector
DATE: 3/21 /01
CERTIFICATE OF OCCUPANCY
REQUEST FOR FINAL INSPECTION
NEW RESIDENTIAL/APARTMENT BUILDING****
DATE: 3I Zt Ili 1
ADDRESS: $t
CONTRACTOR/PROJECT NAME:
The Building Dept. Has prepared a certificate of occupancy for theabovelocationandisrequestingafinalinspectionbyyourdepartment. After your inspection, please contact the BuildingDept. To sign off on the C.O. or submit an addendum if it hasbeendenied. Your prompt attention will be appreciated. Thankyou.
Engineering:
Public Works:
Fire Department:
Zoning Departmer
L;, (d' g
Utilities/Cross Connection:
C04 C' 4
01%/11991+ 1:'31 9042397120' Z ,. .,,. _ z ;.,'• -; ERFORMANCE C 2P• ? „ wPAGE.02,
r. F'•i.r',. },"
i 2 `.r'H .• t ,:i_•Ti+'i'}:<.i {a• —1 .r`1•x••^ 'Jx.r1y'
CIVIL ENGINEERING
61VELOPMENT
PLANNING
MEMORANDUM
TO: Martin Koch
FROM: Joe Hopkins
DATE: October 16, 1998
RE: Westlake Apartments
The following information is as per your request:
Tax Parcel No: 28-19-30-506-0000-0210-0-3
Site Address: 1200 Upsala Road
Sanford, FL 32771
Legal Description: Lots 21 and 22 of M.M. Smiths 3rd subdivision, according
to the Plat thereof as recorded in Plat Book 1, Page 86,
Public Records of Seminole County. Florida.
Ifyou should have any questions or require additional information, please contact me.
NO S. @UCN ST., UM W6 OIIRONR /ELM R UN
Ta "WE194110
CITY OF SANFORD PLUMBING APPLICATION
PERMIT NO.
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT
TO INSTALL THE FOLLOWING PLUMBING:
OWNER'S NAME: Xr a ,,on, 1
ADDRESS OF JOB: IDS
PLUMBING CONTRACTOR NES. SON-RES.
Subject to rules and regulations of Sanford Plumbing Code
C.F -Co 571
State License#
BUILIPING1
101 ' 12 21 8
102/ 12 21 8
103 8 10 8
104 8 10 8
105 12 21 8
10 12 21 8
107 12 21 8
108 12 20 °8
109 12 21 8
110 12 21 $
TOTAL 112 187 80
OTAL UNITS
t
WESTLAKE APARTMENTS
1200 UPSALA RD.
WATER SEWER
21,287.50 55,675 76,962.50
21,287.50 55,675 76,962.50
13,975 36,550 50,525
13,975 36,550 50,525
21,287.50 55,675 76,962.50
21,287.50 55,675 76,962.50
21,287.50 55,675 76,962.50
AI 7,V7,50 55,(o75— 7(0 9
7
21,287.50 55,675 76,962.50
197 0 $25 , 87.50
wcs1/2 1 C1
V ( vrl ou CA-1
o - no
0.00 *
21,287.50 +
209An0.00 — I
1,8 7. 50
0.00 *
551675.09 +
56,600.00 -
1+?75.00
76+962.50 +
75,2r)0.00 -
4.cxk , 7 6 2. 5 0
0.00
i CJ
CITY OF SANFORD MECHANICAL APPLICATION
PERMIT NO. ` —C DATE: /42
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO INSTALL THE
FOLLOWING MECHANICAL EQUIPMENT:
OWNER'S NAME Jo // ^! T 0- A/. A, A HA PJ; S o AAS 1A AC .
wcs-rAAKC /9PT. d,. # /or
ADDRESS OF JOB 1200 u PS Ak A R. b-. S A LJ o& 1L% •L 3377
MECHANICAL CONTRACTOR: 1.. R 2 }- 10 i5 A RS QAJ /N c —rA C
Subject torules and regulations of Sanford Mechanical Code
By Signing this application I am stating that I am in compliance with City of Sanford
Mechanical Code. t1
Applicant Signature
0-A Co 5--7
States License#
a
LPAC
LARRY PEARSON
AIR CONDITIONING / HEATING, INC.
IAQ INVESTIGATIONS
DUCT CLEANING - SANITIZING
October 9, 2000
I, Larry D. Pearson, do hereby authorize my employee, Don Ralston, to act as my agent
only in securing permits within the City of Sanford. I understand I am responsible for
any and all work performed by my agent.
LarryPeson -
State of Florida County of Manatee 1.
Sworn to subscribed before me this 91" day of October, 2000
Notary Public My Commission Expires: 2-11-03
TOB%W ccB
y (-OmtovON - 1 20W
1625 MANATEE AVENUE EAST - BRADENTON, FL 34208 - (941) 755.7122 - FAX (941) 727-8533
1-800-557-LPAC - www.iagexperts.com - CLASS "A" LIC. # CAC057386
CITY OF SANFORD ELECTRICAL APPLICATION
PERMIT NO. 60' U, DATE:
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO INSTALL THE
FOLLOWING ELECTRICAL WORK:
OWNER'S NAME: %V 5?L/i ICE• Apfirtr7"Y1e/lrrS L`7t
J L U =*P-- %40 YreADDRESSOFJOB:
ELECTRICAL CONTRACTORAUWA EaC_710CRES NON-RES
Subject to rules and regula ions of the city electrical code:
States License#
S,4 Ban FEZrn q-
W oou"
CITY OF SANFORD
FIRE DEPARTMENT
FEES FOR SERVICES
PHONE #: 407-302-1091
DATE: 19k PERMIT #: O
BUSINESS NAME: W-2XS T [6k4 ).S+Gn1e-6(-"CLqLeLan"."
ADDRESS: Q00 UOSCIC, R8 BlCLq 10g
PHONE NUMBER: 33 1-430 O
PLANS REVIEW TENT PERMIT
BURN PERMIT REINSPECTION
TANK PERMIT FIRE SYSTEM
COMMENTS:
AMOUNT $ Cn 0• q-(p
S S
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
l
Sanford Fire a)ention
I certify that the above information is
true and correct and that I will comply
with applicable codes and ordinances
oPtNe,Qity of SaMordj%orida.
nts Signature
Plumbing, Corp.
November 6, 2000
To: CITY OF SANFORD
BLDG. DEPT.
300 N Park Ave.
Sanford, FL 32771
RE: Buliding # 103 & 108
Westlake Apartments Building=# 103 &=108C-)
1200 Upsala Rd.
Sanford, FL 32771
We would like to inform you that as of June 6, 2000, John T. Callahan & Son, Inc.
hired another plumbing company to continue doing the work for buildings # 103 & 108.
S.R. Plumbing only did the 1st plumbing stage (Underground Plumbing) on these two
buildings. Therefore, permit BP00-1632 & BP00-1390 needs to be cancel ASAP. We
want the current plumbing company to be responsible for their own permits and fees.
Original notarized lettler in the mail. If you have any questions, please do not hesitate
to call me.
Th you, -
Samuel Rivera
State Certified Plumbing Contractor
CFC057159
Swo o and subscribed before me this
ga<1a a of Notary Public
Commission No.
Commission Expires: / • 3 i
Afiiant is personally known to me.
IX ie)_,day of _A10 e/n 2000
ABIGAIL COLON
MY COMMISSION # CC 771805
EXPIRES: August 31, 2002
i BondM Thiu Notary Public UndMwiilers
1147 Dennis Avenue, Orlando, FL 32807 0 (407) 275-9614 Office • (407) 275-9615 Fax
i CITY OF SANFORD PLUMBING APPLICATION
PERMIT NO.
r ` 7J v DATE 4.1
r
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT
TO INSTALL THE FOLLOWING PL BING: /
OWNER'S NAME: X , •G (
I
d
ADDRESS OF JOBr _ 0 X4-- PLUMBING
CONTRACTOR & --L ON-RES. Subject
to rules a regulations of Sanford Plumbing Code AW
Number Amount Residential
and CommercibfAddiflon, Alteration, Repair New
Residential: Ofie
Water et AdditionAVW
Closet fib
X, ommercia
mimu .00 fixtures
F%Mrain, Tra Sewer
Water
911pilig Gas
Pi NfflffiTe`*
rn4J Des '
bed Mork.. Application
Fee: $10.00 p 7btal
6Z,OZ By
Sknine this application I am statine that I am in compliance with City o Sanford Plumbing
Code. Z
p2nw xv-tiq pplicant
Signature GF-
Go5-71 Slate
License#
1WI: ' .
W-I",SALAr.-. At'' T IT'
407)
Pt3r.T.t r_i'Ur.tlii tE:a;IMDI
r:desc - .
e- r7n:i t Fee . . . . 2277. GO
Y L;Sue : •)atE . . . . 2/1 % 00
E::j..i t: ra1O7; Date,8/09/UG
i
UMP: \G COYXI P
350+.) ALOHA AV s U.. W_ 15
W I E71' PA,:w L 7
f7 j-:t
Orin C:hoak Fee . . .00
Qt:y Unz.t C.ilarge Per 'Ex t;(,71:_3.C):;
00 5. UO0+ , ITIOINAL W 'y CLOT
t;.;C; t-;C3S-------- -----•----- ---C).--- "L'E r'L.)pfPT a=;_'_._. _.. 1• 1 -1 MBT 1000
c:e summary 0!1 ;ed aici Credited Due
z'Nrmit e -Tc: - --•'7--- -- --- -UC) ----- ---00 --- ?77 00
Plan Check Tota? .00 .00 .UO
Other Fee Tot- 1 _00 .00
rand Total " 8 Uc) tjC( UU 228? . OU
nI T, 7 1uTJ ' T
A; r f2287.00 BP
Y M. J•l1/0Q' 03 Receipt; 0005463
1. NATIONAL FLOOD INSURANCE PROGRAMr+es jujy.31,.20trL
ELEVATION CERTIFICATE
Important: Read the Instructions on pages 1 - 7. "
SECTION A - PROPERTY OWNER INFORMATION .For•lnsurance'Compeny Use; .
UWNG OWNEWS NAME Policy Number,... STL A i9 A& TM Aim C TO
UMJMNG,STR EETADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Company NAICNumber. N 1aw Cq& 0.*AJA 4L C4bV4F C C6E
y,..• , e
STATE
HIV 3 Z 7 7 % ZIP CODE
i R ,OESCFtIPT]ON (Lot and Block Numbers. Taut Parcel N .Legal Description, eta
Z, s Z Apt P A4 . SAt i r*W V .ems scj8 P8 /
ILDINO 3E (fi g.,• . roenoal. non-8`e31eenu8l, Addition. Accessory. etc. Use comments section if necessary.) _
r vvvwnvi rwe tvrr "NAL) pfuta4um JAL w nmt: SOURCE: U GPS (Typek00.t Q LNAD 1927 U NAD 1983 U USGS Quad Map LJ Other.
3r>w:•. SECTION 8 - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
1UNFiRCOMMUNiTY NAME & COMMUNITY NUMBER B2, COUNTY NAME 83. STATE
SMIA410VOLE ieIDr4
a. I7 - __ •" - ... _" . . -. .. .. _.. .... .. ".. -. w.. v . V.••.vG r..WV GVG . ownF.' ;'NUMBER DA EFFE SED DATE zONE(S) (Zone AO, use depth of floodiner
10 IndloaW the, source of the Base Flood Itlevadon (BFE) data or,base flood depth entered in 89.
N'1; (J FIS'Piif 1s L.J FIRM U Community Determined LW Other (Describe): C o VNT
11 intliaei* ft elevation datum used for the BFE in 89: ff4 NGVD 1929 LJ NAVD 19M U Other (Describe):
12'is_",building located Ina Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? _J•Yes; ,9J No
6ilj^lil Date:
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
1.:BuUding;elevations are based on: "Constnxton Drawings' LjlJ uilding Under Construction• aMFlnished Construction'
W Elevation CerUficate will be required when construction of the building is complete.
2: Buildino' Diagram Number I_ (Select the building diagram most similar to the building for which this certificate is being completed =
peges'. Wand 7, If no diagram accurately represents the budding, provide a sketch or photograph.)
3..-8 at1dns ,Zones Al-A30. AE, AH, A (with BFE), VE. V1V30. V (with SFE), AR, AR/A, AR/AE, AR/A1-A30. AR/AH, AR/AO
mlets Items C3a-i below according to the building diagram specified in Item C2. State the datum used. if the datum is different fror. r > ,,.
re`th4dstum`used for the BFE in Section B. convert the datum to that used for the SFE. Show field measurements and datum eonversior:
wiculaUal. Use the space provided or the Comments area of Section D or Section G, as appropriate. to document the.datti'm convert
Datum Conversion/Comments ..
E tbn: Werence mark used Does the elevation reference mark used appear on the FIRM? . e, U
op'ofbottom floor (including basement or enclosure) IL(m) #
opofnext higher floor L .toft.(m) H
of lowest horizontal structural member (V zones only) 3 / . R(m) E,, i
4si0'd)'Att died garage (top of slab) _ ft.(m) g
l]-.e)TCWe—st elevation of machinery and/or equipment W "
siMdc g the building
a
4 .. °4. •
wt3/ O„f) L'adjacent grade (LAG) o ft (m) Z Aowwaes
0'.&Highest adjacent grade (HAG) S ft.(m)
w' •O''hj.,No. of permanent openings (food vents) within 1 ft. above adjacent grade
Tota1 area'of all permanent openings (flood vents) in C3h — sq. in. (sq. cm)
i`r °, ;t. SECTION D -SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATtO ;":;; ;;•;.-:r• •s`r:<.
E ;This d"fieaUon',is to be signed and sealed by a land surveyor. engineer, or architect authorized by law to ceWy elevation Information'"
I: th the lnforinaflon in SectionsA. S. and C on this cerfilicale mpresents ray best efforts to Interpret the date440a_ti_/e
statement maybe punishable by fine or imprisonment under-1 <:: 1
a.undersl8nd,lhat.an tai 8 U.S. Code Section
TIFIE S N9ME LICENSE NUMBERWE
TITLE W COMPANY NAMEaP'.5±/al NT
AOD ESS¢ :«I>t oizT l'I g• R. 4 3- S v TEC Z /SAS' /4 C.T S
TAT
LI:. 3 Z % /
D '
r,%';, . 4r ;
a•SIGNATUR DATE TELEPHONE
CITY OF SANFORD, FLORIDA
APPLICATION FOR BUILDING PERMIT
0
b
d
U
7
d
O
4
a
tz
0
PERMIT ADDRESS 1200 (%t2401a f2 ro,tj VloS Total
Contract Price of Job ( iiot J Describe
Work Type
of Construction 016r, P Number
of Stories 3 Number Occupancy:
Residential PERMIT
NUMBER O0` 16an Total
Sq. Ft. 455 Al.-
L= Floo Prone (YES) ((N22 of
Dwellings 4W qfi Zoning Pp Commercial
Industrial LEGAL
DESCRIPTION (please attach printout from Seminole County) TAX
I.D. NUMBER Z5 - 11) - 3 O - SM. • 0000 - 0 2110 - 0 - S OWNER
4'It(I 4 vk . IYIG PHONE NUMBER AD7.33I-45C0 ADDRESS
a 5.2. CITY
L&MOwmr) • STATE f=L- ZIP '3276-0 TITLE
HOLDER (IF OTHER THAN OWNER) ADDRESS
CITY
BONDING
ADDRESS
CITY
COMPANY
STATE
STATE
ZIP
ZIP
ARCHITECT •
ADDRESSSs '
CITY
STATE ZIP 32I?847 MORTGAGE -
LENDER ADDRESS
CITY
STATE ZIP CONTRACTOR /
O I AI (/7LL/7 k-J041S / A/C PHONE NUMBER 905 2-3S 76V% ADDRESS
1.?,1C-XC-C_11nV& CIRCLE Sl// r,67ST. LICENSE NUMBER CG- COS/ %/S CITY
e,4C1,i STATE LD2liA ZIP w***
ww**ww*******w***wtr***,t***+r**w***t***r+r,*,t**+t********w*w*w********ww****w******* 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 TIFY THE OWNER OF THE PROPERTY OF THE
REQUIREMENTS OF FLORIDA LIEN LAW, FS713. Signature
of Owner gen & Date g
h Type
or Print OwnertKoeiA Name Date
1.
f. L } A) SOn/ sI Contract
is Name M
V ('..
t o
o
n
b4 z
x
0 Siggnna
re of Contractor J
C l N Typ
r Print VI
C
w
3 O
ro
WQ t
H y
G
O N
o 0
0 d J ,
a Oa)>
I Z
14 EE yy/,,..
p n
M IE
7 M Signature
of Notary & Date Signature of Notary & D to 0 Official
Seal) %wSew CE
R. PC:-,*-: }'C ARLENE K. RUMBI_Ell y
Corm Exp. 1! 0: LL3 MY COMMISSION M CC 82'i9(!9 n oil
al?t X7x:CedBySenrcCI::s . EXPIRES: Jun 26, 2003 No. CC506484
IMD-MOTARY Fla. Notary Servmce 8 Boron-, t r a ro t 0 b
0 aApplication
Approved
BY: 190• Date: 1' 6- ci FEES: Building
Radon Police U&7&f. Fire cP V30,07 66.7 Open Space / (
o - Road mpact Application M^ N PERMIT
VALIDATION:
CHECK C.+SH DATE a BY ORIGINAL (BUILDING)
YELLOW (CUSTOMER) PINK (COUNTY TAX OFFICE) GOLD (CO. ADMIN) a THIS APPLICATION
USED FOR WORK VALUED $2500.00 OR MORE