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3653 Orlando Dr - BC03-002336 (WALMART) INTERIOR ALTERATION (DOCUMENTS)PE I\A;:5; RMIT ADDRESS ADDRESS PHONE NUMBER ELECTRICAL CONTRACTOR MECHANICAL CONTRACTOR , PLUMBING CONTRACTOR a MISCELLANEOUS CONTRACTOR PERMIT NUMBER MISCELLANEOUS CONTRACTOR FEE PERMIT NUMBER FEE SUBDIVISION 404 PERM[IT#CS&dj14 PERMIT DESCRIPTION PERT VALUATION 1MI4 2 SQUARE FOOTAGE d H o uj CERTIFCATE`OF OCCUPANCY REQUEST FOR FINAL INSPECTION INTERIOR REMODEL TO A COMMERCIAL BUILDING**** DATE: `'-\j-O PERMIT #:03• ADDRESS: o C'C \ Cw'L i'41A s CONTRACTOR: %x1v PHONE F m -"16?) I The building division has prepared a Certificate of Occupancy for the above location and is requesting final inspection by your department. After your inspection, please sign off and date the C. O. or submit addendum if it has been denied or approved with conditions. Your prompt attention will be appreciated. ngineering Public Works Utilities Q IL &Ii 1%3 b" Sijty" O Fire OZoning ElLicensing CONDITIONS: ( TO BE COMPLETED ONLY IF APPROVAL IS CONDITIONAL) 1 Y' v CERTIFCATE OF OCCUPANCY REQUEST FOR FINAL INSPECTION INTERIOR REMODEL TO A COMMERCIAL BUILDING**** DATE:`' -\3-0 2) PERMIT #:0- ADDRESS: CONTRACTOR: PHONE #: The building division has prepared a Certificate of Occupancy for the above location and is requesting final inspection by your department. After your inspection, please sign off and date the C. O. or submit addendum if it has been denied or approved with conditions. Your prompt attention will be appreciated. DEngineering J—ublicWorks Utilities DFire DZoning 0 Licensing CONDITIONS: (TO BE COMPLETED ONLY IF APPROVAL IS CONDITIONAL) A` INSPECTOR REQUEST FOR FINAL INSPECTION CERTIFICATE OF OCCUPANCY/COMPLETION INTERIOR REMODEL TO A COMMERCIAL BUILDING***" DATEU' PERMIT # ` , ADDRESS J S ( oti=eC;.fl1 PROJECT, V\LA CONTRACTOR \ C The Building Division has received a request for a final inspection and a Certificate of Occupancy for the above referenced address. We would appreciate a final inspection of the site by your department. Approval by your department would result in a granting a C.O. for the address. If you have any issues that the contractor will need to address, please submit a statement for denial of C.O. or a conditional agreement to be attached to the C.O. Thank you for your cooperation. Engineering Fire Public Works Utilities Conditions: (to be completed only if approval is conditional) Sl ot35v 5 W r CERTIFCATE OF OCCUPANCY REQUEST FOR FINAL INSPECTION INTERIOR REMODEL TO A COMMERCIAL BUILDING**** DATE: -1J-0 PERMIT ADDRESS: CONTRACTOR: PHONE #:_` 1M The building division has prepared a Certificate of Occupancy for the above location and is requesting final inspection by your department. After your inspection, please sign off and date the C. O. or submit addendum if it has been denied or approved with conditions. Your prompt attention will be appreciated. Engineering DFire Public Works tilitie DZoning icensing CONDITIONS: (TO BE COMPLETED ONLY IF APPROVAL IS CONDITIONAL) LMbUvgV1 %1ITZ yr 0&wNxvzw Address Misc. Information Maintenance V / 17/ V./ 13:36:16 Location ID . . . . . Parcel Number . . . Alternate location ID Location address . . . Primary related party Type information, press Sequence Code(F4) App 11.00 CSVC UT 6 CSVC UT Tg—.Uu _ 7=. F2 Address F3=Exit F10=Subdivsion Notes 149605 11.20.30.300-035C-0000 1911 3653 ORLANDO DR WAL MART Enter. Special Free -form information Date notes CHG'D FROM A 1 1/2" TO A (2" #4040898) & 11003 Y IS NOW ABOVE GROUND INSTEAD OF IN VAULT* —r= Y More... FS=Notes display F6=Change display F9=Parcel Notes F12=Cancel F16=Related pty data LMBC0401 CITY OF SANFORD Address Misc. Information Maintenance 8/14/03 13:36:16 Location ID . . . . . . Parcel Number . . . . Alternate location ID Location address . . . . Primary related party Type information, press Sequence Code(F4) App 1.00 HISB BP CSVC UT 6 HISB BP 4= HISB BP 57n HISB BP HISB BP 7.79 CSVC UT CSVC UT TM CSVC UT ru-.79 CSVC UT 149605 11.20.30.300-035C-0000 1911 3653 ORLANDO DR WAL MART Enter. Free -form information NEXT TENT: 9/11/93 WALMART NEXT TENT: 6/27/94 NEXT TENT: 5 NEXT TENT: (PUT UP 2 TENTS) NEXT BANNER PERMIT 10/18/98 SW DEV FEE $ 9350.00 WA DEV FEE 57 . PD - 7- BP 4 SEE REC 5 4 WALMART****** ********** PER L.H. AFTER CONSTRUCTION NEW METER IS Special Date notes 22593 Y 12= 9= Y zS4 Y b Y Y 7= _ 7= Y r= Y More... F2 Address F3=Exit F5=Notes display F6=Change display F9=Parcel Notes F10=Subdivsion Notes F12=Cancel F16=Related pty data CERTIFCATE OF OCCUPANCY REQUEST FOR FINAL INSPECTION INTERIOR REMODEL TO A COMMERCIAL BUILDING**** DATE: -NJ-0 2-1 PERMIT #:0- wt ADDRESS: CONTRACTOR: PHONE #: The building division has prepared a Certificate of Occupancy for the above location and is requesting final inspection by your department. After your inspection, please sign off and date the C. O. or submit addendum if it has been denied or approved with conditions. Your prompt attention will be appreciated. DEngineering - I1q)b3 Public Works . !:]Zoning Utilities Licensing CONDITIONS: (TO BE COMPLETED ONLY IF APPROVAL IS CONDITIONAL) 4-:?- 384— 0 -Z 3 1 Dint 34uef ti CERTIFCATE OF OCCUPANCY REQUEST FOR FINAL INSPECTION INTERIOR REMODEL TO A COMMERCIAL BUILDING**** DATE:`' -NI-0 2-) PERMIT #:0- ADDRESS: CONTRACTOR: PHONE #: pim -AC c1R The building division has prepared a Certificate of Occupancy for the above location and is requesting final inspection by your department. After your inspection, please sign off and date the C. O. or submit addendum if it has been denied or approved with conditions. Your prompt attention will be appreciated. DEngineering Fire Public Works N,-CAning lU Utilities _ DLicensing CONDITIONS: (TO BE COMPLETED ONLY IF APPROVAL IS CONDITIONAL) CITY OF SANFORD PERMIT APPLICATION A v -31 Permit # :0 1 - `_ _ Date: 06/20/03 Job Address: 3653 Orlando Ave., Sanford, FL 32773 Description of Work: Interior Seafood Additon, demo existing wall, saw cutting, adding 1 floor drain Ais nc'Dtsrtr coal circuits, on ngrigerated cirsa uof o k:s re rigerated case. $44200.00 Permit Type: Building X Electrical X Mechanical X Plumbing X Fire Sprinkler/Alarm Pool Electrical: New Service — # of AMPS Addition/Alteration X Change of Service Temporary Pole Mechanical: Residential Non -Residential X Replacement New X (Duct Layout & Energy Calc. Required) Plumbing/ New Commercial: # of Fixtures 1 # of Water & Sewer Lines # of Gas Lines Plumbing/New Residential: # of Water Closets Plumbing Repair — Residential or Commercial Occupancy Type: Residential Commercial X Industrial Total Square Footage: Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X) Parcel #: 11-20-30-5QU-0000-0010 (Attach Proof of Ownership & Legal Description) Owners Name & Address: Wal—Mart Stores, Inc. 2001 SE LOTH St., Bentonville, aR 72716-0550 Phone: 479-273-4000 Contractor Name &Address:Michael G. Stover DBA Alltech Commercial Services, Inc. P.O. Box 255 Lake Helen, FL 32744 State License Number: CBC059272 Phone & Fax: 386-228-0733 FAX-386-228—"99 Person: Pam Crowley Phone: 386-228-0733 X1 Bonding Company: Address: NA Mortgage Lender: NA Address: Architect/Engineer: HendPrGnn Frigi neers, Tnr - Phone: 91 1-3117-5 Ann Address: 8325 Lexena Dr.. Suite 406 Lexena. KS 66214-1695 Fax: 913-307-5400 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, ctc. OWNER'S AFFIDAVIT: 1 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. there.mi y,be adaitioi al permits required from is virifrcation the I will notify the owner of the property e of Owner/A Date rl?_ -7- i-tc m r t.vmmlbblQN I DD 16426o EXPIRES: November iz 2ox9000Nv1l "Notary 8ani" PrWrplly Known to Me or restrictions applicable to this property that may be found in the public records of al entities such as water management districts, state agencies, or federal agencies. requirements of Florida Lieg Lay,rFS,} 13... tture of Contractor/Agent Date chael G. Stover I Date J Signature of Notary -State of Florida Date APPLICATION APPROVED BY: Bldg: ` _Zoning: Initi.al & Date) Special Conditions: - 1 06/20/03 Sheree-D. Crowley Commission#0189954 Contractor gent is ; .erso j4 Btwt f8VNh f 06, 2007 o uced ID +'; `'F' Bonded Thru Atlantic;Btind Utilities: I ititi!afi A,r;a),y +^.rt•+, (initial`&FDate)•(Initial;& Dale)r a-),!a.c.-ArD, CITY OF SANFORD FIRE DEPARTMENT FEES FOR SERVICES PHONE # 407-302-1091 * FAX #: 407-330-5677 DATE: jc2 BUSINESS NAME / PROJECT: ADDRESS: a3 -a33b 2202F—MA4, I PHONE NOC:! 20FAX NOC q/3 / 30 7 ..- CONST. INSP. [ ] C / O INSP.:[ ] REINSPECTION [ ] PLANS REVIEW F. A. [ ] F.S. [ ] HOOD [ ] PAINT BOOTH [ ] BURN Q R ,;T [ ] TENT PERMIT ] TANK PERMIT [ ] OTHER ,t CI TOTAL FEES: $ " © (PER UNIT SEE BELOW) 5 CL nn - COMMENTS: / F/o.4. AD Address / Bldg. # / Unit # Sauare Footage Fees per Bldg. / Unit 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11, 12. 13. 14, 15. 16. 17. 18. 19. 20. Fees must be paid to Sanford Building Department, 300 N. Park Ave., Sanford, FI. 32771 Phone H -407- 330- 5656. Proof of Payment must be made to Fire Prevention division before any further services can take place. I certify that the above is true and correct and that I will comply with all applicable codes and ordinances of the City of Sanford, Florida. Sanford Fire Prevention Division Applicant'sig6fure Ailtech COMMERCIAL SERVICES, INC. 170 N. Summit AvenueRefrigeration, Air Conditioning, Building Contractor 800) 497-9098 • (386) 228-0622 Fax P. O. Box 255 Lake Helen, FL 32744-0255 Licenseholder: License #: I do hereby authorize my authorized agent, Signed, Michael G. Stover, Sr. Licenseholder NOTARY State of Florida County of Volusia LETTER OF AUTHORIZATION Michael G. Stover, Sr. CAC056761 CBC059272 CITY OF SANFORD DONALD BAUER to issue permits and licensing to on my behalf. Date: 07/17/03 The foregoing instrument was acknowledged before me this 17TH day of ` ULY , 2003. Signed, Sheree D. Crowley Commission #DD189954 Expires: Mar 06, 2007 o: Bonded Thru Ati;mtic Bonding Co., Inc. Mike Stover, Owner • FL CAC056761 • FL CB059272 9 GA CN208256 9 SC G94885 • NC 3792 m WAL-*MART really July 9, 2003 To Whom It May Concern: Re: Refrigeration Permit Authorization Please be advised that Michael Stover Sr. of Alltech Commercial Services, Inc. is authorized to obtain permits on behalf of said corporation/ business trust relative to refrigeration installation. Should you have any questions, please call me at 479-277-9078. Sincerely, a es Kneedler rations Manager Mechanical Services JK/jc 4, Jul 09 03 12-.41p RLLTECH COMMERC?RI_ SVCS 386 228 0622 Ml EM CITY OF SANFORD FULMI f APPLICATION Permit # : 93 O ooUC23- Date: 10) /! / O-_ lob Addrexs 63 Q O / Z5 Description of Work: 1 IiAcf Historic District: -_ Zoning: - Value of Work; S- Permit Type: Building Electrical Mcchantwl 1'lumtiing _ 1-im SprinklerlAlarnl Purl Electrical: New Service - # of AMPS _— Addition;Alte-retion _ Chsnge .)f 5crvicc Temporary Yule Mechanical: Residential Non-Reside;dial Replacement New (Ut;ct Layout &: Energy Calc. Regaimd) Mumbling/ New Commercial: # -if Fixtures # of Watar St Sewer Lines # oi.Gas Lines _ A Plumbing/ New Residential: # of Nh ater Closes Plumbing Repair - Residential or Coir mrcial Occupancy Type: Rcsidcntisl Colrtinerc:al __- ind,Istrial —__ Total Square Footage: Construction Type: _ # orStories: y of DV'Oling Units: 1`730t Zatle: -, (FEMA forth required for other tharr X1 Parcel p: (Attach Proof of Ownership & Legal Description, Owners Name & Address: ODO es . E Aoy—• — 46---Arnw (f`,/P%%/Ost,oAne: Conti, rWr N nc Address: \ - rsonr= t1[YhenJSe, — 77 Bunding Company: tiq Address: _ lortCage Lender: _ Address:-- Architect/ Gtigincer: Phone:. — Address: _ i — _ M Fax: Appli--; ation to hereby niade to obtain a permit to do the work and i,s!atistions as indsa!eC. l cc!tify iloo no work or installatint has corrm'cnced prior to the 4suwrce ut'a permit and that all r: oa: will be peribm:cd w meet s:crdar;is of a!i iavrs r:g:Idting ccn:.:r_:tro;t ): this jurisdict;un. I t:rdrratand inat a sepitTale p.- nrit trust he secured for E'_ECTR:CAL WORK. PLi!M51,11r, :vC+!:S, WELLS, POOLS, FUR`;„i: ES, DOILERS, HcATERS, TANKS, cad AIR CONDIT!ONERS, etc. OWNER' S AFFIPAVIT• 1 certify that aii of the foregoing information !, acc': rate ar.'. that ail worl; v;r:'I - .a; as a compliance with --h applicublt !a:::: regulating cocshuction and ror:ng. WARN(NO TO OWNER: 'r CRIR F•AIl IUV E rO RECORD A ` -,)y ]C'F OF t :'.9C.•".ENrEti*•_! T MAY RESU.r t?v YOUR PAYING TV: i:'.E FOP. IMPROVEMENTS TO YOUR ?ROPE.'-"Y. Ir %T,!; !r TeND TO OdYAI`! F:?+.:.: iiC ', r:C'd:SUi T ti !TH YOUR LENDER OR P.hi aT' rORNEY BL=c}uL 7FCOKL`i:G'r'Ol'R \;?';l!'!= CF CC)%!t.?1:r:;-f1!T1 T. OT! CE: In additirr.. w the requir.:n^nts of this permit. V iremay ba addir;onal r. srric;;nrs apoticz :: ro !!!s ,r..roperythat nray be found ii; :he pub''c reoords of this eouaty, and there play be addirior•u! penrits required from othe: p-,, ernmeota! cniits :ucb as •v ter rrana2cmea- districts, .state agracies, or Fedetzl agencies Acc= prance of pc nih is veri!'icatior. Crat ! will rotiP+ lire Dwner w°tl:e ;r,o etty ofthe rec,t:iremen;s nr Flo -id I Lierr Law FS 7 i-. Sigituturc of (hvnetiAgent` -- — ;tale Si stare:rtC-)m"uctor/Agent Late Print Own,•ri.4gent's Na!ae —, _ Pn:,l traciur„ger•: s .' . e 7 / y I Igltal! L.'e o! Nuury.ytare of Flonda Vat' Signature of Nc!.r: '+-State -A F?ur.^a Da• ci eree' D. Cro e Ownet;Agcut is Pcom,ally KnoN rt to h1c ur ('onlractort` aar a r , rr, dnt:ed ifl.-----..-------- i$ f I`lli Sillii ` i a99 y spires. M 06 -2007 Bonded Thtu rrwrnt. APPLICATION APPROVED B '': Bldg: Lrring . U:.rh ics: Atlantic Bonding Cpj lnc. _ initia; & `.) air) (lnitia? i Pa:e! (Innis? &Date) llritfal & Uste) Special Conditions: _ i r- Licenseholder: License #: I do hereby authorize Ken Mullen Plumbing P.O. Box 220 Lake Helen, Fl. 32744 386-228-3576 Letter Of Authorization Ken Mullen CFC043021 CITY OF SANFORD to issue permits and licensing to My authorized agent, DONALD BAUER on my behalf. Signed, " Cr Date: 07/15/03 Notary Sheree-D. Crowley Commission #DD189954 Expires: Mar 06, 2007 Bonded Thru Atlantic Bonding Co.. Inc. The Foregoing instrument was acknowledged before me this 2003. Signed, 61' 0 16TH day of JULY Permit # :03 00002336 Job Address: 3653 Orlando Ave. CITY OF SANFORD PERMIT APPLICATION Date: 07/09/03 Description of Work: Adding one refrigerated case Historic District: Zoning: Value of Work: S 15 , 000. Permit Type: Building Electrical Mechanical X Plumbing Fire Sprinkler/Alarm Pool _ Electrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary Pole _ Mechanical: Residential Non -Residential Replacement New _X_ (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: Residential Commercial X Industrial Total Square Footage: Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X) Parcel #: 11-20-30-5QU-0000-0010 Attach Proof of Ownership &Legal Description) Owners Name & Address: Wal—Mart Stores Inc. 2001 SE loth St. Bentonville, AR 72716-0550 Phone: 1-800-273-4000 Contractor Name & Address: P.O. Box 255 Lake Helen, FL 32744 State License Number: CAC056761 Phone & Fax: 386-228-0733 386-228-0622 eNct Person: Pam Crowley Phone: 800-497-9098 X1 Bonding Company: N/A Address: Mortgage Lender: N/A Address Architect/Engineer: Henderson Engi nPPrs, Tnr - Phone: 913-307-5300 Address: 8325 Lexena Dr.. Suite 400 Lexena, KS 66214-1695 Fax: 913-307-5400 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. 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 1 will notify the owner of the property of the requirements of Florida Lien Law, FS 71 t;Z/09/03 Signature of Owner/Agent Date ignature of Contractor/Agent Date Micahel G Stover Print Owner/Agent's Name Signature of Notary -State of Florida Date Owner/Agent is _ Personally Known to Me or Produced ID APPLICATION APPROVED BY: Bldg: Initial & Date) Special Conditions: Zoning: Pri t Contractor/Agent's Nan. tgnature of Notary -State of Florida Date tM P'" She D. Crowle mission #DD1899 Q Contrae3Ni/Ag t'pgpalL raKpQwn,WMe or Pi6 ced Y IVf 1 Vv Ll/vlJ // Oi Atlantic Bonding Co., Inc. initial & Date) Utilities: FD: Initial & Date) (Initial & Date) This Instrument Prepared By: Name Pam Crowley of Alltech Commercial Services, Inc. AddrgZs P.O.ox 255IIIIIIIIIIIIOIIIIIIIgI11111111N11NMN11110111 Lake Helen, FL 32744 QV MARYW E HORSE, CLERK OF CIRCUIT COURT Permit No. Tax Folio No tF11 NOTICE OF COMMENCEMENT Inxlt F COUNTY BK 04891 PG 1973 CLERK'S # 2003112866 RECORDED 07/02/2003 91144115 PN RECORDING FEES 6.00 RECORDED BY L McKinley STATE OF FLORLPA, COUNTY OF Seminole 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. 1 PrttIofp lZ:3e O2 Oc r oety' d strearrf a II aceDp7-W eminoaee ekS 39 & 40 3653 OrlandoDrS Sanford, FL 32773 2 interioreseat000(F aT8iRion, demo existingwall, saw cutting, g, adding 1 floor drain, 3 electrical circuits, 1 refrigerated circuit, and 1 refrigerated case. 3. Owner information Wal-Mart Stores, Inc. a. Name and address: 2001 SE LOTH St. b. Interest in property; Bentonville, AR 72716-0550 ; c. Nam ' e and address of fee simple' titleholder (if, other than owner): N/A 4.Contractor: Michael G. Stovwer DBA Alltech Commercial Services, Inc. a. Name and address: P. O. Box 255 b. Phone number: Lake Helen, FL 32744 386-228-0733 c. Fax number (optional, if service by fax is acceptable): 386-228-0622 FAX 5. Surety N/A a. Name and address: b. Amount of bond $ c. Phone number: d. Fax number (optional, if service by fax is acceptable): CERf IFIED COPI MARYANNE MORSE CIERK OF CIRCUIT COU SEMI LE . FxOR My Clow 6. Lender N/ A ` a. Name and address:.,JUL` U G b. Phone number: t, c. Fax number (optional, ifservicebyfaxisacceptable): 7. Persons within' the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(I)(a)7., Florida Statutes: a. Name and address: ' J. W. McF rland b. Phone number: 2459 Shi rock Ct. , Deltona, FL 32738 479-633-5676 c. Fax number. (optional, if service by tax is acceptable): FAX 407=574-6875. 5. In addition to himself, Owner designates the following person(s) to receive a copy of the Lienors Notice as provided in Section 713.13(I)(b), Florida Statutes: a. Name and address: Michael G. Stover DBA Alltech Commercial Services, Inc. b. Phone number: P.O. Box 255, Lake Helen, FL 32744 386-228-0733 c. Fax number (optional, ifservicebyfaxisacceptable): 386-228-0622 FAX 9. Expiration date of notice of comrnencerft2 nt 't3e expiration date is 1 year from the date of iecoiding unless a different date isspecified) // Signature of Owner Owner's Name ffland, Construction Manager Owner's Address 2459 Shinrock Ct . Deltona, FL 32738 Sworn to and subscribed before me by J.W. McFarland who is personally known to me or produced r duc d as identiiation, and who did _ take an oath, this day of June 20 Uu Signature of Nota ;R.. Sheree D. Crowley Printed Name of Notary go row ey - = Commission NDDI89954 Commission No./Expiration D6 v., Expires: Mar 06, 2007 SEAL: '''i a--.o, Bonded Thru Atlantic Bonding Co., Inc. ALL INFORMATION MUST BE TYPED OR PRINTED LEGIBLY TO COMPLY WITH RECORDING REQUIREMENTS. DEVELOPMENT FEE WORKSHEET CITY OF SANFORD UTILITY - ADMIN. P. O. BOX 1788 SANFORD, FL 32772-1788 Project Name: Phone: Address: 3(, .s-3 Q, LIv4 R Type of Development: 1) RESIDENTIAL W/9t—/`76.27` or,66044 6/2r/ a Date: O, aner/Contact Person: 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 (3/411, 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): Water Meter Size (3/4" 1 211, etc.) REMARKS: CONNECTION FEE CALCULATION: REVISED N 171'tN/jL / LV,^7v"N G Nt / gO r 7r'o.ti/A L Cy 7 n 62 S!w f j.,OgC 7 %f S