HomeMy WebLinkAbout262 Towne Center Cir 12-216Application No:
Job Addressa -"
Parcel ID:
DEC 12 2011
T
CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
.Z / Documented Construction Value: $
Description of Work: —
Plan Review Contact Person:
Phone:
Fax:
Historic District: Yes ❑ No f5`
Zoning:
� F
Title:
E -mail:
Property Owner Information
Name Phone:
Street: Resident of property?
City, State Zip: _
Name
Street:
City, S
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Contractor Information
Phone: l4C5? [(.
Fax: 3a�� 3 2-Z
State License No.:
Hrcrinecvtngineer information
Phone:
Fax:
E -mail:
Mortgage Lender:
Address:
l ,x,3 ,a uria l
pER ,1T NFORMATION
Building Permit S34c ii Ao2ziOmq1
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Square Footage: o s ffurbu Type: No. of Stories:
No. of Dwelling Units: Flood Zone:
Electrical ❑
New Service — No. of AMPS:
Mechanical M Duct layout required for new systems)
Plumbing ❑
.--
New Construction - No. of Fixtures:
Fire Sprinkler /Alarm ❑ No. of heads:
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, sig
air conditioners, etc. us, wells, pools, furnaces, boilers, heaters, tanks, and
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. 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.
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 Florida
Lien Law, FS 713.
The City of Sanford requires payment of a plan review fee. A copy of the executed contract is required in order
to calculate a plan review charge. If the executed contract is not submitted, We reserve the right to calculate the
plan review fee based on past permit activity levels. Should `calculated charges exceed the' documented
construction value when the executed contract is submitted, credit will be applied to your permit fees when the
permit is released.
signature of Uwner /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
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
Rev 11.08
UTILITIES:
1'
Signature o o ctor /Agent Date
Pnnt Contractor Agent's Name
/C9.
Date
RY P �; DEBBIE BLANTON
B
P Notary Public - State of Florida
E My Comm. Expires Feb 25, 2015
Commission # EE 60182
Bonded Through National Notary Assn.
Contractor /Agent is ersonallx own to Me or
Produced ID Type of ID ft U e N- I f 1/ -7/1,(.,
WASTE WATER:
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