HomeMy WebLinkAbout401 W Seminole Blvd 12-1749Application No:/<9
JUN S2012
CITY OF SANFORD
BUILDING &FIRE PREVENTION °
PERMIT APPLICATIONiqufQ
Documented Construction Value;$.—QfitJ I I
JobAddress:Uh ."Te/h'tAi o/e 8/lk^.^HistoricDistrict:Yes D No D
Parcel ID:Zoning:
DescriptionofWork:ts STntr M
Plan Review Contact Person:•S'cqT/'Title:Pac .jSTT
Phone:7^33^Fax:7^3 "7^W E-mail:S^g^/<^r*y<S>i^/itgtOy4rfr f
Name
Street:
Property Owner Information
Phone:
Resident of property?:
City,State Zip:
Contractor Information
Name ^Phone:*^^7 "7^??
Street:3»g?Q A/UJ Fax:f/'-y 7^3-7^^^
City,State Zip:CcS>f"fii State License No.:C^C/5'^5'7//
Name:
Street:
City,St,Zip:
Bonding Company:
Address:
Building Permit •
Square Footage:
No.ofDwelling Units:
Electrical •
New Service~No.ofAMPS:
Architect/Engineer Information
Phone:
Fax:
E-mail:
Mortgage Lender:
Address:
PERMIT INFORMATION
Construction Type:
Flood Zone:
No.ofStories:
Plumbing •
New Construction -No.ofFixtures:
Mechanical •(Duct layout required for new systems)
.3^
Fire Sprinkler/Alarm •No.ofheads:
3^
Applicationisherebymadetoobtainapermittodotheworkandinstallationsasindicated.Icertifythatno
workor installation has commenced priortothe issuance ofapermitandthatallwork will be performed to
meetstandardsofalllawsregulatingconstructioninthisjurisdiction.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 alloftheforegoing information is accurate and that all work will
be done in compliance withall 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:Inadditiontothe requirements of thispermit,theremaybeadditionalrestrictionsapplicabletothis
property thatmaybefoundinthe public records of thiscounty,andtheremaybe additional permits required
fromothergovernmentalentitiessuchaswatermanagementdistricts,stateagencies,orfederalagencies.
AcceptanceofpermitisverificationthatI will notifytheowner ofthepropertyoftherequirementsofFlorida
Lien Law,PS 713.
TheCity of Sanfordrequires payment ofaplanreviewfee.Acopy ofthe executed contract isrequiredinorder
to calculate aplanreviewcharge.If the executed contract is not submitted,wereservetherightto calculate the
planreviewfeebasedonpastpermitactivitylevels.Shouldcalculatedchargesexceedthedocumented
construction valuewhenthe executed contract is submitted,creditwillbeappliedtoyourpermitfeeswhenthe
permit is released.
SignatureofOwner/Agent
PrintOwner/Agent's Name
Signabm^
STEPHANIEWILLIAMS
Notary Public-Stateof Florida|-6 ^I)*|My Comm.Expires Aug 18,2013
Commission #DO 917956
Bonded Througti National Notary Assn.
Owrier/Agentls ^^Person^lylCnown to Me or
Produced ID V Type ofID _
ignature ofConlractor/Agent
PrintContra^wr/Agcnt's Name
Signature ofNotary-State ofFlorid^)Date
Contractor/Agent is
Produced ID
Personally KnowntoMeor
Type ofID
APPROVALS:ZONING:
ENGINEERING:
UTILITIES:WASTE WATER:
BUILDING:FIRE:
COMMENTS:&\l iU
Rev 11.08 NotaryPublicStateofFlorida
T i
Expires 12/19/2015
.DarleneKathryn Gagnon
MyCommissionEE154533