HomeMy WebLinkAbout117 palmetto ave 19-000042ytohp OF
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Parcel ID:
PERMIT APPLICATION
Application No:
Documented Construction Value:
Type of Work: New ❑ Addition ❑ Alteration ❑
Description of Work:
Plan Review Contact Person:
Phone:4W 92-4 �U V� Fax:
Name
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Historic District: Yes [3 No ❑
Residential ❑ Commercial 0
❑ Demo ❑ Change of Use ❑ Move ❑
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Property Owner Information
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Resident
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Resident of property?
Contractor Information -
Phone: �� 1 ®9Z
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Fax:
State License No
Architect/Engineer Information
Phone:
Fax:
&mail:
Mortgage Lender:
Address:
WARNING TO OWNER: YOUR FAIIARETO RECORD A NOTICE OF COMMENCEMENT MAYRESULT 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
Application is heieby made to obtain a permit to do the workand 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,
etc. �\ C"k 6LA
PBC 105.3 Shall be inscribed with the date of application and the code in effect as of that date: 6u' Edition (2017) Florida Building Code
ON TICS:Inadditiontotherequirementsofthispermit,theremaybeadditionalrestrictionsapplicabletothispropertythatmaybefoundinthepublic
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 at the time of permit submittal. A copy of the executed contract is required in order to
calculate a plan reviewcharge andwillbe considered the estimated constructionvalue of the job at the time of submittal. The actual constructionvalue.,
will be figured based on the currentICC Valuation Table in effect at the time the permit is issued, in accordance with local ordinance. Should calculated
charges figured off the executed contract exceed the actual construction value, creditwill be applied to your permit fees when the permit is issued.
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 an�zoning.
Signature of Owner/Agent Date Sign ofContrn r/Agent Date
Print Owner/Agent's Name Print Contractor/Agent's Name
Signature of Notary -State of Florida Date Signature of Notary -S tION
MY COMMISSION 4 FF 17P,548
'•: ; EXPIRES: Fetxuary 25.2019
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Owner/Agent is _ Personally Known to Me or Contractor/Ag son own to Me or
Produced ID Type of ED Produced ID Type of ID
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building ❑ Electrical ❑ Mechanical ❑ Plumbing ❑ Gas ❑ Roof ❑
Construction Type: Occupancy Use: Flood Zone:
Total Sq Ft of Bldg: Min. Occupancy Load: # of Stories:
New Construction: Electric - # of Amps Plumbing - # of Fixtures
Fire Sprinkler Permit: Yes ❑No ❑ # of Heads Fire Alarm Permit: Yes ❑ No ❑
APPROVALS: ZONING: UTILITIES: WASTE WATER:
ENGINEERING: FIRE: BUILDING: