HomeMy WebLinkAbout104 Loren Ctt , CITY OF SANFORD
BUILDING & FIRE PREVENTION
JAN PERMIT APPLICATION
Application No:
Documented Construction Value: $
Job Address: X-Y .10���C/ - Historic District: Yes ❑ No ❑
Parcel ID: Residential ❑ Commercial,®
Type of Work: New ❑ Addition ❑ Alteration ❑ Repair ❑ Demo ❑ Change of Use ❑ Move ❑
Description of Work:
Plan Review Contact Person: eog eiNS _r"e, Title: _/i� rJ . - [ a,r Ls*
Phone: Fax:Email:
Property Owner Information
Name AGr GO Q _Pa-L 4--A0'-r r Phone:
Street:
City, State Zip':,"..
�,:..,,�
Name
Resident of property? :
ntractor Information
Phone: ,?gig - 9.4) q- ,3d'8S
Street: �S�D S, '�(2,, Z3,Z ✓42. Fax:
- F -
City, State Zip: D,! %6e4 F"z State License No.:
Architect/Engineer Information
Name: Phone:
Street: Fax:
City, St, Zip: E-mail:
Bonding Company: /1//G� Mortgage Lender:
Address: Address:
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.
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, etc.
FBC 105.3 Shall be inscribed with the date of application and the code in effect as of that date: 5" Edition (2014) Florida Building Code
1�
Revised: June 30, 2015 Permit Application
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 at the time of permit submittal. A copy of the executed contract is required
in order to calculate a plan review charge and will be considered the estimated construction value of the job at the time of submittal.
The actual construction value will be figured based on the current ICC 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,
credit will 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 and zoning.
/— - 18
Signature of Owner/Agent Date Sig6durc of Contractor/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
Print
Signature
Produced ID
s Name
�j
ANNETTE BLAND
Notary Public - State of Florida
Commission # GG 060623
My Comm. Expires Jan 16, 2018
Type of ID
BELOW IS FOR OFFICE USE ONLY
Me or
Permits Required: Building ❑ Electrical ❑ Mechanical ❑ Plumbing[] Gas❑ Roof ❑
Construction Type: Occupancy Use: Flood Zone: _
Total Sq Ft of Bldg:
Min. Occupancy Load:
New Construction: Electric - # of Amps
Fire Sprinkler Permit: Yes ❑ No ❑ # of Heads
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
UTILITIES:
FIRE:
# of Stories:
Plumbing - # of Fixtures
Fire Alarm Permit: Yes ❑ No ❑
WASTE WATER:
BUILDING:
Revised: June 30, 2015 Permit Application
V-
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: 01 /10/2018
I hereby name and appoint: David Cox
an agent of Calkins Electric Construction Company, Inc.
(Name ofCompany)
to be my lawful attorney -in -fact to act for me to apply for, receipt for, sign for and do all things
necessary to this appointment for (check only one option):
X The specific permit and application for work located at:
104 Loren Court, Sanford FL, 32771
(Street Address)
Expiration Date for This Limited Power of Attorney: 1/12/2018
License Holder Name: William Hollenback
State License Number: EC13007869
Signature of License Holder:
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged before me this to day of 3&n,Cr-t2 ,
2001 , by k�i j t o, % "o l l e rigoc�a., —1% who is "ersonally known
to me or o who has produced
identification and who did (did not) take an oath.
RMD
SANTp A-�EjARDS i�asebf Floridaission a GG 06731s. Expires Jan 30, 2021ough Nalional Notary �sn.
(Rev. 08.12)
Sign t'
Print or pe name
Notary Public -State of Clo f ld cA
Commission No. C4 o6-13R
My Commission Expires: Tan ;3010�
as