HomeMy WebLinkAbout128 Bristol Forest TrCITY OF
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DEPARTFIRE
Building & Fire Prevention Division
PERMIT APPLICATION
Application No:
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ocumented Construction Value:
Job Address: ZU o f;'►AC?fjt- :TCCXI Historic District: YesF—]NoD_
Parcel ID: 22 — lq- 10 —: 6 — pninip- — of 76 Residentialatommercia17
Type of Work: New❑ Addition❑ Alteration Repair 11 Demo Change of Use Move
Description of Work:
Plan Review Contact Person:
Phone:._ . ��� �o9a Fax:
Name
Street:
'Tz A
City, State Zip:
Name AuAbr
Street:
City, State Zip:
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Title:
ail:
Property Owner Information
Phone: ��2I . lq6 . 1 7
Resident of property?
01
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Fax: .3&. 73l2- 3Ao
State License No.: CWJ �162% S
Architect/Engineer Information
Phone:
Fax:
E-mail:
Mortgage Lender:
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 taws 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: 6"' Edition (2017) Florida Building Code
Revised: January 1, 2018.Pei mit Application BD
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 wilt 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 lob 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.
Signature of Owner/Agent
Print Owner/Agent's Name
Datc
Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
01 hy
Signature o ,ontmctor/Agent
Print C9�tractor/Agent anv
,- / / r,
gT!-R-3tat ofFlo ida.—.......... Date
�Jotary �ublic - State of Florida
My Cornm. Expires May 21, 2018
�;�Commission # FF 125242
Contractor/A entJ'�' Personall own to Me or
Produced ID g ;/ Type of ID VL- 6�_
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building ❑ Electrical ❑ Mechanical ❑ Plumbing❑
Construction Type: Occupancy Use:
Total Sq Ft of Bldg:
Min. Occupancy Load:
Gas ❑ Roof ❑
Flood Zone:
# of Stories:
New Construction: Electric - # of Amps Plumbing - # of Fixtures
Fire Sprinkler Permit: Yes ❑ No ❑ # of Heads
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
UTILITIES:
FIRE:
Fire Alarm Permit: Yes ❑ No ❑
WASTE WATER:
BUILDING:
Revised: January I, 2018 Permit Application
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a 1 N/A N/A'
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Note
:b 1,N/A. yN/A_
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b 1:.N/A -N/A
$
Note:,
a ! N/A N/A
Note: No Pre NEAT.
Note:.......
Notp
b 1 N/A ,N/A —_
Note:
a 1 N/A NIA
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Note:
b 1, N/A -NA:$
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Note:
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a 1.N A ,N/A:$
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Note:
b liN/A -NM
Note:
Energy, Measures. Sub -Total
_
$ 3,553.00
$ 1,900.00
Disclaimers:
SWS B's are for Reference and may Include many other sections.
Contractor to warrant work to pass bldg. codes & Wx Program,
Contractor verify lead test as needed.
Contractor's Signature Date
Version GBD-5.OlanuayQDla
version o,u
TOTAL $ 4,491.50 $ 2,763.50 $ 72SS.00
Meals on Wheels, Etc. Date
Page two for: Ahyan Tyler
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6A1P ENERGY AUDt1 i7 T ASS ENT &'�'ES711VGff?I2 House Sketch
Ahyan Tyler_
128 Bristol forest Trail v
Sanford FL,32771