HomeMy WebLinkAbout2391 Key AveCITY a ORD
p _(00='5VF Building & Fire Prevention Division
MAR 2 6 2018
PERMIT APPLICATION
_
FIRE EPART EN'
BY: plication No:
t9 0
Documented Construction Value: $ �v0 s
Job Address: N1 Historic District: Yes[:] Nod
Parcel ID: `0000 ` 00 �(D Residential❑ Commercial❑
Type of Work: New[] Addition[] Alteration[] Repair ❑ Demo ❑ Change of Use El Move ❑
Description of Work: AE --ZWOF SCE _ M A J6 6ES
-Z� w14 )---)Ov✓lv4g�'
Plan Review Contact Person: k s C,/,q y. Titl :
Phone: Lill'1 y3 j� 0'0 Fax: Email: S�� // A ►
Property Owner Information
Name �eA 0l14 )44ATT74 ✓ S%SX
Street: L " «' /
City, State Zip: : J4 ry r( "3
Phone:
Resident of property? :
Contractor Information
Name �/�L-0n Phone: X77 V ,r 0%7b
Street: I i YdM4 /�_ ✓D -h�/n U-.7- Fax:
City, State Zip: (� S sE ni 0 State License No.: C CC 0!�122 0
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
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 laws regulating construction
in this jurisdiction. I understand that a separate permit must be secured for electrical work, plumbing, signs, wells, pools,
furnaces, boilers, beaters, 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: 61 Edition (2017) Florida Building Code
Revised: January 1, 2018 Pernrit Application 110-
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.
F1'at A k 3 -�)o 11'� g pelI"r
'Signature of Uwner/Appnt Date 5ignatw-e o -tractor/Agent Date
of Fto HDRIJI a Sign ture o to
MY ISSION # FF 243W CRYSTAL INDRU
�� MY COMMISSION # FF 243854
EXPIRES: June 24, 2019 "S±= 2019
Bonded Thru Notary Public Underwriters '" EXPIRES: June 24,
Bonded Thru Notary Public Underwriters
Owner/Agent is Personally Known to e or r9 Contractor/Agent is Personall w own to f��r
Produced ID Type of IDr, 1 d� Produced ID Type oft�
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building ❑ Electrical ❑ Mechanical ❑ Plumbing❑ Gas❑ Roof ❑
Construction Type:
Total Sq Ft of Bldg:
Occupancy Use:
Min. Occupancy Load:
New Construction: Electric - # of Amps
Fire Sprinkler Permit: Yes ❑ No ❑
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
# of Heads
UTILITIES:
FIRE:
Flood Zone:
# of Stories:
Plumbing - # of Fixtures
Fire Alarm Permit: Yes ❑ No ❑
WASTE WATER:
BUILDING:
Revised: January 1, 2018 Permit Application
pi
THIS INSTRUMENT PREPARED BY:
Name: LUIS CUADRA
Address: 1495 SEMINOLA BLVD. #1047
CASSELBERRY, FL 32707
NOTICE OF COMMENCEMENT
Permit Number:
Parcel ID Number: 31-19-31-527-0000-0040
HINIM1111110111111111111111111111111
_ -y:4`. +_,,
C.L..E'_4'`.t`. a 2013033054
.[... `. ti f`, i.'.t.t it_I i' i_I._./�'1
The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the
following information is provided in this Notice of Commencement.
1. DESCRIPTION OF PROPERTY: (Legal description of the property and street address if available)
2391 KEY DR SANFORD FL 32771 LOT 4 CEDAR HILL REPLAT PB 63 PGS 96 97 98
2. GENERAL DESCRIPTION OF IMPROVEMENT:
RE ROOF
3. OWNER INFORMATION OR LESSEE INFORMATION IF THE LESSEE CONTRACTED FOR THE IMPROVEMENT:
Name and address: MATTHEW C SISK AND ELADIA S SISK 2391 KEY DR SANFORD FL 32771
Interest in property:
Fee Simple Title Holder (if other than owner listed above) Name:
Address:
4. CONTRACTOR: Name: SKYLINE ROOFING GROUP LLC Phone Number: 407-435-0476
Address: 1495_SEMINOLA BLVD. #1047, CASSEBERRY. FL 32707
5. SURETY (If applicable, a copy of the payment bond is attached): Name: N/A
Address: Amount of Bond:
6. LENDER: Name: N/A Phone Number:
Address:
7. Persons within the State of Florida Designated by Owner upon whom notice or other documents maybe served as provided by Section
713.13(1)(a)7., Florida Statutes.
Name: N/A Phone Number:
Address:
In addition, Owner designates
of
to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Phone number:
9. Expiration Date of Notice of Commencement (The expiration is 1 year from date of recording unless a different date is specified)
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE
CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13, FLORIDA STATUTES, AND CAN 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 COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true to the best of my knowledge and
beli�1106 q�K
ef
(Signature of ovp6r or Lessee, or Ovmer's or Lessee's
Authorized Officer/Director/Pariner/Manager)
(Print Name and Provide Signatory's Title/Office)
State of 0 0 Y � ( 4//1 County of-0 (A At
The foregoing insstrrum mtw�as, acknowledged before me this day of
by 1y l a of .�aK--
Name of person making statement
who has produced identification tion produced:
CRYSfALINDRUMS
MY COMMIS dOuN F 2
>ntarb>anpf*u3895
°'r CQPy G"rTHE C1
N
A+%Iri CV`_,.' TiPTI,! i G/.H w
Who is personally known to me ❑ OR
vai t � n
DtEylrP/ CI,iR
SCPA Parcel View: 31-19-31-527-0000-0040
Page 1 of 2
frAC Property Record Card
P P Parcel: 31-19-31-527-0000-0040
sckcNoU_ COUNTY, FI.Cx Property Address: 2391 KEY DR SANFORD, FL 32771
Parcel Information
Parcel
31-19-31-527-0000-0040
Owner
SISK, MATTHEW C
SISK, ELADIA S
Property Address
2391 KEY DR SANFORD, FL 32771
Mailing
2391 KEY DR SANFORD, FL 32771
Subdivision Name
CEDAR HILL REPLAY
Tax District
S1-SANFORD
DOR Use Code
01-SINGLE FAMILY
Exemptions
00-HOMESTEAD(2016)
N
W
a6 55.72 w �t
a
w
x
Legal Description
LOT 4
CEDAR HILL REPLAT
PB 63 PGS 96 97 & 98
Taxes
.25
Seminole ounty GIS
Value Summary
2018 Working
2017 Certified
Values
Values
Valuation Method
Cost/Market
Cost/Market
Number of Buildings
1
1
Depreciated Bldg Value
$135,010
$127,254
Depreciated EXFT Value
$380
$400
Land Value (Market)
$32,000
$30,000
Land Value Ag
Just/Market Value "
$167,390
$157,654
Portability Adj
Save Our Homes Adj
$24,160
$17,370
Amendment 1 Adj
$0
P&G Adj
$0
$0
Assessed Value
$143,230
$140,284
Tax Amount without SOH: $2,214.00
2017 Tax Bill Amount $1,883.00
Tax Estimator
Save Our Homes Savings: $331.00
Does NOT INCLUDE Non Ad Valorem Assessments
Taxing Authority
Assessment Value
Exempt Values
Taxable Value
County General Fund
$143,230
$50,000
$93,230
Schools
$143,230
$25,000
$118,230
City Sanford
$143,230
$50,000
$93,230
SJWM(Saint Johns Water Management)
$143,230
$50,000
$93,230
County Bonds
$143,230 .
$50,000
$93,230
Sales
Description
Date
Book
Page
Amount Qualified
Vac/Imp
WARRANTY DEED
6/1/2014
08282
1577
$137,000 Yes
Improved
CORRECTIVE DEED
6/1/2014
08288
0515
$100 + No
Improved
WARRANTY DEED
6/1/2012
07793
0978
$112,500 Yes
Improved
WARRANTY DEED
5/29/2009
07206
0042
$140,000 No
Improved
WARRANTY DEED
1/1/2006
06078
1713
$267,000 Yes
Improved
CORRECTIVE DEED
7/1/2004
05395
1088
$100 ' No
Vacant
SPECIAL WARRANTY DEED
1/1/2004
05164
1033
$122,700 , No
Vacant
�ntii'C'oni'parabje Sales
Land
- -I
Method
Frontage
Depth
Units
Units Price
Land Value
LOT 1 $32,000.00 $32,000
Building Information
http://parceldetail.scpafl.org/ParcelDetaillnfo.aspx?PID=31193152700000040 3/26/2018
SCPA Parcel View: 31-19-31-527-0000-0040
Page 2 of 2
-Is Bed/Bath count incorrect? Click Here
#
Description
Year Built
Actual/Effective
Fixtures
Bed
Bath
Base Area
Total SF
Living SF
Ext Wall
Adj Value
FRepl Value
Appendages
1 SINGLE 2005 8 ' 4 ` 2_0 1,872 2,494 1,872 CB/STUCCO $135,010 $141,372
Description
Area
FAMILY FINISH
GARAGE 437.00
FINISHED
OPEN
PORCH 135.00
FINISHED
OPEN
PORCH 50.00
FINISHED
Permits
Permit #
Description
Agency
Amount
CO Date
Permit Date
D2095
6' ALUMINUM FENCE
'SANFORD
$2,480
7/30/2012
D2143
182' X 6' VINYL FENCE
SANFORD
$4,110
7/16/2009
D0832
PAD PER PERMIT 2391 KEY AVE
SANFORD
$90,644 11/29/2005
10/28/2004
Extra Features
Description
Year Built
Units
Value
New Cost
SHED
5/1 /2012 1 $380 $500
http://parceldetail.scpafl.org/PareelDetailInfo.aspx?PID=31193152700000040 3/26/2018
1495 Seminola Blvd. #1047 # (asselberry, Florida 32707
officei (321) 203.2250
cell: (407) 435.0476
SkylineRoofingGroup@gmail.com
(((057220
TO: Matthew Sisk -�
2391 Key Ave.
Sanford, FL 32771
ATT: Matthew Sisk
ESTIMATE/CONTRACT
s i SK
SUBJECT: Re -roof at 2391 Key Ave., Sanford, FL 32771
Scope of work to be completed:
• Provide all required permits
• Remove approximately 37 SQ of shingles (1 Layer) Owens Corning
• Install new Synthetic Underlayment- Rhyno or Robotech
• Install New 30YR. Architectural Shingles 37 SQ
March 6, 2018
• Re -nail deck to meet County Code
Repair any rotted wood deck plywood. It will be charged at $55.00/ply material and labor
• Fascia board and other to be repaired will be charged at $5.501LF material and labor
• New eaves drip metal
• Roof cement all required areas
• New valley material as required
• New Bullet boots and goose vents
• New cobra ridge vents
• Clean up and haul off debris
Note: All labor and material included in price. Wood repairs not included in price. 30 Year Manufacture
Warranty. Contractor will be placing wheel dumpster on driveway for roof debris.
Payment: 50% upon commencement and 50% upon completion.
SHINGLE ROOF TOTAL: $129200.00
Accepted by: J
Prepared By; Lulis CUadra-Vice President
PERMIT #
Building & Fire Prevention Division
RESIDENTIAL RE -ROOF SCOPE OF WORK
JOB ADDRESS: �! A_jF-
STRUCTURE TYPE: INGLE FAMILY RESIDENCE/TOWNHOUSE O MOBILE HOME O APARTMENT/CONDOMINIUM
RE -ROOF TYPE: REPLACEMENT (TEAR OFF EXISTING ROOF AND REPLACE WITH NEW COMPONENTS)
RE-COVER (NEW ROOF INSTALLED OVER EXISTING OOF) /
DECK TYPE (PLEASE SPECIFY): Z
**PLEASE NOTE: ONLY 100 S U.4RE FEET OF THE EXISTING DEC
ROOF VENTILATION: ( GE O RIDGE OSOFFIT
TO BE REPLACED**
OPOWERED VENT OTURBINES
SKYLIGHTS: O YES NO IF YES, PLEASE PROVIDE FLORIDA PRODUCT APPROVAL #:
MAIN ROOF AREA
ROOF SLOPE: O LESS THAN 2:12 O 2:12 —4:12 0 412 OR GREATER
TYPE OF ROOF
MANUFACTURER
FLORIDA PRODUCT APPROVAL
SHINGLE
FL#
O METAL
FL#
O MODIFIED BITUMEN
FL#
O TORCH DOWN
FL#
OINSULATED
FL#
OT
FL#
OTHER: 4 L b�
FL# / / / / r
ROOF EXTENSIONS (PORCHES, PATIOS, ETC.) **IFAPPLICABLE**
ROOF SLOPE: O LESS THAN 2:12 O 2:12 - 4:12 O 4:12 OR GREATER
TYPE OF ROOF
MANUFACTURER
FLORIDA PRODUCT APPROVAL
O SHINGLE
FL#
O METAL
FL#
O MODIFIED BITUMEN
FL#
O TORCH DOWN
FL#
OINSULATED
FL#
O TnLE
FL#
O OTHER :
FL#
Category / Subcategory
Manufacturer
Product
Description(including
Florida Approval #
decimal
3. Panel Walls
Siding
Soffits
Storefronts
Curtain Walls
Wall Louver
Glass block
Membrane
Greenhouse
E.P.S Composite
Panels
Other
4. Roofing Products
Asphalt Shingles
Underla ments
Roofing Fasteners
Nonstructural
Metal Roofing
Wood Shakes and
Shin les
Roofing tiles
Roofing
Insulation
Waterproofing
Built up roofing
System
Modified Bitumen
Single Ply Roof
Systems
Roofinq slate
Cements/
Adhesives /
Coating
Liquid Applied
Roofing Systems
Roof Tile
adhesive
Spray Applied
Polyurethane
Roofing
E.P.S. Roof
Panels
Roof Vents
Other
June 2014
CITY OF'
NANFORD Building & Fire Prevention Division
RESIDENTIAL RE ROOF POLICY & PROCEDURES
FIRE D ARTM NT
PERMITTING REQUIREMENTS — NO PLAN REVIEW REQUIRED
THIS DOCUMENT (SIGNED) ALONG WITH AN ACCURATE AND COMPLETED RESIDENTIAL RE -ROOF SCOPE OF WORK ARE
REQUIRED TO BE SUBMITTED AS PART OF YOUR PERMIT APPLICATION.
THE SCOPE OF WORK MUST INCLUDE ALL APPLICABLE FLORIDA PRODUCT APPROVAL NUMBERS FOR ALL ROOF
COMPONENTS THAT WILL BE INSTALLED ON THE PROJECT.
A PERMIT WILL NOT BE ISSUED WITHOUT THESE DOCUMENTS. COPIES WILL BE MADE TO POST ON THE JOB SITE.
**PROJECTS LOCATED IN THE SANFORD HISTORIC DISTRICT WILL REQUIRE PLAN REVIEW AND APPROVAL BY THE
SANFORD HISTORIC PRESERVATION BOARD
INSPECTION POLICY & PROCEDURES
A FINAL ROOF INSPECTION IS THE ONLY INSPECTION REQUIRED FOR RESIDENTIAL (SINGLE FAMILY, TOWNHOUSE,
MOBILE HOME, APARTMENT AND/OR CONDOMINIUM) RE -ROOF PERMITS.
THE FOLLOWING IS REQUIRED TO BE PROVIDE ON THE JOB SITE:
• PERMIT CARD, POSTED IN A CONSPICUOUS AND WEATHERPROOF LOCATION
• COMPLETED RESIDENTIAL RE -ROOF SCOPE OF WORK
• COMPLETED AND NOTARIZED INSPECTION AFFIDAVIT
• ALL FLORIDA PRODUCT APPROVAL AND CORRESPONDING INSTALLATION INSTRUCTIONS
(PRODUCT APPROVAL SHALL MATCH WHAT IS ON THE SCOPE OF WORK)
• DIGITAL PHOTOGRAPHS (MUST INCLUDE THE PERMIT NUMBER OR ADDRESS IN EACH PICTURE)
o EACH PLANE OF THE ROOF, SHOWING THE UNDERLAYMENT INSTALLED
o ROOF DECK NAILING PATTERN & SPACING (INCLUDING A MEASURING DEVICE OR RULER)
o ROOF DECK NAILS USED (INCLUDING A MEASURING DEVICE OR RULER SHOWING SIZE OF NAILS)
o UNDERLAYMENT PATTERN & SPACING (INCLUDING A MEASURING DEVICE OR RULER)
o DRIP EDGE & VALLEY ATTACHMENT (INCLUDING A MEASURING DEVICE OR RULER)
o SHINGLES INSTALLED, NAIL PATTERN AND LOCATION OF NAILS
• SKYLIGHTS (IF APPLICABLE)
o DIGITAL PHOTOGRAPHS SHOWING ALL INSTALLATION COMPONENTS, PER FL PRODUCT APPROVAL
o DIGITAL PHOTOGRAPHS SHOWING ALL REQUIRED FLASHING, PER FL PRODUCT APPROVAL
FAILURE TO FOLLOW THESE SPECIFIC GUIDELINES WILL RESULT IN AN AFFIDAVIT PROVIDED BY A FLORIDA DESIGN
PROFESSIONAL (ARCHITECT OR ENGINEER), CERTIFYING FBC CODE COMPLIANCE BY PERSONAL INSPECTION.
-�
CONTRACTOR (OR OWNER/BUILDER) SIGNATURE: DATE: .�
14, . City of Sanford
tr Building aI . `l 1 L
Product Approval Specification Form
Permit #
Project Location Address
As required by Florida Statute 553.842 and Florida Administrative Code 9N-3, please provide the
information and product approval number(s) on the building components listed below if they are to be
utilized on the construction project for which you are applying for a building permit. We recommend that
you contact your local product supplier should you not know the product approval number for any of the
applicable listed products. Be aware that windows, skylights, and exterior doors must be tested in
accordance with the Florida Building Code, Section 1714.5. More information about Statewide Product
Approval can be obtained at www.floridabuilding.org.
The following information must be available on the jobsite for inspections:
1. This entire product approval form
2. A copy of the manufacturer's installation details and requirements for each product.
Category/Subcategory
Manufacturer
Product
Description
Florida Approval #
(include decimal)
1. Exterior Doors
Swinging
Sliding
Sectional
Roll Up
Automatic
Other
2. Windows
Single Hun
Horizontal Slider
Casement
Double Hun
Fixed
Awning
Pass Through
Projected
Mullions
Wind Breaker
Dual Action
Other
June 2014
Building & Fire Prevention Division
RESIDENTIAL RE ROOFAFFIDAVIT
RESIDENTIAL RE -ROOF INSPECTION AFFIDAVIT
NAILING, SHEATHING, DRY -IN, FLASHING, AND ALL FINAL ROOF COVERINGS
PERMIT #: �/ ADDRESS: 3 /
3a:71
I (. DA014, , AS A(N) GENERAL, BUILDING, RESIDENTIAL, OR
ROOFING CONTRACTOR, ENGINEER, ARCHITECT, OF F.S. CHAPTER 468 BUILDING INSPECTOR, I HEREBY AFFIRM, THAT ALL OF THE
FOREGOING INFORMATION IS TRUE AND ACCURATE AND THAT ALL ROOFING COMPONENTS LISTED ON THE SCOPE OF WORK AT THE
ABOVE REFERENCED ADDRESS HAVE BEEN INSTALLED IN ACCORDANCE WITH THEIR PRODUCT APPROVALS AND ALL APPLICABLE CODE
REQUIREMENTS — SPECIFICALLY FLORIDA BUILDING CODE, EXISTING BUILDING. IN ADDITION I CERTIFY THE INSTALLATION MEETS ALL
REQUIREMENTS FOR SECONDARY WATER BARRIER AND NAILING OF THE ROOF DECK, IN ACCORDANCE WITH THE HURRICANE RETROFrr
MANUAL REQUIREMENTS (BASED ON F.S. CHAPTER 553.844).
LICENSE ##:
COMPANY / CONTRACTOR:
CONTRACTOR SIGNATURE:
(MUST BE SIGNED BY LICENSE HOLDER OR
A FINAL ROOF INSPECTION IS REQUIRED:
DATE:
THIS SIGNED AND NOTARIZED AFFIDAVIT MUST BE PROVIDED AT THE JOB SITE AT THE TIME OF THE FINAL ROOF INSPECTION,
ALONG WITH DIGITAL PHOTOGRAPHS OF EACH PLANE OF THE ROOF SHOWING IN DETAIL ALL COMPONENTS (DECKING,
UNDERLAYMENT, FLASHING, DRIP EDGE ATTACHMENT) WITH THE PERMIT NUMBER OR ADDRESS CLEARLY MARKED ON THE DECK
FOR EACH INSPECTION. THE PHOTOGRAPHS MUST INCLUDE A RULER OR MEASURING DEVICE TO CONFIRM ALL NAIL SPACING AND
OVERLAPS, INCLUDING DRIP EDGE AND VALLEY FLASHING. PLEASE REFER TO THE RE -ROOF POLICY AND INSPECTION PROCEDURE
PAPERWORK FOR FURTHER EXPLANATION OF ALL REQUIREMENTS.
**FAILURE TO FOLLOW ALL REQUIREMENTS WILL RESULT IN A FAILED INSPECTION, A RE -INSPECTION FEE AS
WELL AS REQUIRING A DESIGN PROFESSIONAL (ARCHITECT OR ENGINEER) TO CERTIFY, BASED ON PERSONAL
INSPECTION, THE INSTALLATION OF ALL ROOFING COMPONENTS.
STATE OF FLORIDA COUNTY OF 001
Sworn to and Subscribed before me thi& day of 20 w by:
Who is ❑ Personally Known to me or has kroduced (type of
id tiffn) as identification.
Sign of Nota ublicCRYSTAL INDRUNAS
ate of Flori :* , E MY COMMISSION M FF 243854
" '' EXPIRES: June 24, 2019
Rf�� 4Bonded Thru Notary Public Unden+riters
Print a/Stamp Name
of Notary Public
Category / Subcategory
Manufacturer
Product
Description
Florida Approval #
include decimal
5. Shutters
Accordion
Bahama
Colonial
Roll up
Equipment
Other
6. Skylights
Skylights
Other
7. Structural
Components
Wood Connectors /
Anchors
Truss Plates
Engineered Lumber
Railing
Coolers/Freezers
Concrete Admixtures
Precast Lintels
Insulation Forms
Plastics
Deck / Roof
Wall
Prefab Sheds
Other
8. New Exterior
Envelope Products
Applicant's Signature
Applicant's Name _
(Please Print)
June 2014 3