HomeMy WebLinkAbout717 W 1 St (3)CITY OF
rySANFORD
Job Address: /
Parcel ID:
Type of Work:
Description of W
,.; Building & Fire Prevention Division
PERMIT APPLICATION
M
MAY 2 2 2013 Q
�Application No:�
BY -
Documented
Construction Value: $
Alteration ❑
Historic District: Yes ❑ No ❑
Residential ❑ Commercial ❑
❑ Change of Use ❑ Move_❑
Plan Review Contact Person: Title:
Phone:
Name
Street:
City, State Zip
Name 1
Street: �t
City, State Zip: —C
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Fax: Email:
—
Property Owner Information
Phone:
Resident of property? :
' Goritractor Information
Phone: Y� 7-��� 7
Fax: 00_2_61-�3
/State License No.: ?/Cy
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, 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: 611 Edition (2017) Florida Building Code
Revised: August 1, 2017 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 1CC 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
Cozonin .
Signature of Owner/Agent Date ignature of ntrac r/Agent Date
J � (7�06
Print Owner/Agent's Name Print Contractor/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
MY CpMMISSI# FF 956284
EXPIRES: March 23, 2020
Bonded Thru Notary Public Underwriters
Conf'ractor/Agent i Personally Known to Me or
Produced ID Type of ID 1" lam. > (—
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
Flood Zone:
# of Stories:
Plumbing - # of Fixtures
Fire Sprinkler Permit: Yes ❑ No ❑ # of Heads Fire Alarm Permit: Yes ❑ No ❑
APPROVALS: ZONING: UTILITIES: WASTE WATER:
ENGINEERING:
COMMENTS:
FIRE:
BUILDING:
Revised: August 1, 2017 Permit Application