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HomeMy WebLinkAbout514 Palmetto Ave 17-1230; WATERHEATERMAY - 1 2017 ti CITY OF SANFORD BUILDING & FIRE PREVENTION PERMIT APPLICATION Application No: I I- J I b Documented Construction Value: $ - , 020-DO Job Address: t% a _ on ft , :j10. Historic District: Yes © No Parcel ID: a ]q-305w(g-Ci-7oa -OD4U Residential N Commercial Type of Work: New Addition AlterationFT Repair Demo Change of Use Move Description of Work: f 11'lQ 'iDhKl Y.IPn tifl/t -RUIIQ (3Vtll 1 tt,Q Plan Review Contact Person: Ah'su Yl J) '—b u—p Title: 0)(V%rJt&(03- Phone: op ` T( 4 - ta44 Fax: Email: Property Owner Information Name now Phone: Street: 1y S'- W1(V,a-'Ub 06-LQ- Resident of property? : 1f City, State Zip:, 'F61CA R- Sam k J Contractor Information Name C Phone: y Q ` -n A -90 4'A Street: F` ( ` ( y g Fax: 3 —n) j l(-i t City, State Zip: Q - ', _. a j}C State License No.: CIEMS71949 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, 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'h Edition (2014) Florida Building Code O Revised: June 30, 2015 Pennit 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 ca tr ction and zoning. Signature of Owner/Agent Date ntractor/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 Vt C,t' O Z-2 t Print Contactor/Agent's Name s 17 Signature of Notary -State of Florida MWa L plorio NOTARY PUBUO STATE of FuMDA Explrea X1712020 Contractor/Agent is Personally Known to Me or Produced ID Type of ID BELOW IS FOR OFFICE USE ONLY Permits Required: Building Electrical Mechanical Plumbing Construction Type: Total Sq Ft of Bldg: Occupancy Use: Min. Occupancy Load: Gas ] Roof Flood Zone: 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: COMMENTS: FIRE: BUILDING: SF 2-1-7 Revised: June 30, 2015 Permit Application 4110/2017 senar oes cx x+"rv, rt,t%ixaw Parcel information SCPA Parcel View: 25-19-30-5AG-0702-0040 Prope ft Record Card Parcel: 25-19-30-5AG-0702-0040 Owner: SHREVE MARIA S Property Address: 514 PALMETTO AVE SANFORD, FL 32771 i a tr iu Seininale County GIS Legal Description S 40 FT OF LOT 4 + ALL LOT 5BLK7TR2 TOWN OF SANFORD PB 1 PG 59 Value Summary 2017 Working 1 2016 Certified Values Values Valuation Method Cost/Market Cost/Market Number of Buildings t 1 1 Depreciated Bldg Value $55,383 53,568 Depreciated EXFT Value Land Value (Market) $32,980 26,190 Land Value Ag JustMarketValue" $88,363 79,758 Portability Adj Save Our Homes Adj $0 0 Amendment 1 Adj $629 0 PSG Adj $0 0 Assessed Value $87,734 79,758 Tax Amount without SOH: $1,599.00 20 o_TaxBillRmoimt $1,599.00 Tax Estimator Save Our Homes Savings: $0.00 TRIM Notice He!R Does NOT INCLUDE Non Ad Valorem Assessments Taxes Taxing Authority Assessment Value Exempt Values i Taxable Value i County General Fund 87.734 0 87,734 . s Schools 388.363 1 0 88,363 City Sanford 87,734 0 87,734 SJWM(Sainl Johns Water Management) 5 87.734 i..-...... 0 ' 87,734 County Bonds 87,734 0 . 87,734 Sales e.,..__..._......__...._._..._..._.___......_.._.__...____._.._.. Description Date i_......_._..._.___._..._..._.._._..__._.._....._....,.._.._..____-_.. Book Page Amount } Qualified j Vaclimp WARRANTY DEED 1/1/2015 08625 1749 104.000 Yes Improved WARRANTY DEED 1/111977 01149 0971 18,500 Yes Improved Frontage i Depth Units I Units Pnce _Land Value 97.00 ' 117.00 i 0-$340.00 ounumg mrormaaon 32,980 I # Description ActaBllElftective Fixtures ;Bed Bath ;Base Area I Total SF I Living SF 1 Ext Wall j Adj Value ^ Rapt Value 'Appendages 1 httpJ/parceldetail.scpafl.orgfParcelDetailinfo.aspx?PID=2519305AG07020040 112 dotloop signature verification: °s•, s.nr.Ucaa.r= s=,:rr, n: f;€--2T,; i_Z,;ai.:?...2` i Gas Plumbing Services Inc. 590 W. Main St. Lake Helen, FL. 32744 Office: 386-774-8244 Fax: 386-775-1749 Maria Screve 514 S Palmetto Avenue Sanford, FL. 32771 t A terms and conditions document must be signed and returned to G.P.S. prior to getting on our schedule. PLEASE NOTE: Prices are subject to change if changes are made to a job after signing the contract. If the footage changes due to any unforseen reason G.P.S. will notify the customer immediately. Any footage costs not previously quoted due to changes, such as mother nature or personal preference will be the responsibility of the signer on contract. Any additional trips required by our company not due to G.P.S. error are billable to the contract signer. Any failed inpsections not due to G.P.S. error will be billed to the contract signer before final inspection is performed. A restocking fee will apply to all parts and/or appliances returned. Any labor or parts that are not covered under your equipments manufacturer warranty will be billed directly to the signer of the contract All custom orders are final sale. This estimate is good for 30 days. After the expired date, the price maybe subject ftochange,.,E TOiial $1,090.00 doNooPPver92EOi MOHK-UD7 .M5, O4REOFACCEPTANCE NOTICE TO CONSUMER: BY SUBMITTING CHECKS FOR PAYMENT. I AGREE AND AUTHORIZE MERCHANT, OR ITS AGENT, UPON RECEIPT OF MY CHECKS, TO CONVERT THE CHECKS TO ELECTRONIC PAYMENT ITEMS OR DRAFTS AND TO SUBMIT ANY ONE OR ALL OF THEM FOR PAYMENT AS ACH DEBIT ENTRIES TO MY ACCOUNT, IN ACCORDANCE WITH THE SAME TERMS AND CONDITIONS AS THE CHECKS SUBMITTED. Customer E-mail I Customer Contact I Customer Phone housegirl905@gmaii.com 1 1 407-474-9961 Gas Plumbing Services, Inc. 590 W. Main Street - Lake Helen, F! 32744 Office: (386) 774-8244 Fax: (386) 775-1749 STATE LICENSE # : CF-CO57948 LP LICENSE # : LP-17000 PERMIT # : BUILDER: ADDRESS: MODEL # : GAS TYPE : e* l 1 DELIVERY PRESSURE: PIPE TYPE: CSST/ GALVANIZED LONGEST RUN: S FURNACE: G OP. - RANGE: WATER HEATER : DRYER: FIREPLACE: GRILL: 6d k SPA/POOL HEATER: OTHER: C) r_ m O(nDC > C)O m6Cmv DATE: O om=7-r m m zO7 7D' K c0 --{0- OfD=O MC Opz>=OOm zSOrm<ma O O-00-MMCn e 7 D n siQ5CD<m*rOODzcn- -I p ? l tiT p Z mZD-{m Z-nOou)rnmO cn K D m m* IV T 6 nO=m2DMm CJ4 TV-:MTzo 0 0 -0 :q 0 m Z>>y ft TOTAL LOAD : 30-0 J SIZING TABLE USED: n'p'G P, 4q_ 1 CREATED BY: LA R, 0 0 A HISTORIC PERMIT Y All work ow be done in strict accordance with the Approved Certificate of Appropriateness D Build doer sot approve any work outside this scop, Pewit Applicant is coley responsible for compliance CERTIFICATE OF APPROPRIATENESS HISTORIC PRESERVATION BOARD CITY OF SANFORD 300 S. Park Avenue Sanford, Florida 32771 407.688.5145 • www.sanfordfl.gov/HP THIS DOCUMENT MUST BE POSTED AT ALL TIMES UNTIL PROJECT IS COMPLETED. ISSUED TO: DATE ISSUED: Maria Shreve April 27, 2017 for 3 0 514 Palmetto Avenue DATE EXPIRES: Sanford, FL 32771 October 27, 2017 BP# 17-1220` Approved to install gas lines for range, furnace, and water heater at the rear of the property, per locations depicted on the attached drawing. No appurtenances are proposed to be installed on the exterior of the building. Should any items such as a water heater, meter box, or other utity items be proposed for the exterior, a separate CofA denoting the dimensions, design, and location ust e submitted. zy Christine Dalton, AICP Historic Preservation Officer/Community Planner Please be advised it is the owner and/or agent's responsibility to notify staff of any potential changes from the approved COA that arise and obtain approval prior to commencing the changes. This Certificate of Appropriateness does not constitute final development approval. The applicant is responsible for obtaining all necessary permits and approvals from applicable departments before initiating development. IS A BUILDING PERMIT REQUIRED FOR THE ACTIVITY LISTED ABOVE? 0 YES NO Building Department Representative iF7 APPLICATION # 0. 1 ??D FOR A CERTIFICATE OF APPROPRIATENESS Answer all the questions on this form and submit all required attachments. Incomplete applications will not be reviewed. if you have questions about application requirements contact the Historic Preservation Officer at407.688.6146 to ensure your application Is complete. General Information Downtown Commercial Historic District © Residential Historic District Is this a retroactive request? []Yes ff] No Is this application filed in response to a Notice of Violation from the Code Enforcement Department? Yes [TNo Proposed improvements will affect the following elevations: n North N South East P§West Property Address: OA 9• WwaRb akw- Property Owner Information Print Name: M\ok S - Sh y - fi % Mailing Address: 5Jq g•wtQ Q- l l[i[ 7 Phone: YVl Email: j, Signature: IP-DING OR Applicant/Agent information 5 R Print Name: • of c Mailing Address: M0 - Y>-6VI Q-X! 391-1 Phone: VYp—111$a Ema11: s4CWr (10_((4dtiy ibi @hl __)T Caignature: BY SIGNING BELOW YOU ACKNOWLEDGE THAT A BUILDING PERMIT MAY BE REQUIRED FOR THE SCOPE OF WORK LISTED BELOW. YOU MUST CONTACT THE BUILDING DEPARTMENT TO DETERMINE IF A BUILDING PERMIT IS REQUIRED. FAILURE TO OBTAIN A BUILDING PERMIT OR DEVIATION FROM AN APPROVED CERTIFICATE OF APPROPRIATENESS WILL RESULT IN A STOP WORK ORDER, DOUBLE PERMIT FEES, AND POTENTIAL FINES. BY SIGNING BELOW, YOU ALSO ACKNOWLE I THAT THE INFORMATION CONTAINED IN THIS APPLICATION IS TRUE AND ACCURATEE BEST OF YOUR KNOWLEDGE. Date: q—( d" - 17 Yes, I would you like to receive emaits regarding Historic Preservation and Community Planning within your community. Description of proposed work Completely describe the entire scope of work, including changes in material and color, and methods that will be used to accomplish the proposed work. For large projects an itemized list is required. Use the reverse side if necessary. kJSTR G, lac s To /Lieu l rini c ,,,/N't . N Cn4 Wswgrr P,- R1141'AT All work must be done in strict accordance with the Permit Applicant is soley responsible for compliance HISTORIC PRESERVATION BOARD • 300 N. Park Avenue - Sanford, Florida 32771 •407.688.5145 • www.sanfordfl.gov/HP APPLICATION-# 17, I ZD FOR A CERTIFICATE OF APPROPRIATENESS Supplemental Information - Please use the space below to provide additional details regarding proposed work. Description of proposed work (continued from previous page): A 17 30 HISTORIC PERMIT All work must be done in strict accordance with the Approved Certificate of Appropriateness Building does not approve any work outside this scope Permit Applicant is soley responsible for compliance HISTORIC PRESERVATION BOARD • 300 N. Park Avenue • Sanford, Florida 32771 9407.688.5145 • www.sanfordfl.gov/HP REQUIRED INSPECTION SEQUENCE RR# I-1 — 12'SO Address: 157c •.t S• e rp BUILDING PERMIT Min Max Ins ectionn Descrll Lion Footer / Setback Stemwall Foundation / Form Board Survey Slab / Mono Slab Prepour, . Lintel / Tie Beam / Fill / Down Cell Sheathing — Walls Sheathing — Roof Roof Dry In Frame Insulation Rough In Firewall Screw Pattern Drywall / Sheetrock Lath Inspection Final Solar Final Firewall Final Roof Final Stucco / Siding Insulation Final Final Utility Building Final Door Final Window Final Screen Room Final Pool Screen Enclosure Final Single Family Residence Final Building (Other) ELECTRICAL P.ERMIT Min Max Insl2ection Descri Lion Electric Underground Footer / Slab Steel Bond Electric Rough T.U.G. Pre -Power Final Electric Final d Minn I max I Inspection Description Mechanical Roug Mechanical Final 11 Min I Max I Inspection Description Gas Underim 0 1 1 Gas Rough 11-y-D I I Gas Final REVISED: June 2014 City of Sanford Building & Fire Prevention Division Residential Permit Card PERMIT NO. • 7 ®0 /07ISSUEDATE: • 0 3 A CONTRACTOR: JOB ADDRESS: TYPE Of Post this permit in a conspicuous location outside Loofe all work uncovere I in cte profbe Approved plans must be posted with permit for inspection Permit expires C month e o a s PROTECT FROM WEATHER BUILDING INSPECTIONTYPE APPROVED REJECTED INSPECTOR ELECTRICAL INSPEC77ON TYPE APPROVED REJECTED INSPECTOR FOOTER INSPECTION ELECTRIC UNDERGROUND STEMWALL FOOTER/SLAB STEEL BOND FORMBOARD SURVEY T.U.G. / PRE POWER SLAB / MONO -SLAB ELECTRIC ROUGH LINTEL / TIE BEAM ELECTRIC FINAL SHEATHING - ROOF MECHANICAL INSPECTION TYPE APPROVED REJECTED INSPECTORSHEATHING - WALLS FRAME MECHANICAL ROUGH INSULATION ROUGH IN MECHANICAL FINAL DRYWALL/SHEETROCK PLUMBING INSPECTION TYPE APPROVED REJECTED INSPECTORLATHINSPECTION FINAL STUCCO/SIDING UNDERGROUND ROUGH FIREWALL SCREW TUB SET FIREWALL FINAL SEWER INSULATION FINAL PLUMBING FINAL FINAL SFR GAS INSPECTIONS INSPECTION TYPE APPROVED REJECTED INSPECTORROOF INSPECTION TYPE APPROVED REJECTED INSPECTOR GAS UNDERGROUND PIPE ROOF DRY -IN GAS ROUGH -IN FINAL ROOF IGAS FINAL MISCELLANEOUS / FINAL INSPECTIONS INSPECTION TYPE APPROVED REJECTED INSPECTOR INSPECTION TYPE APPROVED REJECTED INSPECTOR PRE -DEMO FINAL DOOR FINAL DEMO FINAL WINDOW FINAL SOLAR PANELS IRRIGATION FINAL FINAL POOL SCREEN FINAL SCREEN ROOM FINAL UTILITY BUILDING FINAL BUILDING (OTHER) MOBILE HOME TIE -DOWN MOBILE HOME FINAL I 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. 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 FBC 105.3.3 REVISED: OCTOBER 2014 Inspection Line: 855.541.2112 TO SCHEDULE AN INSPECTION: Dial 407.792.6069 or 855.541.2112 Provide the items requested during the message The type of inspection requested must be scheduled under the appropriate permit type Follow the prompts To Schedule Fire Inspections: Please call 407.562.2786 *** PLEASE NOTE: Inspections scheduled by 3:30 p.m. will be conducted the next business day. If you experience difficulty, please call 407.688.5150 Monday - Thursday 7:30 am - 5:30 pm for assistance. AUTOMATED INSPECTION SYSTEM CODES BUILDING ELECTRICAL FOOTER 104 ELECTRIC UNDERGROUND 211 STEMWALL 102 FOOTER / SLAB STEEL BOND 221 FORMBOARD SURVEY 147 T.U.G. 216 SLAB / MONO -SLAB 103 PRE POWER FINAL 218 LINTEL / TIE BEAM 105 ELECTRIC ROUGH 212 SHEATHING - ROOF 106 ELECTRIC FINAL 213 SHEATHING - WALLS 115 MECHANICAL FRAME 109 MECHANICAL ROUGH 409 INSULATION ROUGH -IN 110 MECHANICAL FINAL 410 DRYWALL / SHEETROCK 131 PLUMBING LATH INSPECTION 132 UNDERGROUND ROUGH 322 FINAL STUCCO / SIDING 130 TUB SET 312 FIREWALL SCREW 120 SEWER 311 FIREWALL FINAL 143 PLUMBING FINAL 313 INSULATION FINAL 113 GAS FINAL SFR 138 GAS PIPING UNDERGROUND GAS ROUGH -IN 328 314ROOF ROOF DRY -IN 116 GAS FINAL 315 FINAL ROOF III MISCELLANEOUS / FINAL INSPECTIONS PRE -DEMO 144 FINAL DOOR 136 FINAL DEMO 126 FINAL WINDOW 137 FINAL SOLAR PANELS 134 IRRIGATION FINAL 321 FINAL POOL SCREEN 139 FINAL SCREEN STRUCTURE 127 FINAL UTILITY BUILDING 124 FINAL BUILDING - OTHER 112 MOBILE HOME TIE -DOWN 145 MOBILE HOME BUILDING FINAL 146 Miscellaneous Notes: REVISED: 4-17 Inspection Line: 407.792.6069 or 855.541.2112 FIRE INSPECTIONS CITY OF SANFORD 407.562.2786 BUILDING & FIRE PREVENTION BUILDING INSPECTIONS 300 N PARK AVE 855.541.2112 SANFORD FL 32771 DRIVEWAYS -SIDEWALK 407.688.5080 Page 2 Application Number . . . . . 17-00001230 Date 5/03/17 Property Address . . . . . . 514 PALMETTO AVE Parcel Number . . . . . . . . 25.19.30.5AG-0702-0040 Application description . . . PLUMBING PERMIT Subdivision Name . . . . . . TWN OF SANFORD (TRAFFORDS MAP) Property Zoning . . . . . . . SINGLE FAMILY Permit . . . . . . PLUMBING PERMIT-ALTER/ADD/FIX Additional desc . . Phone Access Code 982959 Permit pin number 982959 Required Inspections Phone Insp Seq Insp# Code Description Initials Date 10 314 PL06 GAS ROUGH -IN 1000 315 PL07 GAS FINAL / / Gas Plumbing Services, Inc. 590 W. Main Street - Lake Helen, FI 32744 Office: (386) 774-8244 Fax: (386) 775-1749 STATE LICENSE # : CF-0057948 LP LICENSE # : LP-17000 PERMIT # : BUILDER: ADDRESS: MODEL # : GAS TYPE : ON DELIVERY PRESSURE: PIPE TYPE: CSST/ GA1ALVANIZED LONGESTRUN: d FURNACE: RANGE: 4,0 WATER HEATER: DRYER: FIREPLACE: GRILL: G- p- SPA/POOL HEATER: OTHER: DATE: nm Cmz1 o Tcmi m-4zrnz_ XCoM CnTmzl=OMK_ M2Cn-<-i { Z'Cnn3>pU'-n zz'mGDmoO0 0ozt!> m! ti Qomoo 1 3 XO mmiD p CJ XU'm -mAm O Zp m17zo 0-v v=Mzo m n z> C D 4 TOTAL LOAD : 3`c SIZING TABLE USED: - I - C ' CREATED BY: LA A p,& -kr I U m O z t cn A Z m r` A M HISTORIC PERMIT All worst must be done in strict accordance with the Approved Certificate of Appropriateness Building does not approve any work outside this scopepin%N Permit Applicant is coley responsible for compliance CERTIFICATE OF APPROPRIATENESS HISTORIC PRESERVATION BOARD CITY OF SANFORD 300 S. Park Avenue Sanford, Florida 32771 407.688.5145 • www.sanfordfl.gov/HP THIS DOCUMENT MUST BE POSTED AT ALL TIMES UNTIL PROJECT IS COMPLETED. ISSUED TO: Maria Shreve for 514 Palmetto Avenue Sanford, FL 32771 BP# 17-1220 DATE ISSUED: April 27, 2017 DATE EXPIRES: 'J i 2 3 October 27, 2017 # Approved to install gas lines for range, furnace, and water heater at the rear of the property, per locations depicted on the attached drawing. No appurtenances are proposed to be installed on the exterior of the building. Should any items such as a water heater, meter box, or other utity items be proposed for the exterior, a separate CofA denoting the dimensions, design, and location ust e submitted. Christine Dalton, AICP Historic Preservation Officer/Community Planner Please be advised it is the owner and/or agent's responsibility to notify staff of any potential changes from the approved COA that arise and obtain approval prior to commencing the changes. This Certificate of Appropriateness does not constitute final development approval. The applicant is responsible for obtaining all necessary permits and approvals from applicable departments before initiating development. IS A BUILDING PERMIT REQUIRED FOR THE ACTIVITY LISTED ABOVE? 0 YES NO Building Department Representative f.^.f' C, y ` a f APPLICATION # , I ?D FOR A CERTIFICATE OF APPROPRIATENESS Answer all the questions on this form and submit all required attachments. Incomplete applications will not be reviewed. If you have questions about application requirements contact the -Historic Preservation Officer. at407.688.5146 to ensure your application Is complete. General Information Downtown Commercial Historic District © Residential Historic District Is this a retroactive request? Yes Ea No Is this application filed in response to a Notice of Violation from the Code Enforcement Department? Yes MNo Proposed improvements will affect the following elevations: [ North N South East P4West Property Address: 5w R• WYYti O ow Property Owner Information Print Name: M ' Cc 3MailingAddress: . C(kw t-p J .-O a, •R_ Phone: nn Email: hr~ Signature: Applicant/Agent information nQYCRD Print Name: F '> n rs `` Mailing Address: D 00 • 11'i - Qh -V a--j--1 Phone: 3%' 1`j1 Email: &JW(IO(gTOolm jAftwibt%Mt)We ff@ignature: BY SIGNING BELOW YOU ACKNOWLEDGE THAT A BUILDING PERMIT MAY BE REQUIRED FOR THE SCOPE OF WORK LISTED BELOW. YOU MUST CONTACT THE BUILDING DEPARTMENT TO DETERMINE IF A BUILDING PERMIT IS REQUIRED. FAILURE TO OBTAIN A BUILDING PERMIT OR DEVIATION FROM AN APPROVED CERTIFICATE OF APPROPRIATENESS WILL RESULT IN A STOP WORK ORDER, DOUBLE PERMIT FEES, AND POTENTIAL FINES. BY SIGNING BELOW, YOU ALSO ACKNOWLE,C G THAT THE INFORMATION CONTAINED IN THIS APPLICATION IS TRUE AND ACCURATE E BEST OF YOUR KNOWLEDGE. Date: `T —o- - 17 Yes, l would you like to receive emails regarding Historic Preservation and Community Planning within your community. Description of proposed work Completely describe the entire scope of work, including changes in material and color, and methods that will be used to accomplish the proposed work. For large projects an itemized list is required. Use the reverse side if necessary. 16,1ST.41 t 4 /o-c S To /l"Ie , hini c ,, /Nrn -, MSMELC EF;iQR IT All work must be done in strict accordance with the Approved Certificate of Appropriateness ui ing not approve any work outside uns scope Permit Applicant is soley responsible for compliance HISTORIC PRESERVATION BOARD • 300 N. Park Avenue • Sanford, Florida 32771 •407.688.5145 • www.sanfordfl.gov/HP APPLICATION# 17, IZM FOR A CERTIFICATE OF APPROPRIATENESS Supplemental Information - Please use the space below to provide additional details regarding proposed work. Description of proposed work (continued from previous page): 5 30 HISTORIC PERMIT All work must be done in strict accordance with the Approved Certificate of Appropriateness Building does not approve any work outside this scope Permit Applicant is coley responsible for compliance HISTORIC PRESERVATION BOARD • 300 N. Park Avenue • Sanford, Florida 32771 •407.688.5145 • www.sanfordfl.gov/HP