HomeMy WebLinkAbout519 E 2 St 17-1521; Permit app AC AND DUCT WORKf
CITY OF SANFORD
t jUN 0 26V BUILDING & FIRE PREVENTION
PERMIT APPLICATION
BY• ----- - 1-7-- ( 5 - I
Application No:
Documented Construction Value: $ ,5 0 D
Job Address: 9_p Historic District: Yes No ELIParcelID: Residential Commercial
Type of Work: New .Addition Alteration Repair Demo Change of. Use Move
Description of. Work: V
Plan Review Contact Person: Title:
Phone: 9kax: Email:
Property Owner Information.
Name Phone:
Street:'
t'
a i•, s Resident of property?
J [tA ttff 3rf 9
City, StateVA
05 l s v,: rrs • r Information
NamePhone: h 9'7-y"7 f
Street: __' :2 &1 r TP, /nos ) I S/E % Fax:
City, State Zip: ,/% ll(A y%' 3 9N r State License No.: G[J &Z0.
Architect/Engineer Information
Name: Phone:
Street: Fax:
City, St, Zip: E-mail:
Bonding Company: 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
Revised: June 30, 2015 Permit Application
2
v
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 urate and that all work will
be done in compliance with all applicable laws regulating,constructio zoning.
Signature of Owner/Agent Date Signature Contractor/Agent Date
Print Owner/Agent's Name Pri or/Agent's Name
C,J
Signature of Notary -State of Florida Date Signa "--'d- — Dat
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
WiE 61AW
WWY Pub k • SUb 01 F.loflds
Canmbsion / 66 060823
ho oti My Comm. EXPIM Jnn 16, 2018
Con rat to Me or
Produced ID Type of ID .r
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: June 30, 2015 Permit Application
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date:
I hereby name and appoint:
an agent of:
n
Name of Company)
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):
19' The specific permit and application for work located at:
Street Address)
Expiration Date for:This Limited Power of Attorney: — 3l p/ 7
License Holder Name 1J11) fAx e t J YL,r,, o `7/-/-
State License Number:
Signature of License H
STATE OF FLORIDA
COUNTY OF gZG!
The foregoing instru ent was ac knowledged before me this /tOay of20 / Zby ' who is o per onally known tomeorowhohasproducedA identification
and who did (did not) take an oath. lgnature
Notary
Seal) "Y P LISA ANTONINI Florida
t0flMm.
Expires May 21. 2018 OF: •`,
Commission # Ff 125242 pn
nNP`• Commission
No. My
Commission Expires: Rev.
08.12) as
CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: z ' /_5 C-
Documented Construction Value: $ 31,2 cl
Job Address: TM Z N A <.4 rt zr, 4 t" Historic District: Yes No
Parcel ID: 36 , I q 3 1 - S' 15' - 1 tp ou -y a 56 Residential R] Commercial
Type of Work: New Addition Alteration Repair Demo Change of Use Move
Description of Work: ,1't i,, 14'qe s"z31&4 i iJei9f 6 ac lArj 1
Plan Review Contact Person: ,„r.,,4i 6.." t Title: R)-J 1OrvNft
Phone: Fax: tfio7- 3 21 ti Email: $,ifs 32 77 r1 &. fsou-Ih r/ig 7
Property Owner Information
Name N-n1M /rss G C L & (, Phone:
Street: 3 I 'l `1 1. A TTA J K--Y\ 6 1 N V Resident of property? :
City, State Zip: Rc6 li e s •T Pa. r1 y I g t' 12,
Contractor Information
Name 196Aw f s 6JegY,, Phone: q&7` 3z3 - BSI 7
Street: %/S 'P'd s1or f Fax: 9c,7-- 32 f - 5757 I
City, State Zip: Se------ef iti 3z7'7) State License No.: e4cp3(,&-zY
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Arch itectlEngineer 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
7 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 corikruction
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
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.
Signature of Owner/Agent
Print Owner/Agent's Name
Date
Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
4)
Signatu ontractor/Agent Date
1,74>
Print Contractor/Agent's Name
Signature of Notary -State of Florida Date
MY Cc' My 0
EXP'`
1 .... • mc
1
writers
Contractor Personally mown to N
Produced ID Type of ID
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:
Flood Zone:
of Stories:
Plumbing - # of Fixtures,
of Heads Fire Alarm Permit: Yes No
UTILITIES: WASTE WATER:
FIRE: BUILDING:
I V
Revised: June 30, 2015 Permit Application
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