HomeMy WebLinkAbout202 Bradshaw Dr; 18-3579; TEMP POLEjob Address:
Parcel ID:
BUILDING DIVISION
20Z
C.8
PERMIT APPLICATION
Application NO: 1 e
Documented Construction Value: $
5& Q LJ Historic District: Yes No
Residential 0 Commercial[]
Type of Work New Addition Alteration F1 Repair El Demo El Change of Use Move
Description of Work:
Plan. Review Contact Person:
Phone:
Name
Street:
City, State Zip -
Property Owner Information
Phone:
Title:
Resident of property? :
Contractor Information
Name S 1 F— E&CLA4., , T 2 Phone: ? 3
Street- Pp 6/) Fay ff(! - % 3 K_ -2--
City, State Zip: &o,kA _?-V State License No.• L:C 0 0
Architect/Engineer Information
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Phone: _
Fam
E-ima.d.:
Mortgage Lender:
Address:
WARNING TO O'GVNM YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT INYOUR 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 workand Wtallatioas 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 pleet smndu& o 11 laws re gtrlatirtgcvnatuctivn in this jurisdiction i understand that
a separate.perniit must be secured for electrical. work, plumbin& si as, Webs, pools, 46nrnaces, boilers, heaters, tanks, and air conditioners, eta
FB 1o53 Ball be iunscAbed with the date of appliesion and file eude In effect as of that date: 6!REdition (2017) Florida Building Code xgfiCii
In addition to the requirements of this pemdt, there may be additional restrictions applicable to this property that maybe found in the public records
of this county, and there may be additional permits required from other govrxmaental entities such as water u=agement 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, PS 713, The
City of Samford requites payment of a plan review ice at the time of permit submittal. A copy of the eaecated 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 "fable in effectat 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 AlEMAVIT: I certify that all of the foregoing information is acc-t mte and that all work will be done
in compliance with all applicable laws regulating construction and zoning. Sigttature
of owner/Agent Date Print
Owner/A pups Name Sipattire
of Notary --State of Florida Date Owner/
Agent is Personally KuOwn to Me or Produced
ID Type of ID Signature
of Contractor/Agent Dace G
to re,-ic e 11 bb 5 Print
Cootractor/Agent'a Name Signature
of Notary S of Niorida Date Contractor/
Agent is Produced
ID BELOW
IS FOR OFFICE USE ONLY Me
or Commission #
GG 085698 PIresiti
t!?2,2021 SM&
rf M troy F* Msurn= s0 MS.?r pemits
Required! Building [ Electrical Ivle&anical Piumbing Gas Roof El Construction
Tye Occupancy Use: Total
Sq Ft of Bldg: Min. Occupancy Load. Hood
Zone: of
Stories: New
Construction: Electric - * of Amps Plumbing - # of Fixtures Fire
Sprinkler Permit: Yes No # of Heads Fire Alarintt Permits "Yes No . APPROVALS:
ZONING: UTILITIES: WASTE WATER: ENGINEERING:
FIRE: BUILDING: COMNIF14TS: