HomeMy WebLinkAbout909 Cypress Ave; 18-4043; DEMOCITY OF SEP Z 6 ZU16
SkNFORD PERMIT APPLICATION
BUILDING DIVISION c 3ApplicationNo: I
Documented Construction Value: $
Job Address: % Cal & .SS 961;e Historic District: Yes No
Parcel ID: Residential 1 Commercial
Type of Work: New Addition Alteration /R/epair []Demo Change of Use Move
Description of Work: hi0/ dam tit /ftJ &
C_
Plan Review Contact Person:
Phone: Fax:
Lfv v 3`S3
t Title:
Email: AX\_ V' 0 W 7C0 !! aj.^
V a _.
cov--t_
Property Owner Information
Name (* Phone:%'
Street: 7 C% if ii Ite, Resident of property?: -5r
City, State Zip: sue. '-/,c . Z 72/
Contractor Information
Name\ Phone:
Street: • `a- l S 1' J
City, State Zip:
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
67--3I-2-o313
Fax:
qq
State License No.: C 6s f ! /0
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: W i Edition (2017) Florida Building Code
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/ ent
Print Owner/Au lit's Name
Date Signature f Contractor/Agent Date
NLe_x k %5e t
Print Contractor/Agent's Name
Signafure of Notary -State of Florida Date Signature of Not .$ $t plorida DEBBIE BLANTON 2
MY COMMISSION # FF 178648
EXPIRES: February25, 2019
Bmded Thru Notary Public Underwriters
Owner/Agent is Personally Known to Me or Contractor/Agent is Personally Known to Me or
Produced ID Type of ID Produced ID Type of ID V
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building Electrical Mechanical Plumbing Gas Roof
Construction Occupancy Use:
Total Sq Ft of Bldg: Min. Occupancy Load:
New Construction: Electric - # of Amps
Fire Sprinkler Permit: Yes No # of Heads
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
UTILITIES:
Flood Zone:
of Stories:
Plumbing - # of Fixtures.
Fire Alarm Permit: Yes No
WASTE WATER:
FIRE: BUILDING:
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
2
Date: .--__
I hereby name and appoint: 4rc, J`irEiS
s o,. LC - an agent of:
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):
The specific permit and application for work located at:
go"/ 5;2,z6al , X 32- 7 / Street
Address) Expiration
Date for This Limited_Power of Attorney: QG,?, ; Zed License
Holder Name: k' State
License Number:` Signature
of License Holder: STATE
OF FLO IDA , COUNTY
OF The
foregoing instrument was acknowledged before me thisJGel day of -'- 20_
L:, by ' who is personally known to
me or who has p oduce ( _ identification
and who did (did not) take an oath. 1
Signature
t
Y">''• DEBBIEBLANTON rqaG•; Notary
Seal =:: :+: MY COMMISSION # FF 178648 Print
or type name =;,r, a= EXPIRES: February 25, 2019 Bonded
Thru Notary Public Underwriters Notary
Public - State of _ Commission
No. My
Commission Expires: Rev.
08.12)