HomeMy WebLinkAbout1107 W 12th St 04-443 interior plumbingr-_ v ._ __ 7
CITY OF SANFORD PERMIT APPLICATION
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Permit # : y 3 U
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Date: \ Q
Job Address: 1w S
Description of Work: , ,- Sl y-w r
r7l'l\ N
Historic District: Zoning:
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Value of Work: $ a CYpC',
Permit Type: Building Electrical Mechanical 1 Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/Alteration CYiattge of Service Temporary Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Calc. Required)
77Plumbing/ New Commercial: # of Fixtures # of Water &Sewer Lines ! # of Gas Lines
Plumbing/New Residential: # of Water Closets Plumbing Repair — Residential or Commercial
Occupancy Type: Residenti Commercial Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #: `` (
Attach Proof of Ownership & Legal Description)
Owners Name & Address:\
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Phone:_
Contractor Name & Address: - ass, (\ , , _ ,
State License Number:
Phone & Fax: "dart+ \: — -530o Contact Person:. " il, _" 1 Phone
Bonding Company: n1
Address:
Mortgage Lender:
Address:
Architect/Engineer: Phone:
Address: Fax:
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.
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. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. 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
this county, and there may be additional permits required from other governmental entities such 44rw3tq man
Acceptance of permit is verification that I will notify the owner of the property of the
Signature of Owner/Agent Date
Print Owner/Agent's Name
Signature of Notary -State of Florida
Owner/Agent is — Personally Known to Me or
Produced ID
that may be found in the public records of
districts, state agencies, or federal agencies.
2 oZ o-}
Date
P ' t ion ent' e
Date ign" r dtapyfm}98tWILD. Date
EXPIRES: November 12, 2006
OF F\-oe`Oe Bonded Thru Budget Notary Services
Contractor/Agent isPersonally Known to Me or Produced
ID APPLICATION
APPROVED BY: Bldg0— i 2:—U3 Zoning: Utilities: FD: Initial &
Date) (Initial & Date) (Initial & Date (Initial &Date) Special
Conditions:
I
December 1, 2003
City Manager
City of Sanford
300 North Park Avenue
Sanford, FL 32771
Re: ESTOPPEL LETTER
via HAND DELIVERY
New Mount Calvary Missionar
Baptist Church
1109 West 12t' Street
Sanford, Florida 32772-1821
Multi -Purpose Building and Parking Lot Addition (Foundation Plumbing Only)
This ESTOPPEL LETTER is provided to the City of Sanford for reliance upon by the City of
Sanford and as the basis for the issuance of Permit No. U A - -A\A3 for the following work:
Foundation Plumbing Only New
Mount Calvary Missionary Baptist Church, hereinafter referred to as the "Owner", recognizes that
issuance of Permit No. G y r '-A'-A 3 will be with numerous limitation as more particularly
set forth herein. The Owner recognize that this approval does not exempt us from complying
with any applicable building codes, land development regulations, Comprehensive Plan requirements,
or exempt our site or building(s) from any applicable development regulations. By
issuing Permit No. y3 , the City does not guarantee approval of any other development
orders or development permits. The Owner acknowledges and agrees that no Certificate
of Occupancy will be issued by the City for the foundation until all required land development
approvals have been obtained and all required improvements have been installed, inspected
and authorized for use by the City. The Owner hereby grants the City the right to deny use of
the foundation for occupancy until all of the above -referenced project is in compliance with all applicable
development regulations. The
Owner hereby agree to indemnify and hold the City and its officers, employees and agents harmless
for any and all losses, damages, injuries and claims in any way relating, directly or indirectly,
to the permitting or construction of the above -referenced project or the issuance of Permit No.
G k-A - X-1'l . The Owner also agrees to the following as additional conditions for Permit
No. 0 J
December 1, 2003
Page 2
The Owner hereby agrees to disclose the contents of this document to any and all of our successors
in interest, contractors, sub -contractors and agents. The undersigned further warrants that he or she
is authorized to bind the Owner and has duly authorized to sign this document.
WITHNES SES :
Signature
0 j IJ- W0QbtUqt2_D
Printed / Typed Name Print / Type Name
Signature
1y CJber l -J Oef 6 r-41
Print / Typed Name
STATE OF FLORIDA )
NEW MOUNT CALVARY
MISSIONARY BAPTIST CHURCH
Signature
Title
COUNTY OF SEMINOLE)
The foregoing instrument was acknowledged before me this day of Ad2f-
2003, by Ricky Scott as Pastor for New Mount Calvary Missionary Baptist Church
who is personally know to me or who produced their Florida Driver' License as
identification.
Nota P lic
y
Print Name: ,u x ,
My Commission Expires:
RIUSY N. SLAKE
Notary PuY tic st to of Flcr;d3.
leJ MY CZ T ,t0--+ FXP3 v Nh. 14 ?i1:is t
COMMiSsion
a 4 DD 071903