HomeMy WebLinkAbout2543 Palmetto AveUt C L 2010D CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION.
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Ap 'cation No: Doc mented Construction Value: $
z {3 _.
Job Addres' Historic District: Yes No
Parcel ID: h t - 0 _ .- O (7 0()c) -037 O Zoning:
Description of Work:
Plan Review Contact Person: Title: 0 w.., er-
Phone:3 5 S Fax: 32 -'S-P -u E-mail:
Property Owner Information
Name . (' 5^- e Phone: Q 09 - 2Z ^ ZA
Street: 3 1c ' Resident of property?
City, State Zip: J `3 3
l Contractor Information
Name C
Street:
City, State Zip:
Name:
Street: ,
City, St, Zip:
Bonding Company:
Address:
Phone: 3 2_ '- 416 " 6 5' S
v Fax: 3 Z I -GSd
3 3 State License No.: JC V lu bfl 3
Architect/Engineer Information
Phone:
Fax:
E-mail:
Mortgage Lender:
Address:
PERMIT INFORMATION
Building Permit
Square Footage: Construction Type:
No. of Dwelling Units: Flood Zone:
Electrical
New Service - No. of AMPS:
Mechanical (Duct layout required for new systems)
No. of Stories:
Plumbing 13.
New Construction - No. of Fixtures: _
Fire Sprinkler/Alarm No. of heads:
1 1 C3\^ \ / %
O
O
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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. 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.
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. A copy of the executed contract is required in order
to calculate a plan review charge. If the executed contract is not submitted, we reserve the right -to calculate the
plan review fee based on past permit activity levels. Should calculated charge's "exceed the documented
construction value when the executed contract is submitted, credit will be applied to your permit fees when the
permit is released. / nl
Signature of Owner/Agent Date
q Cc slc s
Print er/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
UTILITIES:
of
w
Date
Pri ontractor/Agent's Name ` \
Signature of Notary -State of Florida Date
DEBBIE BL-"A_N -90N ' g c
r `r! MY COMMISSION 4 DD629096
Po D PiR _S: F'ehruary 25, 2011
Notary Discount Assoc. Co.
Contractor/Agent is Personally Known to Me Qr
Produced ID Type of ID (- . d3 11 l e
WASTE WATER:
BUILDING:
Rev 11.08