HomeMy WebLinkAbout14011 Millwood DrCITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Applicabon I 'No: Documented Construction Value: $ ?1,5-, 6)()
Historic District-. Yes El No ElJobAddress. Z 42aoto// -A/ cy A-
Parcel ID: 3A 4L 3Q -, 300 -A4 -_O Zoning:
Description 0 f Work: A/2 42no /S/ Vq 14L:i,' Scot-411C , LA' -6 WKYAf e --el ZAM
Plan Revi4 Contact Person: 6q( ) - 0),, Title:
9, Z R E-mail: Phone: _V_5k X110 fFax 1
Property Owner Information
Name Phone:
Street: 1?06),I) 4,, 0 E Resident of property? Ar
I
City,StateZip:
Contractor Information
Name Phone: 3
Street'. Fax: 7fff - ;z
City, State Lip: Pv/n 1 e State License No.: z!62a
Architect/Engineer Information
Name: Phone:
Street: Fav
City, St, Zip: E-mail:
Bonding C mpany: Mortgage Lender:
Address.- Address:
Building P rmit 0
PERMIT INFORMATION
Square Foo tage: Construction Type: No. of Stories:
No. of Dwelling Units: Flood Zone:
Electrical Plumbing 0
New Servic No. of AMPS: New Construction - No. of Fixtures:
Mechanical 0 (Duct layout required for new systems) Fire Sprinkler/Alarm 0 No. of heads:
Application ils hereby made to obtain a permit to do the work and installations as indicated. I cer* 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 junisdiction. I understand that a separate permit
Imustbesecured 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.
I
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: ln 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 bf permit is venification that I will notify the owner of the property of the requirements of FloridaI
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 night to calculate the
plan review fee based on past permit activity levels. Should calculated charges exceed the documented
colist
i
ru
i
ction value when the executed contract is submitted, credit will be applied to your t fees when the
permit is released.
C2__C 7// 117116
Signature of Owne'r/Agent Date Signature of Contractor/Agent Date
Print Owner/Agen t's Name
Signature of Notary -State of Florida Date
Owner/Ageni is
Produced ID
APPROV
COMMEN
Rev 11.08
Personally Known to Me or
Type of ID
ZONING:
ENGINEERING:
M11911143
FIRE:
panc,e 480rdel-d -
Print Contractor/Agent's Na c
ml'lld
Signature tV,4p%-State oVlorida Date
MOM MOP2AN
2myco,%Ajs
EXPIRE6: Uecernber 13,2010
OF onded Thru Budget Notary Serkes
Contractor/Agent is Personally Known to Me or
Produced ID - Type of ID
WASTE WATER:
BUILDING:
P VR CHA SE OR DE R
RFMAWD612147
o**. CV-aa-vdaLalms (10,4401)
Date: Novembox 9,2010
Tri 5-7CltyMacticalConbutors, w.
P.O. Box -160849
Akamonte, *hW, FL'32716
Atta: Geoxp Parsons
Monet 407-788-3500
Fox #. 407-789-2W
TaxlD#:020657423 VemdorkO13124
Fronr JohnReffiel
ColonialprWafies-Trust
2222 Arrowgrags Dflve W5
Wesley Chapel, FL 33544
Phone: 321-257-1108 (6), 813-83"77 (m)
Fax
Due Date: ASAP
Imp vim
CostCode-. 16880
Must showpurchase order numbm on bookesforpayment*
Qnm* Desedption uhi&ica Amomts
2
2
WeLlPmp Flecalcal Service Scope ofWork Includes-
Insto two (2)60 amp/sbWepbasa mvioesforwelt POV on a concrete post
trench 60 ft to the Awisfonner
Labor/MatrIal
pendt
840.00
75.00
1,680.00
150.00
ProduatTetol; Subtotal 1 830.00
Standud Ddiverr
Tax:
TOTAL 1,830.00
TXEASE ATrACH CERUnCATE OF XAANlEXlY.1N9CMMCE
S- Name C00oge 141ba Now ' 0
TO*
p'tawl Aj-- A", JeA - Sipawn
u
Name
Date
lof3
SIGN:
GAR
I
R - ETA§-K'-EW
V.P. CONSTRUCTION DATE: