HomeMy WebLinkAbout4001 MyrtlewoodD, CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: Documented Construction Value: $ ?/S Od
Job Address: -470 i/ A 4L 11e oD 1( Historic District: Yes No
Parcel ID: _54 -M-30 90 -O/Ta -Udd(-) / Zoning:
Description of Work: -/c /oRQS SP'lii e A- Py -16) r'n we 11
n
Plan Review Contact Person: C- r!L/ 0 Title:
Phone: ''1U%'%8L VS9 X//G tax: hid-7 W 71 E-mail:
Property Owner Information
Name rol"a / li l Phone:
Street: UGY/ ' 127 a/ 'T /D 5' Resident of property? :A,-,-)
City, State Zip: eedlc ht, 7Y %el/3-,LL
1
Contractor Information
Name r/ - Phone: '`z017 -19S cr 3,5 GY
Street: / Lf%g/f i^/ // Fax:l'p—%rS ri - o2GYi
City, State Zip: (7 ct l tOYi OrjTS , 3/ State License No.: z cld05'W
Architect/Engineer Information
Name:itT
Street:
City, St, Zip:
Bonding Company
Address:
Building Permit
Square Footage:
No. of Dwelling Units:
Phone:
Fax:
E-mail:
Mortgage Lender:
Electrical A
New Service - No. of AMPS:
Address:
PERMIT INFORMATION
Construction Type: No. of Stories:
Flood Zone:
Mechanical 0 (Duct layout required for new systems)
Plumbing
New Construction - No. of Fixtures:
Fire Sprinkler/Alarm No. of heads:
f
o
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 ofthe 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 aplan 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 charges exceed the documented
construction value when the executed, contract is submitted, credit will be applied to your permit fees when the
permit is released.
0" 01 ^o
Signature of Owner/Agent Date Signature of Contractor/Agent Date N 2.9
CC o Q
O a
Print Owner/Agent's Name Print Contractor/Agent's Name
ac
a
wm
Signature of Notary -State of Florida Date Signature otary-State ofFl id. Date 1
Odoa .
UAHULY11 iVJUrjti ,r
a * MY COMMISSION # DD r 10,
7 EXPI tP s
RES. Decem:., N
9lFOF F04e BondedZonallyOwner/Agent is Personally Known to Me or Contractor/Agent is Known to Me or
Produced ID Type of ID Produced ID Type of ID
APPROVALS: ZONING. UTII,ITIES: WASTE WATER:
ENGINEERING:
COMMENTS:
Rev 11.08
11' BUILDING:
PUCHAkSE ORDER
PO # RFC#AB3D612147
Project: mat-TwinLakes (109401)
PO Date: November 9.2010
To: 7Yf-City Elearicat Coutmotors, Inc.
P.O. Box 160849
Altamonte Springs, FL 32716
Attu: George Parsons
Phone#: 407-788-3500
Fex #. 407-78&2007
Tax ID #: 020657423 Vendor#: 013124
3;2,4-? 3
From: JohnRabel
ColoniaLPropmsties_Trust -
2 Arrowgrass Drive =5
Wesley Chapel, FL 33544
Phone. 321257-1108 (o), 813-838-4877 (m)
Fay
Duo Date: ASAP
Ship Via:
Cost Codo: 16880
Must showpurchase order numbers on hw0kesf0r pgyment*
Quantity Description Unit Price Amounts
Xrei]/Pnmp Elecrlcal Service Scope ofwork Includes:
Install two (2) 60 amp/sbWc phase services for well; pump on a wncrdo post
tcenah 60 ft to the transfonuer
2 Labor/Matorial
2 Permit
840.00
75.00
1,680.00
150.00
ProductTotak Subtotal 1,830.00
Standard Delivery:
Tax:
TOTAL 1,830.00
PLEASE ATTACH CERTMCATE 4PIJABdLM INSURANCE
Name `'p0 .e l r , i Name - ` ! % /
Date
Signature P't
Name
Dais
Signature
1 cf3
SIG
GARRE ASKEW
V.P. CONSTRUCTION DATE: f0