HomeMy WebLinkAbout712 S Palmetto Avep 4. RECEIVED
CITY OF SANFORDDES ® 2 2U10 BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: - H Documented Construction Value: $ 5
Job Address: % la- S PAIr .< +4_0 ACE Historic District: Yes No
Parcel ID: Zoning:
Description of Work: I &W) ne. ag Gl $ TeAt&k4 IAA In IMIS6Aw'xx ' Plan
Review Phone:
Ail Fax: E-mail: Property
Owner Information Name ` `
o1a ., v
U`'1 Phone: 4)-) 7yy _1 3 0 Street: _ `
j 1'a- Resident of property? City,
State Zip: Contractor
Information Name (
L , Phone: \k Street „
A Q Fax: City,
State Zip: State License No.': k S 7-1%1 Architect/,
Engineer Information Name:
Phone: Street: -
City,
St, Zip: Bonding
Company: Address!...'
Fax:
E-
mail: Mortgage
Lender: Address:
PERMIT
INFORMATION BuildingPermit
Square Footage: _
Construction 'Type: No. of
Dwelling Units: Flood Zone: t; Electrical Plumbing
New Service -
No. of AMPS: New Construction - No. of Fixtures: Mechanical (Duct
layout required for new systems) Fire Sprinkler/Alarm 0 No. of heads: No. of -
Stories:
f
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. i
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 POSTEDON 'fJI JO 7S1IE—DEED HE
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 c lated charges need the documented
construction value when the executed contract is submitted, cre 'will be a lied t your permit fees when the
permit is released.
Signature of Owner/Agent Date
nt Owner/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: X1 UTILITIES:
ENGINEERING:
COMMENTS:
of
Con tractor/Agent' a
t'),- 2- t I--,
Date
2 /ZilC>
Signature of Notary -State of Fl(M\U110MU0,a,.d Date
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Contractor/Ageni- of
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1}} Known,to e or
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Produced ID or ,So
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WASTE WATER:
BUILDING:
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