HomeMy WebLinkAbout721 Panama PlSEP 112012
CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No. `" Documented Construction Value: $ 4 60• co
Job Address: / QnCt. (y\c\ h Iaee. Historic District: Yes No
Parcel ID: -3 % 3Oo — Qo ao — ocz)O Zoning: R dm ki .
Description of Work: _
Plan Review Contact Person WA
Phone: Fax: E-mail:
Property Owner Information
Title:
Name New :Th,_be5 P)l:sibn - Phone:
Street: ImO C I St 51. Resident of property? : we
City, State Zip: n D/ , r 3, 771-XWI
A //
Contractor Information
Name &TD- -Tech A- etid, /PAynh,,LnC Phone: 91)?— W
Street: ;zyaS 5 fiver 5fr4- 0 ' Fax: Cje 7- Sd,)'4V/ysr
City, State Zip: or o.f" 0 _ tom-• 31,56 q State License No.: Cfid- oa 393
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Building Permit
Square Footage:
No. of Dwelling Units:
Electrical
New Service — No. of AMPS:
Architect/Engineer Information
Phone: 1 R
Fax:
E-mail:
Mortgage Lender: N/pr
Address:
PERMIT INFORMATION
Construction Type:
Flood Zone:
No. of Stories:
Plumbing
New Construction - No. of Fixtures:
Mechanical 0 (Duct layout required for new systems) Fire Sprinkler/Alarm 0 No. of heads:
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 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.
Signature of Owner/Agent Date
v,YZ Z1/} A fA6F
Print Owner/Agent's Name
aasa.u..,..aw
Signature o otary-SWi to Comm# [
Ste
7-
res 1011912012 EOMWtaryAssn., Inc Owner/
Agent is / Personally Known to Me or Produced
ID Type of ID APPROVALS:
ZONING: ENGINEERING:
COMMENTS:
UTILITIES:
FIRE:
Signature
of Contractor/Agent Date Print
Contractor/Agent's Name Signature
of Notary -State of Florida Date SHEILA
MATTERN My
COMMISSION # D13984012 EXPIRES
July 31, 2014 qp7)
398-01/53 FloridallotaryServks.com Contractor/
Agent is / Personally Known to Me or Produced
ID Type of ID WASTE
WATER: BUILDING:
Rev
11.08