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CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No:
Documented Construction Value: S
Job Address: ` HIGt _'P 1`y C SY Ff YI 1 f I . 1'a_n,• Historic District: Yes No 0
Parcel ID:,
Type of W
Description of Work:
Residential -Commercial
Demo Change of Use Move
Plan Review Contact Person- ' 1DOn Title: AQEZ
Phone: LAOID OZ- -1 H I —1 Fax: Email• 1 0;1 '(vv iGl ECYITS - L
Property Owner Information
Name Y, i Phone: W Qr
Street:..(()4 {y: (' „r t YY'C (
ukuo110
POter- Resident of property?
city ' S gq'Ap •!1gY C rC ` t i'1"1
Contractor Information
Name 1 01'1r1 C 1 -r Phone: _Hll_',U2- 1yIZ
Street: _6W5 L :f ye M W e 1 i. 2. d _ r
Fax-
City, State Zip: W n-ke r R1CyL r i 32-.C2 State License No.: CC 13ZCISW
Architect/Engineer Information L
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Phone:
Fax:
E-mail:
MortgageLender: Address:
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.
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. FBC
105.3 Shall be inscribed with the date of application and the code in effect as of that date: 51b Edition (2014) Florida Building Code Revised:
June 30, 2015 Permit Application
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 at the time of permit submittal. A copy of the executed contract is required
in order to calculate a plan review charge and will be considered the estimated construction value of the job at the time of submittal.
The actual construction value will be figured based on the current ICC Valuation Table in effect at the time the permit is issued, in
accordance with local ordinance. Should calculated charges figured off the executed contract exceed the actual construction value,
credit will be applied to your permit fees when the permit is issued.
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.
Signature of Owner/Agent Date Signature of Contractor/Agent Date
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
Print Contractor/Agent's Name
MY COMMISSION @ FF 17i:648
EXPIRES: February 25. 2019
Bonded Thor Notary pub& Unde"ers
Contractor/Agent is Personall Known to Me or
Produced ID Type of ID'
V,p ' , I a 0/ 7
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building Electrical Mechanical Plumbing[] Gas Roof
Construction Type:
Total Sq Ft of Bldg:
Occupancy Use:
Min. Occupancy Load:
New Construction: Electric - # of Amps,
Fire Sprinkler Permit: Yes No
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
of Heads
UTILITIES:
FIRE:
Flood Zone:
of Stories:
Plumbing - # of Fixtures
Fire Alarm Permit: ' Yes No
WASTE WATER:
BUILDING:
Revised: June 30, 2015 Permit Application