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tL FEB 6 Role CITY OF SANFORD
a BUILDING & FIRE PREVENTION
YPERMIT APPLICATION Application
No: k n y Documented
Construction Value: S Job
Address: b• HIC`Ct(i ...Y i Y SYYI(Y I . J j 1 ] Historic District: Yes No Er Parcel
ID -- Type
of W Description
of Work: V-P _ Residentia
ITCommercial Demo
Change of Use Move Plan
Review Contact Person• ' oon Title: 1QE f Phone:
yU12 b2 - 1 y I -1 Fax: 1 -
Email:_
co'-1 @ EM-r • C Property
Owner Information Name
Y, 1 Phone: W Qr Street: :.
l(1 Ih: .n Y P (0)t Resident of property? 1L1 City
Sfatelip 5 ''iP1Y:FOt C I ' l ?'1"1 Contractor
Information Name
1 C 1 ; Phone: --H O-1 Street: _
6wb C-f lY-e -H U W C 112- d _ _ — Fax City,
State Zip: W n-1(-- r c jcy- r 1State License No.: CC I'j2C150U ArchitectlEngineer Information
Name: Street:
City,
St,
Zip: Bonding Company:
Address: Phone:
Fax:
VA
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: 5'b 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
orFh lE sLANTON Dat
W COMMISSION # F 258648
EXPIRES: February 2019
Bonded Thnr Notary PubfzUnderv+dtcrs
Contractor/Agent is Personall Known to Me or
Produced ID Type of ID
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