HomeMy WebLinkAbout100 Wilner Cir 1112CITY OF SANFORD
ECE IVE.- y BUILDING & FIRE PREVENTION
D MAY 2 4 2016 PERMIT APPLICATION
Application No:
�7n ntadConstruction Value: $Job Address: I dV (5GiUvl R,3'2771 Historic District: Yes ❑ No ❑
Parcel ID: Residential ❑ Commercial ❑
Type of Work: New ❑ Addition WAlterationEl Repair ❑ Demo ❑ Change of Use ❑ Move ❑
Description of Work: 3WGIC qG S. jSxw)S
Plan Review Contact Person:(;1�
Phone: H U) • 11 SO.1 SL1 Fax:
Title:
Email: `B--CY Q d?o1� c) Y)
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Property Owner Information
Name mrr da
Street: i (JO lei IVIt f d'r gait/ rd R -1 1
City, State Zip:
Phone: Ll (A •�522• &(A i0
Resident of property? :
Contractor Information
Name d
Street: �myii ll( wrYl.Qcl
City, State Zip: 321 I Z
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Phone:LA(i) '-IKU . 8q-)
Fax:
State License No.: COACMOCi-7 1
Architect/Engineer Information
Phone:
Fax:
E-mail:
Mortgage Lender:
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, weUs, 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: 5i° Edition (2014) Florida Building Code J/
0
Revised: June 30, 2015 Permit Application
� - 6 ��
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
Print Owner/Agent's Name
Date
Signature of Notary -State of Florida Date
vv�L&r
Signature of Contactor/Agent VDate
Print Contractor/Agent's Name
Signature of
DEBBIE BLANTON
MY COMMISSION I% FF 17WB
EXPIRES: February 25.2018
emded Tbru Notary Public Urdeforbs
Owner/Agent is Personally Known to Me or Contractor/Agent is Personally Known to Me or
Produced ID Type of 1D Produced ID Type of ID
f-/) t, e
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building ❑ Electrical ❑ Mechanical ❑ Plumbing[] Gas[] Roof ❑
Construction Type: Occupancy Use:
Total Sq Ft of Bldg:
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