HomeMy WebLinkAbout1005 Persimmon AveCITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
/
Application No: 6� _33 S
Documented Construction Value: $ /'10C)
11
i
Job Address: /W ,5— Pe.,s 4 -,Rout Ave- Historic District: Yes ❑ No ❑
Parcel ID•
Type of Work: New 0 Addition ❑
Description of Work:
Plan Review Contact Person:
Phone: 2V-115-- U Fax:
Residential ❑ Commercial ❑
Repair[]. Demo E] Chane f Use ❑ Move ❑
;. FeCl eYc ( G /'40 P
Title• �eiv� J�
Email•G� S G � Go
p // Property Owner Information
Name D 111-y S cy eye t Phone: q0-7 -6 9? Y6
Street: r'd 0 ,;els% �o 4 Resident of property?
City, State Zip: -sQt,io/k__6 322!
Contractor Information
Name L. d r(f-c
4'."C -
Street: Gold G �l� C
City, State Zip: 0'(az- F G
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Phone:
Fax:
State License No.:
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. 1 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" 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.
IL
Signature of Owner/Agent Date Signature o ontractor/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 Co ractor/Agent's Nary
alj,� / a. /,5 . i(,
Signature of Notary -State of Florida Date
DEBBIE BLAPT
MY ()
COMMISSION d rF 1 iE5C6 i
�.'•� EXPIRES: February 25, 2019
1Jf. tt Bonded Thru Notary Public UraemMers
_.�
Contractor/Agent is Personall nown to Me or
Produced ID Type of ID l.,
�� �� bio/ LZ
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 ❑ # of Heads
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
Flood Zone:
# of Stories:
Plumbing - # of Fixtures
Fire Alarm Permit: Yes ❑ No ❑
UTILITIES: WASTE WATER:
FIRE:
BUILDING:
Revised- June 30, 2015 Permit Application
S
All MateridlZ guaranteed to be as speci
the above work was performed in -accordance with the drawings and specifications provided for -the.
above work and waa_gogIpletedjnj.�����er for the agreeIi sum A i. rl E!,
of
Dollars ($
'This is a E
3Partial E)Full invoice due and payable by:-
Month pay Year
'in accordance with our El Agreement n Proposal No. Dated
Monro. D�y year
&.?;&d8rVM' jC8122 1.1-1 2
V vnr% rrnrvnIVILL/ Mi.
.,"To:
07
Aoofi!�
3>2-7-7 f*
DATE
(12-01-6
YOUR WORK ORDER NO.
OUR BID NO.
All MateridlZ guaranteed to be as speci
the above work was performed in -accordance with the drawings and specifications provided for -the.
above work and waa_gogIpletedjnj.�����er for the agreeIi sum A i. rl E!,
of
Dollars ($
'This is a E
3Partial E)Full invoice due and payable by:-
Month pay Year
'in accordance with our El Agreement n Proposal No. Dated
Monro. D�y year
&.?;&d8rVM' jC8122 1.1-1 2
DESCRIPTION OF
WORK PERFORMED
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All MateridlZ guaranteed to be as speci
the above work was performed in -accordance with the drawings and specifications provided for -the.
above work and waa_gogIpletedjnj.�����er for the agreeIi sum A i. rl E!,
of
Dollars ($
'This is a E
3Partial E)Full invoice due and payable by:-
Month pay Year
'in accordance with our El Agreement n Proposal No. Dated
Monro. D�y year
&.?;&d8rVM' jC8122 1.1-1 2
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date:
1 hereby name and appoint: C%l r %s e
an agent of: F7 JC'.,`�Yi'G
(Name
to be my lawful attorney-in-fact to act for me to apply for, receipt for, sign for and do all things
necessary to this appointment for (check only one option):
The specific permit and application for work located at:
005- P 1Pr C . 41, 12.rl. v`Q
(Street Address)
Expiration Date for This Limited Power of Attorney:
License Holder Name: G..
State License Number:
Signature of License H
STATE OF FLORIDA
COUNTY OF aH
The foregoing instrument was acknowledged before me this /� day99��O_e4t&tt,
201 / , by who is t�personally known
to me or o who has produced —L Z
identification and who did (did not) ake an oath.
`JEVIELY JACKSON
. _ *%4fW lc • State of Florida
COmflliaabft • FF 11263
a...l+' My Comm. Expires May 7. 2017
(Rev. 08.12)
Signature / f
""Bt, (C4J say
Print or type nalffie
Notary Public -State of — otz4'G7A
Commission No.FF [ 1,Aeo 3
My Commission Expires:
as