HomeMy WebLinkAbout1415 West 13 PlCITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
ApplicationNo: P00-.511
7
Documented Construction VXe:W� l'D6
Job Address: S W c--;-/ (3"' Historic District: Yes ❑ No ❑
Parcel ID: Residential ❑ Commercial ❑
Type of Work: New ❑ Addition ❑ Alteration 04e' pair ❑ Demo ❑ Change of Use ❑ Move❑
Description of Work: At Q I A cL Al e t c- C.RN - R c f P he e-- wire Rs*k
Plan Review Contact Person: Title:
Phone:
Name
Fax:
Email:
Property Owner Information
Phone:
Street: Resident of property? :
City, State Zip:
/+Contractor Information
Name t bb S Phone: tt 0 7 y 6 g 1307
Street: I: A f �ce 9%"49Q_ Fax:
City, State Zip: 0 4 A!d. a 32 R 08 State License No.: t R 1 3 ei 1 J) e3!,6�
Name:
Architect/Engineer Information
Phone:
Street: Fax:
City, St, Zip:
Bonding Company:
Address:
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, 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: 51" 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 1 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
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
ggze� J"" 11—,91-14
Signature of Co ctor/Agent Date
�ero% SCol�
Print Contractor/Agent's Name
• �Y
Signature of Nors;,5K.61.1
Contractor/Agent is Personally..Known to Me or
Produced 1D Type of ID
e-zp - g0 a�
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:
Flood Zone:
# of Stories:
New Construction: Electric - # of Amps Plumbing - # of Fixtures
Fire Sprinkler Permit: Yes ❑ No ❑ # of Heads Fire Alarm Permit: Yes ❑ No ❑
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
UTILITIES:
FIRE:
WASTE WATER:
BUILDING:
Revised- June 30, 2015 Permit Application
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, -.Sanford,
Seminole County, Winter Springs
Date:
n ,/
I hereby name and appoint:
an agent
01 %-Umpany)
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):
O The specific permit and,application
(Street Address)
Expiration Date for This Limited Power of Attorney:
License Holder Name: jc 6itlis _
State License Number:
Signature of License H
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged before me this day of
20011,x, by (.C; all � who is al ersonally known
to me or o who has produced (,412-n- qz 5 - 5-1— uq as
identification and who did (did not) take in oa �.
natu
(Notary Seal)
EveW Roper
NOTARY PUBLIC
STATE OF FLORIDA
Cam" 60047449
Expires 10/24/2020
(Rev. 08.12)
Print or fyk name
Notary Public -State of
Commission No. GGC�
My Commission Expires: o L6