HomeMy WebLinkAbout2728 W 25 StJob Address: 4, J/' y W
Parcel ID•
Type of Work: New
Description of Work
Plan Review Contac
Phone:
Name
Street:
City, State Zip:
CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: /4. 3 3 ,� U
Documented Construction Value: $ %, 3o -o, M
-----Historic District: Yes ❑ No
Resid tial ❑ Commercial5(
IAdition ❑ Alteration ❑ Repair ❑ Demo ❑ Chang of Use ❑ Move ❑
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Fax:
Title:
Email:
Property Owner Information
Phone:
Resident of property? :
Contractor Information
Name Donn d .-T- CaLel'C Phone: 39K- Y73�9;
Street:2."7?l ,S )W) 4M2dE —ezd S7 Fax: A_5V_ 9�'0_0
City, State Zip: a�/16 N/�- /-/ . -?V—%:?.s-- State License No.: 6 t�;/_? 6 fid'
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
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, 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 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
of Contractor/Agent
Print Contractor/Agent's Name
0
Date
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MY WMMISS10ti 9 r o� 2pi9
EXPIRES:febrP M
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Owner/Agent is Personally Known to Me or Contractor/Agent is Personal) nown to Me or
Produced 1D Type of ID Produced ID Type of IDL
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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:
UTILITIES:
FIRE:
Flood Zone:
# of Stories:
Plumbing - # of Fixtures,
Fire Alarm Permit: Yes ❑ No ❑
WASTE WATER:
BUILDING:
Revised June 30, 2015 Permit Application