HomeMy WebLinkAbout10b Cypress AveJUL 02
CITY tel:
F Building & Fire Prevention Division
ANFORD' PERMIT APPLICATION
Application No:
7 e
Documented Construction Value: $
Job Address: 10 I) aess AVM, WLfr TL Historic District: Yes NoG__ Parcel
ID: Residential Commercial Type
of Work: NewE]Additionlz Alteration Repair Demo Change of Use Move Description
of Work: C. CeA eAS j,S C rn _ Plan Review
Contact Person: _l Phone: qQ -
t{j 3003a -Fax: Email: Property Owner
Information Title: 0//)
Name
NAof
I Li, (- - Phone: 1+O 4 - Lt.-3 0 3- Street: 3,p "
0 S rtlt4yL-1 (ioye. Resident of property? City, State Zip:
QVIC- o I -FL l S-,0'67 ontr for Information /
L Name Phone: /
T `
U pf 1; /
Street: Fax: City,
State Zip:
State License No.: 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: 611 Edition (2017) Florida Building Code Revised: January 1,
2018 Permit Application
CITY OF`
Building & Fire Prevention Division
A PERMIT APPLICATIONSFIREDEPARTMENT
Application No:
Documented Construction Value: $. _
Job Address: , Histori" istrict: Yes No
Parcel IDi Re ential ,Commercial ,
Type of Work: New[] Addition[] Alteration[] Repair Demo Change of Use Move
Description of Work:'.
Plan Review Contact Person` Titles
Phone: Fax: Email:'
Property Owne nformation
Name Phone:
j Street: ` '
4,
Resident°of property?
City, State Z>Ip
tractor Information
Name ,<,. Phone:
Street: v° Fax: i
City, State Zip: State License No.-
Arc.hitect/Engineer Information,
Name: Phone:
Street: Fax: ,
City, St,.Zip: E-mail:'"
Bonding Company: Mortgage Lender:
Address: Address:
i S
e
WARNING TO OW R: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE' OR IMPROVEMENTS TO YOUR, PROPERTY. -A NOTICE OF. COMMENCEMENT MUST BE
RECORDED AN POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN
FINANCING,` C NSULT WITH YOUR LENDER OR -AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
y COMMENCE ENT.
Application* 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
1 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: 6`1 Edition (2017) Florida Building Code
Revised: January 1, 2018 Permit Application'"
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that maybe
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 constructionvalue, 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 Agent
Date Agent'
s Name Signature
of Notary -State of Florida Date, SigrrEitylre of Notary -State of Florida Date r '''
t[ : JOANN M. ' SON MY
COMMISSION IT956284 EXPIRES:
March 23, 2020 V.
6 rye' Bonded Thru Notary Public Underwriters Owner/
Agent is Personally Known to Me or Contractor/Agent is Personally ow to Me or " Produced
ID Type of ID Produced ID V Type of ID — BELOW
IS FOR OFFICE USE ONLY Permits
Required: Building Electrical Mechanical Plumbing Gas Roof Construction
Type: Occupancy Use: Flood Zone: Total
Sq Ft of Bldg: Min. Occupancy Load: # of Stories: New
Construction: Electric - # of Amps Plumbing - # of Fixtures Fire
Sprinkler Permit: Yes No # of Heads Fire Alarm Permit: Yes No APPROVALS:
ZONING: UTILITIES: WASTE WATER: . ENGINEERING:
FIRE: BUILDING: COMMENTS:
Revised:
January 1, 2018 Permit Application