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RECEIVED
I MAY 19 2011
CITY -OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Q
Application NO: / Documented Construction Value: o/
Job. Address: Historic District:, Yes El No Ki
Parcel ID: 7 —00, . 0 Zoning:
Description of Work: xx /'
Plan Review Contact Person: yTitle
Phone: Fax: E marl
Property Owner Information - -
Name /% / %G/ Phone: 7 mil// 1v v
l Resident of ro ert 9 . Y S
Street: p , p y
City, State Zip: =S '''w2"/Jj 3 7-7-7
Co%tractor Information
Name i P%//J Ae0 e.' LLC . Phone: .y / 6J q1
Street: n Ln'Fax:2
1 013.
City, State Zip:. erno 3 `/ State License No,72—
Architect/Engineer.Information
Name:. L, Phone:
street:, / LU ., Fax:
City,.St, Zipz, PnGi/,l//sz1°--T-DQI%%. E-mail:
Bonding Company: = Mortgage Lender:
Address.:. Address:
PERMIT INFORMATION
Building Permit ' '
Sgpare, Footage Construction Type: No. of Stories: No.
of Dwelling -Units`: Flood Zone: Electrical
New
Service ^'No: of AMPS: Mechanical (
Duct layout required for new systems) Plumbing
New
Construction - No. of Fixtures: Fire
Sprinkler/Alarm No. of heads:,
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.
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.
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 BEFORERECORDING YOUR NOTICE OF COMMENCEMENT.
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
governmental entitiesom,other g es -such as watermanagement districts, state agencies, or federal.agencies. Acceptance
of permitis 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 ofa plan review fee. A copy of the executed contract is required in order to
calculate a plan review charge. If the executed contract is not submitted, we reserve the right to calculate .the plan
review fee based on past permit activity levels. Should calculated charges exceed the documented construction
value when the executed contract is submitted, credit will be applied to your permit fees when the permit
is released. 14
Signature
of Owner/Agent Date'Signature of Contra or/Agent Date 0Ale
PnntOwner/
Agent's, Name Print Con c / ge ame Signature
of Notary -State of Florida Date Sig COMMISSION #
EE090759 EXPIRES
May 16, 2015 407
398-0153 FWidallotaryserviee.eom Owner/
Agent is PersonallyKnown to Me or Contractor/A ent is gPersonally Known to Me or Produced
P. Type of ID Produced ID Type of,ID APPROVALS:
ZONING: UTILITIES: WASTE WATER: ENGINEERING:
FIRE: BUILDING: COMMENTS:
Rev
11.08