HomeMy WebLinkAbout155 W Seminole Blvd (2)I7CLR' APR 2 8 2011
BY: -----------
CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: Documented Construction Value: $71_zzoloo
Job Address: Uj - '1DAay_&u-'6 LOc) - Historic District: Yes 11 No
Parcel ID:
Description of Work:
I -
Plan Review Contact Person: C L A I 6_e:-rtkF)f— -
Title:
Phone: lv-W r-;5061 Fax: 107-67'1-173 E-mail:
Property Owner Information
Name OO,AOD%5&0z 06 J6Phone:
Street: 19j' Al -1tow'-we'1c 92yo Resident of property?: P/X_r'
City, State Zip:
Contractor Information
Name %A_ Phone: Iq
Street: 1006—wV*MA`
1001 le
City, State Zip: 6171-p State License No.:
vu-Ar&2cCTEngineer Information 116qb lZ00 E
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
A
Building Permit
Square Footage:
No. of Dwelling Units:
Electrical 11
New Service — No. of AMPS:
Phone:
Fax:
E-mail:
Mortgage Lender:
Address:
NET INFORMATION
Construction Type: No. of Stories:
Flood Zone:
Mechanical 0 (Duct layout required for new systems)
Plumbing 1:1
New Construction - No. of Fixtures:
Fire Sprinkler/Alarm [3 No. of heads: — [7
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 }oe performed to
meet standards of all laws regulating construction in this jurisdiction. I understand that a separate permit
must be secured for electrical workplumbing, signs,- wells ools __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 BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
NOTICE: In addition 1o, the 'requirements of this permit, there may be additional resirie ions applicable to this
property that may.: be found in the public records of this county, ,and.. there may ;b,e, additional;.. permits; required
from other governmental entities such as water management distracts, 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 paymentof a,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 ngl3t to calculate the
plan review, fee based ``on `past permit activity levels. Should cai'culated 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.
Signature of Owner/Agent
Print Owner/Agent's Name
Date
Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
UTILITIES:
Print Contractor/Agent's Name
Sr atu
jPublic
LAN10NDate
P"°<; State of FloridaresFeb25, 2015 #
EE 60182OWationalNotaryAssn.
Contractor/Agent is Personally Known to Me or
Produced ID Type of ID '1 /c11, 1`7
WASTE WATER:
BUILDING:
Rev 11.08
ram..
r 1
obtain a emit to do the work and installations as indicated. I certify that no
Application is hereby "made to Pe
lion has commenced prior to the issuance of a .perm -it anti t af all ''0rk will be performed to
work or installation urisdicrion. I understand that a separate permit
meet standards of all laws regulating construction in thismustbesecuredforelectricalwork, plumbing, signs, wells, pools, furnacfs, boilers, heaters, tanks, and
air conditioners, etc.
that all of the foregoing information is`accurate and thafrall work wiU- OWNER S AFFIDAVIT. I certifybedoneincompliancewithallapplicable laws regulating construction and Wining.
WARNING TO O W1V'ER: YOUR FAILURE TO RECORD A NOTICE OF pR RTY ME NOTICE
RESULT IN YOUR PAYING TWICE C
ROvEMENTS TO
NOXYREDANDOSTEDONOTHEJOBSITEBEFORETIIE
OF COMMENCEMENT MUST BE RE
FIRST INSPECTION. IF YOU INTEND TRD O OBTAIN FINANCING, CONSULT WITH
LENDE R OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMIVIENC'EMENT hisristot
NOT ICE: In addition to the requirements of this permit, there may be ddiman
be additional perms slrequired
property that may be foundri> shs chbas waterlic rmanagement districdsofthiscounty, ts, state agencies, or federal agencies. ;
from other governmental en
of permit is verification that I will notify the owner of the property of the requirements of FloridaAcceptancep
Lien Law, FS 713.E
t ispaymentofalanreviewfee. A copy of the executed contracrequiredin order TheCityofSanfordrequirespaympa
plan review charge. If the executed contract is not submitted, we reserve e Geed the docight toumented
edlate
the ento
calculate plan
review fee based on past permit activity levels. Should calculate lied to our.perm t fees when the construction
value when the executed contract is submitted, credit will be app Y permit
is released. Z•
7 ri Date
Signature
of Owner/Agent Print
fAwner/ gent's ame ` L S
Date
Signature
f No -State of Florida ANGELA SMINV11 MYcomwssION # EE51598 l
ffi ' 27, 2014 NOTARY
PUBLIC STATE OF FLORIDA / EXP1REs: De'ber Patricia
Lesley FI S:
Dec LBgbYNOTARY
j
Commission # DD912500 Expires:
JULY 30, 2013 BONDED
THRU ATlAVnC BONDING CO., ENC. Contractor/
Agent is Personally Known to Me or Owner/
Agent is Personally Known to Me or Produced
ID Type of ID Produced
ID Type of ID APPROVALS:
ZONING: ENGINEERING:
COMMENTS:
UTILITIES:
WASTE WATER: FIRE:
BUILDING: r.
poffizzra a