HomeMy WebLinkAbout104 4 10 StCITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No:
Documented Construction Value: $
1 - _7
48 SC) , "r
Job Address: 0 { I U S ° S ' - Historic District: Yes P"'No [I
Parcel ID: 0-S- I ci - 3 S46 ()0{ Residential Commercial
Type of Work: New Addition Alteration t`J Repair Demro_ Change of Use Move
Description of Work: N 5Ti_A'r M UA )Ilie W
Plan Review Contact Person: Title:
Phone: Fax: Email:
Property Owner Information
Name C_2 Ga CC.Phone:
Street: 1 Z l V r r L h Resident of.p.roperty?_.:
City, Stat' Zip;,--,, lv w ,.'• Ir
Information
lP; 1 rContractor
Name c 'N'- S YL t1 Wl i
v
St Phone: '" t- ..-:3g Z
o
Street: '3 20 /`%
1--
v- Fax:
City, State Zip: p(%1 32-703 State License No.:
Arch itectlEngineer Information
Name: Phone:
Street: Fax:
City, St, Zip: E-mail:
Bonding Company: Mortgage Lender:
Address: 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. 1 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: 5" 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. +
r
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.
Print Owner/Agent's
foregoing information is accurate and that all work will
gulating construction and zoning.
Sign re of Contractor/Agent Date
Print Contractor/Agent's Name
C 12 i 7
iature of No tat f Florida Date ignatym pf o tm eli GOnzalehate
Emareli Gonzalez o PaY Pis
2N.
1c, State of Florida
State of Florida *My Comm. Expires 10/16/2020
My Comm. Expires 10/16/2020 N9° Commission No. GG 38810
Commission No. GG 38810 oF F%10
oQ Bonded through CIVIA uretmerPAtntisBondled-3brodohl(dkShc e r ersonal no n lo Me or
Produced ID Type of ID L
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: 1Z'2-1(-I1RILITIES:
ENGINEERING:
COMMENTS: `lam `h-,
FIRE:.
Flood Zone:
of Stories:
Plumbing - # of Fixtures
Fire Alarm Permit: Yes No
WASTE WATER:
BUILDING:
Revised: June 30, 2015 . Permit Application
LOCATION O.F'-WORK Steve Shepherd Plumbing, Inc.
Office (407) 788-6485 • Fax (407) 788-6370
LICCFC04# 3320 Walton Rd., Apopka, FL 32703 No Job e
steveshepherdplumbinginc@yahoo.com Too Small
DATE
fit )d -w 17
SERVICE REQUESTED: BILL To: Ac. e v-s -s d CC 4e.1
PHONE
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CITY se,SSATE ZIP
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OCONTRACT
SERVICE CONTRACT
ORMALVES. COMM.
MAKE MODEL SERIAL NUMBER
MAKE MODEL SERIAL NUMBER
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FIRST 1/2 REGULAR ' HRS. OVERTIME
HR. @ / HR. _ @ / HR. _
REGULAR HRS. OVERTIME
HRS. @ / HR. _ @ / HR. _
THNICIAN TOTAL
SEC OTHER
IGNATU R E CHARGES
e • • ® s SALES TAX
I HAVE THE AUTHORITY TO ORDER THE ABOVE WORK AND DO SO ORDER 'SUBTOTAL.
AS OUTLINED ABOVE. IT IS AGREED THAT THE SELLER WILL RETAIN TITLE
TO ANY EQUIPMENT OR MATERIAL FURNISHED UNTIL FINAL & COMPLETE
PAYMENT IS MADE, AND IF SETTLEMENT IS NOT MADE AS AGREED, THE
SELLER SHALL HAVE THE RIGHT TO REMOVE SAME AND THE SELLER WILL
BE HELD HARMLESS FOR ANY DAMAGES RESULTING FROM THE REMOVAL
OFTHEREOF.
y
A SERVIC 1 1 /29 -P ONTH WILL BE MADE ON PAST DUE °
ACCOUN S. S IS ND FEC OF 18%PER ANNUM. °
ABOV OMPLETED I ACKNOWLEDGE RECEIPT OF MY COPY
DATE
TOTAL PARTS
WORK ORDER ID#
PARTS WARRANTY -All parts as recorded are warranted as per manufacturer specifications.
LABOR GUARANTY -The labor charge as recorded here relative to the equipment serviced as noted,
is guaranteed for a period of 1 year.
We do not, ,nf course, -guaranty other parts than those we supply. If repairs later become necessary du
to other defective parts, they will be charged separately.
PLEASE PAY FROM THIS INVOICE - THANK YOU
1, G N y "
GOOD GUYS TO HAVE AROUND"
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104 W. IOTH STREET
SANFORQ, FL32771