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CITY OF SANFOR. .DFRJ*IIT APPLICATION
Permit No:: 02 d ` — Date: 2 F 0 Z
rJob Address: 612 67-/Vv-2 W o eA Sir , f&J mz -2 77 3
Permit Type: 'Building Electrical Mechanical Plumbing Fire Alarm/Sprinkler
Description of Work: % kQ_Vj 0_C1P___ ckt>J Additional
Information for Electrical & Plumbing Permits Electrical: —
Addition/Alteration _Change of Service Temporary Pole _New AMP Service (# of AMPS ) Plumbing/
Residential: Addition/Alteration New Construction (One Closet Plus Additional) Plumbing/
Commercial: Number of Fixtures Number of Water & Sewer Drainage Lines Number of Gas Lines Occupancy
Type: ZResidential _Commercial _ Industrial Total Sq Ftg: !V.1.2 Value of Work: S 26(0,00 Type
of Construction: r` _ Flood Zone: plumber of Stories: Number of Dwelling Units: Parcel
No.: (.Attach Proof of Ownership & Legal Description) Owner/
Address/Phone: /2 ('C VC Gvy'v S 6 6-VI L Contractor/Address/
Phone: State License
Number: Contact Person:
i 4 Phone & Fax Number: (03 Title Holder (
If other than Owner): Address: G /
Z 9 Bonding Company:
Address: Mortgage
Lender:
Address: Architect/
Engineer
Phone No.: Address: Fax
No.: 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. IF YOU INTEND TO
OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING 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 from other governmental entities such as water management
districts, state agencies, or federal agencies. Acceptance of -
permits e`rification thatI will notify the owner of the property of the requirements of Florida Lien Law, FS 713. Signa e
of Owner/Agent Date Signature of Contractor/Agent Date K i
44A) -r - Aq AATE N -- Print Owner/A
ent's Name 3 9 02..
Signature of Notary -
State of Florida ate Melissa Cameron Commission #
DD079918 Expires
Dec 20,
2005 Bonded Thru AtlantiC
Bonding Co.,
Inc. Owner/Agent is
Personally Known to Me or P(. Produced ID
j!m 1. APPLICATION APPROVED BY
Special Conditions: W
i &4 Print Contractor/Agent'
s Name Signature of Notary -
State of Florida Date Contractor/Agent is
Personally Known to Me or Produced ID Date:
I 4
i " 'Z
CITY OF SANFORD UILDING DIVISION
OWNER/BUILDER AFFIDAVIT
CONSTRUCTION CONTRACTING
Owners of property, when acting as their own contractor and providing direct, onsite supervision
themselves of all work not performed by licensed contractors. when building or improving farm
outbuildings or one -family' or two-family residences on such property for the occupancy or use of such
owners and not offered for sale or lease. or building or, improving commereial buildings, at a cost not to
exceed $25 000, on such property for the occupancy or use of such owners and not offered for sale or
lease. In an action brought under this part, proof of sale or lease, or offering for sale or lease: of any such
structure by the owner -builder within. 1 vear after completion of same creates a presumption that the
constriction was undertaken for purposes of sale or lease. This subsection does not exempt any person
who is employed by or has a contract Nyith such owner and who acts in the capacity of a contractor. The
owner may not delegate the owner's responsibility to directly supervise all work to any other person
unless that person is registered or certified under this part and the work being performed Is within the
scope of that person's license. For the purposes of this subsection, the term "owners of property"
includes the owner of a mobile home situated on a leased lot. 'To qualify for exemption under this
subsection. an owner must personal]\ appear and sign the building permit application.
State law requires construction to be done by licensed contractors. You have applied for a permit under
an exemption to that law. The exemption allows vou, as the owner of your property, to act as your own
contractor with certain restrictions even though you do not have a license. You must provide direct,
onsite supervision of the constriction \-ourself. You may build or improve a one -family or two-family
residence or a farm outbuilding. You rnav also build or improve a commercial building, provided your
costsdonot exceed S2 ,000. The building or residence must be for your own use or occupancy. It may not
be built or substantially improved for sale or lease. If vou sell or lease a building you have built or substantially
improved yourself within I vear after the constriction is complete, the law will presume that you
built or substantially improved it for sale or lease. which is a violation of this exemption. You may not
hire an unficensed person to act as your contractor or to supervise people working on _your- building. I_t IS \-
our responsibility to make sure that people employed by you have licenses, required by state law and by
county or municipal licensing ordinances. Your may not delegate the responsibility for supervising work
to a licensed contractor who is not licensed to perform the work being done Any person working Oil
vonr building who is not licensed must work under your direct supervision and must be employed by you.
which means that vou must deduct FICA. and withholding tax and provide workers' compensation for
that employee, all as prescribed by law. Your construction must comply with all applicable laws; ordinances,
building codes, and zoning regulations.: L
CJL V1. M j t,(I i vt do hereby state that I am qualified and capable of performing the requested
construction involved with the permit application filed. I
will assume full responsibility as an ONNner/Builder Contractor, and will personal]y supervise all work allowed
by law on the permitted structure. o3
Z 1 Oivnert, ',
il"& r ignature Date iVG
Tkc 0IY1GC'I Print
Owner/Builder Nanie n
y
Signature
of Notan- State of Florida Date a °' Ovi°
filer is Personalk Knomi to Me or hers g Produced
I