HomeMy WebLinkAbout2100 Cordova DrCITY OF SANFORD PERMIT APPLICATION
Application #: ®1-' �� Submittal Date: A v I
Job Address: Value of Work: $ 3 (0 C)
Parcel ID:
Description of Work:
Zoning:
Historic District:
Square Footage:
........................................................................................
Permit Type: Building Electrical ❑ Mechanical ❑ Plumbing ❑ Fire Sprinkler/Alarm ❑ Pool ❑ Sign ❑
Electrical: New Service - # of AMPS Addition/Alteration ❑ Change of Service ❑ Temporary Pole ❑
Mechanical: Residential ❑ Non -Residential ❑ Replacement 0- New ❑ (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets
Occupancy Type: Residential W11- Commercial ❑ Industrial ❑
Plumbing Repair -Residential ❑ Commercial ❑
Occupancy Use Group(s):
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required)
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Property OwnerA r�'-i � < _ Contractor:
Address: b Address:
Phon :r ail: Phone: State License Number:
Bonding Company:
Address:
Architect/Engineer:
Address:
Plan Review Contact Person:
Mortgage Lender:
Address:
Phone:
Fax:
Phone: Fax:
E -mail:
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.
Acceptan f permit iverifica ' that will notify the owner of the property of the requirements of Florida Lien Law, FS 713.
Signature of Owner/Agent \\ •a4et , • C/j Signature of Contractor/Agent
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Pri Owner/Agent's ame Z -'_z r): ..4 Print Contractor/Agent's Name
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vS'tgnature of oiary-State of Florida : 9 ° 6,, Datd'98 •°>� Signature of Notary -State of Florida
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Owner/Agent isPero II Known to Me or 11
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E _ S, 1_ 26-r-571.2
APPROVALS: ZONING: UTIL: FD:
Special Conditions:
Rev 02/2007
Contractor/Agent is
Produced ID
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Date
Date
Personally Known to e or �'k-)
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BLDG:
City of Sanford
Owner/Builder Affidavit
Construction Contracting
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 you, 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 construction yourself. You may build or improve a one -family or two-family residence
or a farm outbuilding. You may also build or improve a commercial building, provided your costs do not
exceed $75,000. 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 you sell or lease a building you have built or substantially
improved yourself within 1 year after the construction 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
unlicensed person to act as your contractor or to supervise people working on your building. It is your
responsibility to make sure that people employed by you have licenses required by state law and by
county or municipal licensing ordinances. You 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 on your
building who is not licensed must work under your direct supervision and must be employed by you,
which means that you must deduct F.I.C.A. 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.
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 Owner/Builder Contractor, and will personally supervise all work
allowed by w o the permitted structure.
Owner/Builder Si ature Date
Owner is Personally Known to Me or has
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Signature of Notary—State of Florida
My Commission Expires:
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