HomeMy WebLinkAbout159 Longleaf Pine CirL,
6
FEB 2 2012
CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: 00) BY' ocumented Construction Value: $ x+30.
Job Address: X 7%x.3
�, Historic District: Yes ❑ No ❑
Parcel ID: /�—_� - �O- �l39- Com- 0(0/0 Zoning:
Description of Work:
Plan Review Contact Person: Title:
Phone: Fax:
E-mail:
Property Owner Information
Name enr.. Phone: A-/0'7 • & ?Iqr'
Street: '/ Resident of property? : ✓
City, State Zip: �Cl.ntol �! 30'� r7%oJ
Contractor Information
NameL"�'f��u ni b�.�Y� �.. �nC Phone: 440% • 4490- - '7'L/,/5
Street: 611,)o (e ,cele/ Fax: X07- C/4/6 - 0'19 R9
City, State Zip: G/ 3a WO State License No.: C. -CC i'I/a& Sc 4Q
Architect/Engineer Information
Name: Phone:
Street:
Fax:
City, St, Zip: E-mail:
Bonding Company:
Address:
Building Permit O
Mortgage Lender:
Address:
PERMIT INFORMATION
Square Footage: Construction Type: No. of Stories:
No. of Dwelling Units: Flood Zone:
Electrical O
New Service — No. of AMPS:
Mechanical 0 (Duct layout required for new systems)
Plumbing
New Construction - No. of Fixtures:
Fire Sprinkler/Alarm 13 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 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 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. 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.
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:
Rev 11.08
UTILITIES:
FIRE:
-010
Si , of Contractor/ c Date
�/, Mknip—/1"! ( - Javwn
Print Contractor/Agent' Nam
/ D-. v, .- d--
signal ---.--
r oV
DEBBIE BLANTON
Notary Public - State of Florida
i My Comm. Expires Feb 25. 2015
Commission I EE 60182
�'�•° .� ,,rr Bonded Through National Notary Assn.
Contractor/Agent is Personall Known to Me o
Produced ID Type of ID %- C ' "-I Ul I s
WASTE WATER:
BUILDING:
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date:
I hereby name and appoint: c4, cnbeAq Cwo-,wn
an agent of:_
(Name of Compmy) .3 '
to be my lawful attorney-in-fact to act for me to apply for, receipt for, sign for and do all things
necessary to this appointment for:
rk locat� t: sa-114
C(
Expiration Date for This Limited Power of Attorney: Joi • 31 • /Q
License Holder Name:Lf
State Lice
Signature
STATE C
COUNT)
The
20�
to m
identification and who did (did not) take an oath.
Signature
(Notary Seal)
. .:; PAARAE WATKINS Print o type name
� - MY COMMISSION # EE031449
EXPIRES October 03, 2014 Notary Public - State o
I4oi>jsbos s;;: �r�t: �-re �°'a Commission No.
My Commission Expires:
v I
_1
3a'77,3
(Rev. 3f27/07)
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