HomeMy WebLinkAbout250 Kays Landing DrA0 '
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CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: I C3 Documented Construction Value: $
Job Add as: Vai;g L cn�r r 1121 Semon 1A Historic District: Yes ❑ No ❑
Parcel ID:
Zoning:
Description of "Work: 16' K' Alis o t:;,nCQ
Plan Review Contact Person: &A S' -- r- Title: Okzv�ex
Phone: ;38j, 6L:3 6534 Fax: 1� E-mail:
Property Owner Information
Name 4045 L a ,_66-A
Street: �,4
City, State Zip: 3117
Phone:�4nT q
Resident of property? :
Contractor Information
Name CQ Phone: 8(0 Lf,5 55 ?A
Street: ��� P� �t �� Fax: &9L 6bR 579'L
City, State Zip: AQgX% � 311 State License No.: (4q1 Q119 bD ((0
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Building Permit ❑
Square Footage: _
Architect/Engineer Information
Phone:
Construction Type:
No. of Dwelling Units: Flood Zone:
Electrical ❑
New Service - No. of AMPS:
Mechanical 0 (Duct layout required for new systems)
Fax:
E-mail:
Mortgage Lender:
Address:
No. of Stories:
Plumbing ❑
New Construction - No. of Fixtures:
Fire Sprinkler/Alarm ❑ 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 wort: will
be done in compliance with all applicable laws regulating construction and -zoning.
WARiNiNG 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 Date
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced I D Type of I D
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
Rev 11.08
• -12
Signature of Contractor/Agent Date
Print Contractor/Agent's Nano
0/.0,3,/,).,
DEBBIE BLANTON
; Notary Public . State of Florida
• My Comm. Expires Feb 25. 2015
Commission N EE 60132
�' °F "d' •• Bonded Through National Notary Assn.
Contractor/Agent is Personally Known to Me or
Produced 1D Type of 1D
UTILITIES: WASTE WATER:
FIRE:
BUILDING:
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CITY OF SANFORD - BUILDING ILAN REVIEW
PLANNING AND DEVELOPMENT SERVICES
APPROVED ✓ . .Sc% a I fs
DATE�J�
63-00