HomeMy WebLinkAbout429 S Summercia AveA
OCT 6 2011 CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Documented Construction Value: $ Q1 v700. 00
Job Address: x c2 q 5- S UM ME22(.,I Ae AV F Historic District: Yes ❑ No 11
Parcel ID: 30 - / !j - 31- 5A5 -0D0o-O''4/0 Zoning:
Description of Work: ENr_AJ?&[ 0VE12 1- & 4 Q r.Aie 1-G C *D00►2
Plan Review Contact Person:
Title:
Phone: Fax:
E-mail:
Property Owner Information
Name 0 9140) t M VV&< -MO
I- E Y
Phone: q07 -49R-00,22<
Street:
City, St, Zip: /4CTfi40N_rr
Resident of property?
City, State Zip:
5AVvr0YC 0 NF1.
3a77 1
Contractor Information
Name 21e K
M CCA ellK
Phone: Y07 -71,q-7070
Street: 4159
5 VM M E/2L tA1
AVS—
Fax: .410l/ V_
City, State Zip:
✓f AA1:;9 j
3o2 77 1
State License No.: C G G O g 6 5 0 3
Architect/Engineer Information
Name: I?0N/VLI3
WILSON
PF ClC q7/0
Phone: y0,7- dg;- g0Sz
Street: qG&
IAlF4-t"f>'E/ZST/tZD
A(/'�
City, St, Zip: /4CTfi40N_rr
S065.
F(. 32 7/N
'Bonding Company:
Address:
Building Permita '
Square Footage: l6 �f T?1�_�
No. of Dwelling Units:
Electrical D
New Service - No. of AMPS:
Fax: X101— 4Z2 — 3$q l
E-mail:
Mortgage Lender:
Address:
PERMIT INFORMATION
Construction Type: No: of -Stories:
Flood Zone:
Mechanical. O (Duct layout required for new systems)
L
Plumbing O
New Construction - No. of Fixtures:
Fire Sprinkler/Alarm 0 No. of beads:
ell-
Application is hereby made to obtain a permit to do the work and installations as indipated. 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, beaters, 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. .4.
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•regtiirements 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. ON
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.
Signa re of Owner Agent Da
e,13KI,, d de
nt Own Agent's N3
Si ure o otary-State of Florida Date
�AVto0. , ANNE M STOSE
Notary Public - State of Florida
• = My Comm. Expires Apr 21. 2014
mmisslon # OD 955927
•° B ed Through National Notary Assn.
Owner/ gent s n o o e or
Produced ID Type of ID
APPROVALS: ZONING: �u /6.10 UTILITIES:
ENGINEERING(rW /o- /o - // FIRE:
COMMENTS:
•
Rev 11.08
Signature of Contractor/Agent Date
P(k I f `L Cl/e7
Print tractor/Agent's Name
tgnature of Notary -State of Florida Date
ANNE M STOSE
Notary Public - State o1 Florida
My commrExpiree Apr 21, 2014
comaussion # DO 955927
to Me or
Produced ID Type of ID
WASTE WATER: