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CITY OF SANFORD PERMIT APPLICATION
Permit # : /,
pip p ' /
Date:
CJob Address:• 1 ® 7 W— X UiC
r
1?",A0Rd0 ZA1 11111'
CDescription.of_Warl J
Historic District: Zoning: GValue of Work: S
Permit Type:Building~tom Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary Pole _
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & tSewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets Plumbing Repair — Residential or Commercial
Occupancy Type: Residential 1Z Commercial Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X)
Parcel #:
Owners Name &Address:
Contractor Name & Address:
Phone & Fax:
Bonding Company:
Address:
Mortgage Leader:
Address:
Architect/Engineer:
Address:
Attach Proof of Ownership & Legal Description)
State License Number:
Contact Person: Phone:
Phone:
Fax:
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 TN 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 pe it is verification that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713.
of Date Signature of Contractor/Agent . Date
Print er/ nt's N Print Contractor/Agent's Name
237
nature of No / g Notary -State of Florida Date Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or Contractor/Agent is _ Personally Known to Me or
Produced ID _ Produced ID
APPLICATION APPROVED BY: Bldg:
Special Conditions:
Initial & Date)
EVEUNE E. BENNETT
MY COMMISSION # OD 053453
of EXPIRES: August 28 21X15
ondwf1i;n Bnw N0" PL tc undsrwidsn Zoning:
Initial &
Date) Utilities:
FD: Initial &
Date) (Initial & Date)
CITY OF SANFORD BUILDING DIVISION
7' 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 commercial 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 year after completion of same creates a presumption that the
construction was undertaken for purposes of sale or lease. This subsection does not exempt any person
who is employed by or has a contract with 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 personally 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 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 $25,000. 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, uilding codes, and zoning regulations.
I, - .G , do hereby state that I am qualified and capable of performing the
re`q sted`cons tion involved with the permit application filed.
I will assume full responsibility as an Owner/Builder Contractor, and will personally supervise all work
allowed by law on the permitted structure.
erBuild .Signature—^-7 Date
Ao L 10s Print
Ownerfiguildgr Name lM`•'
i+ EVEUNE E. BENNM Owner
is Personally Known to Me or has .: MY COMMISSION N DD 053453 Produced :?'•,
EXPIRES: August 28, 2005
I
I7
Company:
AFFIDAVIT
REGARDING ROOF DRY -IN AND FLASHING INSPECTIONS
License #:
Project Information
Owner: J
Game
013 cd::3w
address
phone
Permit M v -f // a 7
Subdivision:
Lot #:
I:-IJZ,A., , affiant, hereby affirm that I am the duly licensed
contractor oPrecord for the above referenced permit, that all the foregoing information is true
and accurate, and that the dry -in, flashings at the above referenced address or lot has been
installed in accordance with the applicable codes and standards.
Contractor:L W'&V_L
s ature
J4W RV Y4 oore
printed name
STATE OF FL O A
COUNTY OF
This instrument was acknowledged before me this day of Jg n , 200 , by the
above referenced individual,1.,A A., _ , who acknowledged that he/she is a
duly licensed contractor with ^ , and who acknowledged that
he/she was authorized to execute this document. He/she is either onally known to ' r
produced as valid identification.
WITNESS my hand and seal this day of _ , MO S
qp J a- -
Notary Public