1100 Stonebrook Dr 12-1447T 71
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CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
''Application No: /d - /G -I'y 7 Documented Construction Value: $
/Job Address: O�� [7 S-f�'cb� t�,-s (i, Historic District: Yes ❑ No ❑
Parcel ID• Zoning:
__D-9-sc rip tio n of Work: PCP %c /_S 10� 12;/ SL , 6� oYI4 05) /i✓'D q
Plan Review Contact Person:
Phone:
Fax:
E -mail:
Title:
> 9 `Property Owner Information -
NameS��C -L-z "k a,-1a )o v�"cii? Phone:&
Street: ,/ p00 Resident of property?
City, State Zip:
— Contractor Information— � �1Q.��c9
Name ncrS7��ener���/J�S�O ✓A�r/1G Phone: L./D'� -35� 5
Streetz9U6aa SUS �Z 5, ye E-6-411e Fax: ��`7�Z� �� - Uc--0'`7
City, State Zip: /�� a-T•�r, ��- 9 �' State License No.:(' �C, G 60 J Ll ~7
Architect/Engineer Information
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Building Permit ❑
Square Footage:
No. of Dwelling Units:
Electrical ❑
New Service - No. of AMPS:
Phone:
Fax:
E -mail:
Mortgage Lender:
Address:
PERMIT INFORMATION
Construction Type:
Flood Zone:
No. of Stories:
Plumbing ❑
New Construction - No. of Fixtures:
Mechanical ❑ (Duct layout required for new systems) 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 nd
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.
6 (�
Signature of Owner /Agent Date Srgnature of Contractor /Agent Date
Print Owner /Agent's Name Print Contractor /Agent's Name
Signature of Notary-State of Florida Date
Owner /Agent is Personally Known to Me or
Produced ID Type of ID
APPROVALS: ZONING: UTILITIES:
ENGINEERING:
COMMENTS:
Rev 11.08
i` yyayyrt.]w�c Ui i 1—bl -BRIE BLANiOM1i
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Notary Public - State of Florida
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My Comm. Expires Feb 25, 2015
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Commission # EE 60182
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Bonded Through National Notary Assn.
Contractor /Agent is Personally Known to Me or
Produced ID Type of ID r t' • 1) ` )-2-/ 2-e-,
WASTE WATER:
BUILDING: