100 Garrison Dr 11-104RECEIVED CITY OF SANFORD
OCT 141 BUILDING & FIRE PREVENTION
P RMIT APPLICATION
Application No: ` l Documented Construction Val e:'$
Job Address: I(xyLf iSDr Of UQ.i Historic District: Yes No
Parcel ID• Zoning:
Description of Work: or -s W S ;n K eh
Plan Review Cont c erso !
U Title:
Phone: ,X 1, 939 Iy/, Fax: E-mail:
n `
Property Owner Information
Name Puin l _i-I ' Phone:
Street: o Resident of property?
City, State Zip: + Wr_ S-30—)
Contractor Information
Name Phone:
Street Fax:
City, State Zip: State License No.:
Architect/Engineer Information
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Phone:
Fax:
E-mail:
Mortgage Lender:
Address:
PERMIT INFORMATION
Building ,Permit
Square Footage: Construction Type:
No. of Dwelling Units: Flood Zone:
Electrical
New Service — No. of AMPS:
Mechanical (Duct layout required for new systems)
No. of Stories:
Plumbing, l
2
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 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.
11X'4
Signature o Owner/Ag Date"
Print Owner/Agent's Name
i
O f 14t'o
Si cure of Notary -State of Florida j / Date
JO ANN M: J0NNsdiv
MY'COMMISSION 1 bb *978
EXPIRES; Mttsn 25, 2012
9 OF F OQ'\O! sDAAfd 11fr'UEZ!( tNotary Servicet
Owner/Agent is Personally Known to Me or
Produced ID _ Type of ID U)1 'D —
APPROVALS: ZONING: UTILITIES:
ENGINEERING:
COMMENTS:
Signature of Contractor/Agent Date
Print Contractor/Agent's Name
Signature ofNotary -State of Florida Date
Contractor/Agent is Personally Known to Me or
Produced ID Type of ID
WASTE WATER:
BUILDING:
Rev 11.08