101 Sandpoint Ct05/29/2012 05:03 3219518735 '••'FLORIDA BREEZE PAGE 02/10
i •
P•
SAX-4*07 69$'S152
=REECEIVED CITY OF SA14FORD
BUILDING & FIREP��VENTION'
PERMIT APPLICATION
p pp
1 d Construction Valve: $
Application No: Documented �
1 Ci" Wstoric DiStriet:'.Xes [INo
Job Address:
p a� Zoning;
Parcel ID: , O'er 3
Description of work•
Title:
Plan )Review Contact Person:��� CAM
Phone*.
�o Fax: 32t - Property Owner Information
Nance 1-rN
' Phone:
Street: 1 1�T GT Resident of property?
City, StateiZip: a `i T 02_7 4 EL
Contractor Information l
1..0R1 D A L3Cz��?a= Phone:
Name
Street: �I`J F`�D2"f1-i ��2i�E SLI1-i�17 F2X'. �35
City, State Zip: M UR du
State License No.: Gfhc
ArebitectlEngineer Information
Name: Phone:
Street: Fax:
City, St, Zip: E-mail:
Bonding Company-
Address:
, Mortgage Lender.
Address:
PERMIT INFORMATION
Building Permit 13.
Square Footage: Constriction Type: No. of Stories:
No. of Dwelling Units: Flood Zone:
Electrical • 13 Plumbing 13
New Service - No. of AAWS• New Construction - No. of Fixtures:
Mechanical 0 (Duct layout required for new systems) ]Fire Spriuoider/Alarm 0 No. of beads:
°9
05/29/2012 05:03 3219518735 FLORIDA BREEZE PAGE 03/10
F
Application as hereby made to obtain a permit to do the work wer�ni �a bat all work will be Peozmedthat t°
Work or Wstallation� has commenced prior to the issuance of ap
I understand that a separate permit
meet standards of all laws regulating construction in this jurisdiction.,eels furnaces, boilers, heaters, tanks, and
trust be secared for electrical work, plumbing, signs, wells, P ,
Air conditioners, etc.
OWNER'S F+'Ip V1LT- I certify that all of the foregoing infvrutatiom 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 I1V.IPROVEMENTS TO YOUR ON JOBpROSITE
B A NO']EFORE TIHE
CE
OT COMM,NCEMENT MUST BE RECORDED AND POSTED FINANCING) WMJ YOUR
FIRST INSPECTION. IF YOU INTEND TO OD'I'
LENDER OR AN ATTORNEY BEFORE RECORDING XOUIi NOTICLr OF COIVIIViLNCE1VNT.
NOTICM_ In addition to the .requirements of this permit, there may be additional resizictiOJJs 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 sueli. as water management districts, state agencies, or federal agencies -
Acceptance cceptance 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.
sigmttue of owner/Agent Date
Pam Owucr/Agent's Name
Signature of Notary -state of norlda Date
owner/Agent is' _ Personally Known to Me or
Produced ID Type of ID
` 12
signs rco£Contraotor/Agent Dnti
Print Coribmtor/Agent's
p tyotary Pub"C State et ptodde
a� >"ynne Mercier
t,Ay 20,Mmtssion LE022612
EXPlreB Og10t120
contractor/Agent is _Q<- Personally Known. to Me or
Produced ID TyPe of ID
APPROVALS: ZONING: UTILITIES: WASTE WATER:
ENGINEERING:
COMMDNTS:
FIRE: BUILDING:
Rev 11.08
r
05/29/2012 05:03 3219518735 FLORIDA BREEZE PAGE 04/10
a�
/ VICE ORDER
::mod: f�
..�'
;It<
INVOICE
: r..; • rR;fr i..
�o gf4.mmG. .:' .,
, a a lYIDSrlE 1 °
-- BILL TO
NAME jo
'STRF,FT
sAwppp iivr C-0
CITY SCNrn. O AM
SAA F��'1!/ .. nraE ❑ PM
PHONE (HOM[)40� �I�NONE}yV�%Ij� - PHONE (CELL) -
TECHNICIAN ('
WORK TO Be F6RFORMEI7
,�, •1' ,!Sys! ::A ••fnj..::�•
, :1 !.... " •i •,•.:=.":......:i hy.}�ywF� �yy1+ j�'y VI[`,�ryy�pq��a{ (�j��yp�, µ� •{••� �r3:... ': n, ''�f •'? ^„� 4 . /..,i
r.. - �..l�GJtif1�K�f•Ti�,'W P;�WfLi\;iYl\�i7'. 1'•�:�� �:'; t-
Tor
14 Kof r
oTY.* ] nn r� ia�5 s� 4rc
REFRICVRANT R• LBS. I I
1 1
1 1
FILTERS X X t r
1
1 1
I
1 I
f I
1 t
1 t
1 l
1 I
1 +�
t 1
TOTAL MATERIALS
TERMS:
0 CASI•I ❑ CHECK
CREDITCARb ❑ MC U VlSA ❑ AMEX EXP. bATE ,,,, ,.
a..
1 I NAME
I 1
I 1
TOTAL LABOR Mr%Df t
SERIAL NUf-ePER
NAME
M9m4.
SERM NUMMIR
1tM04b WARRANTY: TOTAL
M matedatc, p,.rts and rtgldpmenl nrn wlxmnted by lho monufml"s nr elrppnam' MA7EWAL5
Illan wirmnty only. All labor perfoRma by Flnrtdn timmm 1, ww"n10d for 30 dnya
IoiWlSe hMkplw In vanlna. Florida BreeZo of MetbMirno, Flnrlrin make, no TOTAI. LAR01t
otllgr w:,Trantlar, oapra:. of ImplW, and Its oapntr: ar tnchnklam-, nm tlol A%AberL,.nd
to mako any sur;� wmrnntlr» an banall of P'twWo Broom. TRAVEL
CHARGF
❑ REOIJI.AR ❑ WARRANTY �-
�+ . V TAX
0 SERVICE CONTFAQT
Thank You! TOTAL
/ /�