516 Liberia Ct 17-1555; AC CHANGE OUTnECEIVErl,
CITY OF SANFORD
BUILDING & FIRE PREVENTION
a MAY 3 0 2017 y PERMIT APPLICATION
BY-1-0 Application No:
ocumentea t_,onstrucuon value: iiv
loon E, nn - n ppJobAddress: L L1(_kQ C*, SOS Icy, frt.12,111 Historic District: Yes No V1
Parcel ID: ,31^(q I—p-0 2U- oaa) Residential'® Commercial
Type of Work: New Addition Alteration Repair >< Demo Change of Use Move
Description of Work:
Plan Review Contact Person: Lof'\ `,_p n (d'K+ Title:
Phone: O a i1,- Fax: Email:
Property Owner Information
Name
Street:
City, State Zip: SAA(G , Y.2171
Phone:
Resident of property? :
Contractor Information
Name`Z- j P_h1.
Street: C14 a!5 024 1 m SfOA
City, State Zip: OAA61.
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Phone:
Fax:
State License No.: a' ACA—_2'kzj
Architect/Engineer Information
Phone:
Fax:
E-mail:
Mortgage Lender:
Address:
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.
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.
FBC 105.3 Shall be inscribed with the date of application and the code in effect as of that date: 5t° Edition (2014) Florida Building Code
Revised: June 30, 2015 Permit Application
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.
Signature of Owner/Agent Date
V-1671t, 1 fi/'A/—
Print Owner/Agent's Name
Signature f Cmr..t.,/Agent' Date
o mkt S % /i7 on
Print Contract /Agent's me
C. oel sa
Signature of Notary -State of FI r'
CAROLINA KENNEDY LowlocicH Rt
MY COMMISSION # FF907271 = WCOMMISSION#GG008697
EXPIRES August 05, 2019 'ems ;a EXPIRES: July5,2020
FIorMMNou Service.rom o;F n°•a, Bonded Thru Notry Puble Undewites
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
Contractor/Agent is Personally Known to Me or
Produced ID Type of ID
UTILITIES: WASTE WATER:
FIRE: BUILDING:
Rev 11.08