200 Pine Winds Dr 17-00094; PANEL CHANGEOUTCITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No:
Documented Construction Value: $ ' rxl' 0 C'
Job
Parcel lit:
I?
Type of Work: New
Description of Work:
Plan Review Contact Person:
Phone: Fax: Email:
Property Owner Information
Historic District: Y,',0sE1NoI
Residential Commercial
Title:
M1
Name 't- f°%1°7 %l' f - Phone: (ko"%) Yd;2 —g?
Street: f Resident of property?
City, State Zip: S'7 r23
Contractor Information
7NamePhone: 6i /9
Street: 1,311 10 Fax:
City, State Zip: C.rv—, tA/ e L • "? State License No.:
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Arch itect/Eng !nee r 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: 511' Edition (2014) Florida Building Code
Revised: June 30, 2015 Permit Application
NOTICE: In addition to the requirements of this permit, there ma y be additional restrictions applicable to this property that may befoundinthepublicrecordsofthiscounty, and there may be additional permits required from other governmental entities such as watermanagementdistricts, 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 at the time of permit submittal. A copy of the executed contract is required
in order to calculate a plan review charge and will be considered the estimated construction value of the job at the time of submittal.
The actual construction value will be figured based on the current ICC Valuation Table in effect at the time the permit is issued, in
accordance with local ordinance. Should calculated charges figured off the executed contract exceed the actual construction value,
credit will be applied to your permit fees when the permit is issued.
irate and that all work will
be done in compliance with all applicable laws regulating construction and zoning.
Signature of Owner/Agent Date Signature of Contractor/Agent Date
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
Print Contractor/Agent's Name
Signature of Notary -State of Florida Date
DEBBIE BL 11TON
4 My COMMISSION # F 17K,48y
EXPIRES: February 25, 2019
Notwy Public
Contractor/Agent is Personally nown to Me or
Produced ID _ Type of ID it=
e- :) , J 11
BELOW IS FOR OFFICE USE ONLY
Permits Required: BuildingEl Electrical[] MechanicaIF] PlumbingO Gasn RoofF] Construction
Type: Total
Sq Ft of Bldg: Occupancy
Use: Min.
Occupancy Load: Flood
Zone: of
Stories: New
Construction: Electric - # of Amps Plumbing - # of Fixtures Fire
Sprinkler Permit: YesEl NoEl # of Heads Fire Alarm Permit: Yes [I NoF1 APPROVALS: ZONING: UTILITIES:
WASTE WATER: ENGINEERING: FIRE: BUILDING:
COMMENTS: Revised: June
30,
2015 Permit Application
IVN
ropoat— Pago# of, pages
z
6
41VI
ISAL r JOB47117iTG
ADDRESS
t -
propose _hereby tofurnishmaterial and labor complete in accordance with the above -specifications for the sU-m of: with
payments to be retails a lo SfolWS: Any
alteration or deviation soon above specificabons involving extra en is Respectfully will
be executed only upon written orrier, and will becorne ail extra Charge Submitted over
and abovethe estiniate. All agreements conlingent upon strikes. den€s.
or delays beyond our control Note — this proposal may ....... i,ivvtibytisiftiotic(.,eptedwitill(I days, Cceptance of
J)ropmll Tire riticive
prices, specifications and conditions are satisfactory and are, hereby accepted.
You are authorized to do the work as specified, r . ...... Payments
will
be made as outlined above. signati, e
Date of
Acceptance_ /7 771'17711 Signature . ...... ... . 11