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119 Mayfair Cir 17-1197; ELECTRICr- CITY OF SANFORD BUILDING & FIRE PREVENTION rl 017 PERMIT APPLICATION F Di APR 2 8 2i; 7y y I ! QY: Application No: Documented Construction Value: $ v Job Address: //I )i2 12G j j-p- 3a77 Historic District: Yes No Parcel ID: 3-5-- / e/ — 3© — S- / - Q C_o O - 6 / Z- d Residential V1 Commercial Type of Work: New Addition Alteration Repair , Demo Change of Use Move Description of Work: Arr 2 r Q J f 5-6 i4i /hP 2.-/ % rl dP/(WL PAeticeRtiUoJ,t,,IIJE a Plan Review Contact Person: Phone: Fax: Email: Property Owner Information Title: Name y e2 BCtx Lf Phone: Street: l M 6y1 4tZ Cc /_dP Resident of property? : P City, State Zip: I,y-) 4f1 1 Contractor Information Name ?Pry ` - T(C 4 CL rri Phone: ' 72 5 = 078? Street: Pb T d-* Fax: 9X/'-"4 C, , 1- 3a» State License No.:C 1360/ City, StateZip. ` Name: Street: City, St, Zip: Bonding Company: Address: 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: 511' Edition (2014) Florida Building Code Revised: June 30, 2015 Permit Application 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 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. 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. . Signature of Owner/Agent Print Owner/Agent's Name Date Signature of Notary -State of Florida Date Owner/Agent is Personally Known to Me or Produced ID Type of ID S n re of Contr for/Agent Date Print Contractor/Agent's Name 42ML aX74__) ', 0 V. d 3, ignature of Notary -State of Florida w:'P-'' DEBBIEBLANTON t: MY COMMISSION # I'r" 17864 a EXPIRES: February 25, 2019 F eF N4Q' Bonded Thru Notary Public Undem6tea ` Contractor/Agent is Personall own to Me or Produced ID Type of ID Co BELOW IS FOR OFFICE USE ONLY Permits Required: Building Electrical Mechanical Plumbing[] Gas Roof Construction Type: Total Sq Ft of Bldg: Occupancy Use: Min. Occupancy Load: New Construction: Electric - # of Amps Fire Sprinkler Permit: Yes No # of Heads APPROVALS: ZONING: ENGINEERING: COMMENTS: UTILITIES: FIRE: Flood Zone: of Stories: Plumbing - # of Fixtures Fire Alarm Permit: Yes No WASTE WATER: BUILDING: Revised: June 30, 2015 Permit Application