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CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: /q— 1__5za
Documented Construction Value: $
Job Address: Ln4ki&o Ok• 11 Historic District: Yes No
Parcel ID: ,3"1Q-31-3a0-2Q- com Residential'] Commercial
Type of Work: New Addition Alteration Repair RI Demo Change of Use Move
Description of Work:
Plan Review Contact Person: LoT1 1._.00 h alc+ Title: *?
AaL.WAJ_ Phone: 40-7'&k )-i Fax: Email:OC.In o
Property Owner Information
Name "ki-Fi66eS fk t5$11 Ot
Street: low ,r M y"
City, State Zip: S fiZ—
Phone:
Resident of property? :
Contractor Information
Name-F{-TLP_1. 4&P@6(Y2 'E;__
Street: _)4 a6 0_'
Aj 6EQk 5[Jk
City, State Zip: QtA41f-A n J'v
Phone:'llpt i
Fax:
State License No.: l-ACmqzez)
Architect/Engineer Information
Name: Phone:
Street: Fax:
City, St, Zip: E-mail:
Bonding Company:
Address:
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: 5" 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.
7
Signature of Owner/Agent Date
votc, V, X. '&111
Print Owner/Agent's Name
Signature of Notary-$ to I C06LIN I)M NEDY
i MY COMMISSION # FF907271
EXPIRES August 05, 2019
tgA'7 a9s•0 s3 FWrKkoNota sw".com
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
UTILITIES:
FIRE:
Signature of Contractor/Agent Date
7J-10mQ6 % AI%xon
Print Contract /Agent's me
Signature of Notary -State of FI r'
LORILOCKHART
MY COMMISSION # GG 008697
EXPIRES: JWy 5, 2020
Bonded Thru Notary Public Underwriters
Contractor/Agent is Personally Known to Me or
Produced ID Type of ID
WASTE WATER:
BUILDING:
Rev 11.08