2104 Summerlin Ave 17-92; ELECTRIC METER (2)CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No:
Documented Construction Value: $
Job Address: )21 )_ ('ive, Historic District: Yes D No D
Parcel ID: I- I G1 - 3 )— s Q Residential 0 Commercial El
Type of Work: NewEl Addition 11 Alteration El Repair 5 Demo 11 Change of UseEl MoveEl C) Description of
Work: ('QQQ,r I'C, tVACU- SCC-Of CAINJ CkC')'_4Q- jana"r-' Plan
Review Contact
Person- i0,n Cd,Xna- Title: Phone: Fax: Email:
Property Owner Information
Name'W"'(11A ("'&
JCf Phone: Street: Resident of
property? City State zip:
Sc4onj, FLl i i Contractor Information Name cw-
Ek-cfri'
ct) Phone: _l Street: 6SOI Qlvd Fax:
City, State Zip: State
License No.:Ec I R o. o, N ' —(- - /!C, I- "t3 'Q Name: Street: City, St,
Zip:
Bonding
Company: Address: Arch
itectlEn g
ineer
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, beaters, tanks,
and air conditioners, etc. FBC 105.3 Shall
he inscribed with the date of application and the code in effect as of that date: 51h Edition (2014) Florida Building Code Revised: June 30, 2015
Permit Applicatimi
Nqffl-CE: 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 1 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.
QWNER'S AFF1 DAVIT: 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.
I-- 7
si81 e of Owner t Date signatur wttmetod ate
Pri /A W" Print Contractor/Agent's Namegent's,
MY COMMISSION 0 FF 948145
EXPIRES: January 5, 2020
Boded TttN N*ry Public Undswitirs
I "ate
JAMES THOMSON
Notary Public State of Florida
My Comm, Expires Dec 2, 2017
Commission # FF 74164
Owner/Agent is V Personally Known to Me or Contractor/Agent is YZ Personally - Known to Me or
Produced ID Type of ID Produced ID—Y. Type of
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building[] Electrical El Mechanical PlumbingE] Gas[] RoofEJ
Construction Type: Occupancy Use: Flood Zone:
Total Sq Ft of Bldg: Min, Occupancy Load: of Stories:
New Construction: Electric - # of Amps Plumbing - # of Fixtures
Fire Sprinkler Permit: Yes[] No]
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
of Heads
UTILITIES:
FIRE:
Fire Alarm Permit: Yes No []
0
Wofflom
Revised: huie 30, 2015 Pennit Application
xi{?.?RESS 806 Ecrir}ibia3 Dr Sanford FL We '
11- I}ro'if ull", \oil "III) ti &Nct1E)tion M !lit' Last k lhuf ha, i cfl petfilillz3d 10i Qlc akw,C IO'cla".tik,ed 10b otyy
scription rust C-1 00ya Exg. Price -- Replace
200amp GE Main Breaker 150,00 Replace
200an2p Pieter socket 20u, 20000 1:
W),f41T'RIALS Total 135000 LWITIL 5809
t.
mversit,Y Blvd # 3 t by ater Plaark Florida 3,2792 Offi.+ 6 956-0089 _
EIV
PLIMITEDPOWEROFATTORNEY
EAN E
J 8 4 201?
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date:
I hereby name and appoint:
an agent of Tc- C,,_, LLC
Name of Company)
to be my lawful attorney -in -fact to act for me to apply for, receipt for, sign for and do all things
necessary to this appointment for (check only one option):
an for N
I
Expiration Date for This Limited Power of Attorney: 1
License Holder Name:, "ttln or , T
State Licens
Signature of
STATE OF
COUNTY(
The foregoing W'strumpnt was acknowledged before me this day of Cnc ftA0-- J-L-AC-
200-0—, by LASb t who is m-pWSonally k"n
to rne or o who has produced as
identification and who did (did not) takean oath.
Notary Seal)
IMaCOLE" MY COWSSION # FF 948145
EXPIRES: January 5, 2%0
Bonded Thru ftry Public Underwtsrs *L
Rev. 08,12)
Print or type name
Notary Public - State of-L-Lbal AA -
Commission No. V—V qtj i I ,-1
My Commission Expires:4-L?