1805 Holly Ave; 17-2134; WIRE NEW SFHCITY OF
X PERMIT APPLICATION
a ,
BUILDING DIVISION
Application No: 3 4
Documented Construction Value: $
Job Address: ( Historic Districts Yes No
Parcel ID:
Type of Work- New Addition Alteration
Desc iption of Work: -1 .
Plan Review Contact Person:
Phone: Fax:
Name
Street:
City, State Zip:
Name / _ 1/1&1Q/ S&apx
Street:
City, State Zip:
itt
Residential Commercial
Demo Change of Ilse Move
Email:
Property Owner Information
Phone:
Title:
Resident of property?
rmationl
Phone:
Fax: `
State License No.: _ 6e i 019
Architect/Engineer Information
Name: Phone:
Street:
City, St, Zip:
Bonding Company.
Address:
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 heieby 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: 6" Edition (2017) Florida Building Code
NOTICE: In addition to the requirements of this permit, there maybe additional restrictions applicable to this property that maybe 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 p an review -charge and ial be consideyed the estimated construction value of the job at the time of submittal. T e actd coristruction 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 Omer/Agents Name
Date Signature of Contractor/Agent Date
Jee &—
Pr tractor/Ag—ent'ss Namamee
7j 'n A'j
Signature of Notary -State of Florida Date Signature of Notary, -State o =Flx
ANNETTE BLAND
Notary Public - State of Florida
s• ;org
Commission # GG 060623
Owner/Agent is Personally Known to Me or Co eui - mm. Ex dtna Iy J
Produced ID Type of ID Pro
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building Electrical Mechanical Plumbing Gas Roof
Construction Type: Occupancy Use:
Total Sq Ft of Bldg.--. Min. Occupancy Load:
Flood Zone:
of Stories•
New Construction: Electric - # of Amps Plumbing - # of Fixtures
Fire Sprinkler Permit: Yes No # of Heads
APPROVALS: ZONING:
COMMENTS:
UTILITIES:
ENGINEERING: FIRE:
to Me or
Fire Alarm Permit: Yes No
WASTEWATER:
BUILDING: