2417 S Lake Ave; 18-4109; PANELCITY OF
FOocj PERMIT APPCATION BUILDING
DIVISION pp Application
No: 18- y I Documented
Construction Value: $ )L Co. 00 Job
Address: Li 17 S' Gy Abe ,4Ze Historic District: Yes [I No[-] Parcel
ID: Residential % Commercial Type
of Work: New Addition Alteration Repair Demo Description
of Work: \ 1( Plan
Review Contact Person: Phone:
Fax: Email: Property
Owner Information Name
j ,Pz, Phone: Street:
g q l S /_ fd /i e fief/ e City,
State Zip: Aakl o4 32 7 7/ Change
of Use Move v -
i on Pvn,D, Title:
4o
Z— S72 e?- -72 -K8 Resident
of property?: I
qq Contractor
Information' Name
O j marF `eV N ay) Ae,7 Phone: 1 0-7- a t g' O b a a, Street: 5
0(5 O N E a Q l ye-_
Fax:
ac— City,
State
Zip: 1 r l 1 '-' J O t State License No. 005 3*)- G 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.
sue''.:
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 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 cons17ion an orZ o
Signature of Owner/Agent Date Signat of Contract(A to
C,kC3 u- c _a
Print Owner/Agent's Name Print Contractor/Agent's Name
Cam' i:"'/ 1 V
Signature of Notary -State of Florida Date $igiiaWuat7g„State of Florida Date
ANNETTE BLAND
4g : = Notary Public - state of Florida ± r •_
Commission
JnOwner/Agent is Personally Known to Me or Cad or/
1110
t e } nown to Me or
Produced ID _ Type of ID _o Iu
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:
ENGINEERING:
COMMENTS:
UTILITIES:
FIRE:
Fire Alarm Permit: Yes No
WASTE WATER:
BUILDING:
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: l
I hereby name and appoint: ` ra
an agent of:
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):
The specific permit and application for work located at:
Street Address)
Expiration Date for This Limited Power of !Attorney:
License Holder Name: 0 { G-t- -Hf v VA W L7-
State License Number: E c— ` lj' 0 0 5 1')
a
Signature of License Holder:
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was
200-A3 by ,
before me this day of`?
who is personally known
tome or o who has produced as
identification and who did (did not) take an oath.
Signature
Notary Seal) / 4A, is U' VZ eAft4
Print or type name
DAMARIS ECHEVARRIA
MY COMMISSION # FF951338
EXPIRES January 19. 2020
W0348-01a9 Fforklallo:a-VS(WWO::on•
Rev. 08.12)
Notary Public - State of F/O etdc '
Commission No.
My Commission Expires: -0
n' -_ ALL ELECTRICAL 1 - / (D
P
ECTR/CAL WORK RES/DENTIAL at COMNEWCON'STRUc-rl0N REMODELS CIA\
IT# :
407-260,6001
AI)QITIQNI
USfOmpr. A
I
Address.. q I
cIv- C Quc
I
Tel:
Poll
a -7
Fax:
Qty.
Description: escriPtion:
CL
ff I voice Nr.- 1047
Date:
j 0 1
Celt: Y07 — S
Ins Q rn
All III
Rkle a a0o Pffy,
c4t/ i A. L
EHI
Worker sign: Payment/De posit:
Due amount:
75-0-
00750