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1311 Oak Ave - BR17-000291 - Water HeaterR 3 CITY OF SANFORD JAN BUILDING & FIRE PREVENTION PERMIT APPLICATION Application No: Documented Construction Value: S P-70, Job Address: 1-.i?ll Historic District: Yes El No [T Parcel ID: oZ.5'-1 - __ Residential 0 CommerciallE, Type of Work: NewAddition El Description of Work: 1'('16 Alteration ET Repair 1:1 DemoEl Change of Ilse E] Move 11 Plan Review Contact Person: Title: Phone: Fax: Email: Property Owner Information N timeC Phone - Street., Resident of property? City, - 7 StateZip: Contractor Information Name Phone: Street: Fax- qV) F5-2 6 q1 f try, State Zi G State License No.: OR" C),S-23,''_Y Arch itect/En g ineer Information Name: Phone:. Street: Fax: City, St, Zip: E-mail: Bonding Company: Mortgage bender: Address: Address: WARNING TO OWNER: YOUR FAILURE TO RECORD A No,UlCE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TNVICE FOR II PROVENITENTS TO YOUR PIROPF,RTY. A NOTICE EOF COMMENCENTENT MIUS T BE RFCD ORDED ANP0,STED ON THEJOB SITE BEFORE THE FIRIST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSUL'I'' WITH YOUR LENDER OR AN ATFORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT Application is hereby niade to obtain a pert -nit to do the work and iristallations 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. FIX' 105.3 Shall be inscribed with the date of application and the code in effect as of that date: 5a1 Edition (2014) Florida Building Code Revise& June 30, 2015 Perni4 Application NOTICE: In addition to the requirements ofthis permit, there may be additional restrictions applicable to this property tbai 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 perinit is verification that I will notify the owner of the property of the requirements of Florida Lien Law, FS 711 The City of Sanford requi-res payment of a plart review fee at the time of pertnitsabruittal, A copy of the executed contract is required in order to calculate a I.-)lan review charge and will be considered the e-,tinlated construction vaWe of the job at the time of submittal, The arc tuai construction value will lie figured hased on the current ICC Valuatimi 'Fable in effect at tic time the penint 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 Ire done in compliance with all applicable laws regulating construction and Zoning. 41' Date Print Owner/Agent's Name pepuci sigjlw: : I Ili: 1 mri!i7 i 711ialgro 44 z 91 Oa ros Owner/Agentis0eor Produced ID 11 112 7// 1 Signature ofContractor' Agent Date tary- 0 9 OZ; v Contractor/ A Lent is wri to Me or Produced 11) BELOW IS FOR OFFICE USE ONLY Permits 'Req u ired: Building 0 Electrica]E] MecharficalE] PlumbingE] GasE] Roof 0 Construction Type: Occupancy Use: Total Sq Ft of Bldg: Min, Occupancy Load: # of Stories: New Construction: Electric - 4 of Amps Plumbing - # of Fixtures Fire Sprinkler Permit: YesE] No[] # ofHeads APPROVALS- ZONING- UTILITIES: ENGTNE'ERING- FIRE- COM MENTS-. Fire Alarm Permit: Yes[] No El WASTE WATER: Revnsed: June 30, 2015 Pennit Allphcaiion LIMITED POWER OF ATTORNEY Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford, Seminole County, Winter Springs Date- , /— - 2 // 2 1, hereby name and appoint: to be nay lawful attorney -in -fact to act for nee to apply for, receipt for, sign for and do all things necess, aryto this appointment for (check only one option): The specific pennit and application for work located at- Sueo Address) Expiration Date for This Limited Power of Attorney: ------- License Holder Name:-,-, State License Number: Signature of License Holder- STATE OF FLORIDA COUNTY OF el'C17 c, The foregoing instrument Nva acknowledged before me this -'2'7-,day of 20V17 , by who is onal I y known to me or o who has produced as identification and who did (did not) I-Oath- ok% oll ho-IVLS'0/7 Az Notary's CA VeS Si piature Arint or Typ e pename Notary Public - State Commission No. My Commission Expires._ p6 a 9 t ft Fie' 53_ f3 Q¢1Echnr AddFea,R — v — - CL'tonler C?nirnercial Sit Inspection & L-stidT?az* (see B'Od'ngT5ems Total C t t qe—steal Q,ylLecatton/Descri n Labct' ParisOirount - a m tJrinal(s! •-- -;- jp.. t q c E_ J C4 1'1 Toilet(s) Toilet(s) C Sinkjs -- muses © i. So = 4 t `= 5S • c c --- ------ 0 C] o Grease Trap) _ _. _- ----------- frorn Grease Trap) — ---- -- --- - -- --- U ne (from Building) -- - __ -- - U C t Line -- ---- — — _.— ----- - - _ _ ---- L lrldirec, Drain G-------- --- _ ^ - - -- -- - t 0 I vention 'Device O _.---------- — — 0 re Water Jetting ----- ---- - - -- — — 0 J--- ---- -- ice Pruducts — - -- -- - — -- iscount Package ER AUTHORIZATION I authorize the se -vices indicated and agree to paj the arnourts speeded. t have read and agree to theaverseside, i.cJudfng the limits on Roto Roofer's responsiblity specified in lhuse terms. I acknowledge that under paragraph 5(h) of those hooter equ' gets :u in a I m Pdrt Na be resimsi le for the cost of remaving that equip a t, Inctu in any required excavation. m ' L D DESCRIPTION OF WORK TO BE PERFORMED (The approximate starting date is and the p'etion date is . Neither date is guaranteed. unexpected cunditions or problems could causc deiays. Lion date is not of the essence) JUSTMENTS/CHANGES IN WORK: Total reflects customer authorization of work as indicated above. Tax not included it estimate. Labor $ 7®•©4) Parts Discount $ Product $ Other . a' TOTAL $ f ' 8 P 1 LCa Check Credit Gard described work which has been my For plete satisfa t n+! Print Name) is-:..C...:,•,e Torhriria'c Narita and Numbew) Store Stamp(P.C* Control No.