119 Poplar Ave - BR18-003640 - INTERIOR RENOVATIONSPyI. RU f,
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BUILDING DIVISION
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PERMIT APPLICATION
1 _
Application No:
Documented Construction Value: $ 10 OCS
Job Address: I ( V 1" R AA Historic District: Ye No
Parcel ID: Residential Commercial
Type of Work: New Addition OAlteration Repair Demo Change of Use Move
Description of Work: iA < rta2 rCN-,,oLin 6,v
Plan Review Contact Person:
Phone: Fax:
Name J A s-
Email:
Property Owner Information
Street•
City, State Zip::-
Title:
Phone: q, fl ` W eta t 1'
Resident of property?:
Contractor Information
Name . '/Cc C t? C.G"15Tf vy Phone: _
Street: '5 6 G CS 'z "' a Fax:
City, State Zip: _cam„_ S'l ce State License No.:
Architect/Engineer Information
Name: Phone:
Street: Fax:
City, St, Zip:
M
Bonding Company:
Address:
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 ofa permit and that all work will be performed to meet standards ofall 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 Budding 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 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.
OWNER'S AFFIDAVIT: I certifythat all of the foregoing information is accurate and that all work will be
done in c uce with all Wplicable laws regulating construction and zoning.
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Signature f Owner/Ag" ent Date Signature Contractor/ ent / Date
I
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Print Owner/Agent's ame Print Contractor/Agent's N
Signature of Notary -State of Florida Date Signa Z 3_ HOUMD
MY COMMISSION # FF 949150
EXPIRES: April 9, 2020
Bonded TNu Nolary Public demriMr
Owner/Agent is Personally Known to Me or Con s ersona y now to Me or
Produced ID Type of ID Produced ID Type
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building Electrical Mechanical Plumbing Gas Roof
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 # of Heads Fire Alarm Permit: Yes No
APPROVALS: ZONING: UTILITIES: WASTE WATER:
ENGINEERING: FIRE: BUILDING:
COMMENTS:
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: ^ 2 3
I hereby name and appoint: `- Su , VIVA,'? L
an agent of:
Name
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):
D The specific permit. and for work located
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Street Address)
Expiration Date for This Limited Power of Attorney:
License Holder Name:
State License Number:
Signature of License Holder:
STATE OF FLORIDA
COUNTY OFlL
S C,5 0-
F % S
The foregoing instrument as ackno ledge before me this Z3da of ,
200 by
g g t who >Isy erson own
to me or o who has produced 9 as
identification and who did (did not) take gnpath., ,f /y
Notary Seal)
J16UA /
r-/ 6J lie
Print or type nave
WESLETAHDUAND
My colwMIssloN r 9astso Notary Public - State ofL
a EXPIRES: April9, 2020 Commission No. l" 9 yD/ k p fP' Bonded Thru Notary Public Underwriters
My Commission Expires.
Rev. 08.12)