2119 S Sanford Ave - E18-002798 - rewireI OkpCo JUN 2 12018 PERMIT APPLICATION
Application No: /goq %qr
Documented Construction Value: $ /J 0
Job Address: N 41t d" A/:r,-7 Historic District: Yes No ZI
Parcel ID: 3119 " 3/ -- S// -&X - 03aa Residential 9 Commercial
Type of Work: New Addition Alteration to Repair Demo Change of Use Move
Description of Work: eu TC e*;rs 067 SnP/ i2 -7 iN Li C'' /Loom
QL f . e3wi/k- ', 7 7te oy-e d IIA47`-y
Plan Review Contact Person:
Phone: Fax: Email:
Title:
Property Owner Information
Name 'Re , L) S Phone: L/U
Street: C911 G% S- /7w Resident of property?: l S`
City, State Zip: e A7 4/4 —//r'
Contractor Information
Name 191157A-,< F T tC d 10 dR p-" l l
Street: 006 209( 7y0/ 75-
Phone• 3e > 75'_—_ 67S:F
Fax:
City, State Zip: CA "'AQ .[ /` 3Z 7 / State License No.: GelS,047/4/q
Architect/Engineer Information
Name:
Street:
City, St, Zip:
Phone:
Fax:
E-mail:
Bonding Company: Mortgage Lender:
Address: 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.
00
f `-E23 w73o 80 1 .
Revised: June, 2018 Permit Application
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 ofthe 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 construction and zoning.
Signature of Owner/Agent Date
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Signature of Contractor/Agent Date
i4eve_, GJ.
P int C tractor/Agent' Name
Date
STATE OF FLORIDA
Cam* G0217377
Expires 8/21r=
Owner/Agent is Personally Known to Me or Contractor/Agent/is Personally Known to Me or
Produced ID Type of ID Produced ID JL Type of ID
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
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
UTILITIES:
FIRE:
Fire Alarm Permit: Yes No
WASTE WATER:
BUILDING:
Revised: June, 2018 Permit Application