1119 Park Ave - BR18-004758 - STAIR REPLACEMENTp `1 ok/a
zBUILDINGDIVISIONisl
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FIaRMIT
KApplicationNo.
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Documented Construction Value: $_._ 9t
APPLICATION
Job Address: _ _...._. / Historic District: YeZ No
Parcel ID: ` 1 "' r Residential ist Commercial
Type of Work: New Addition Alteration Repair Demo Change of Use Move
Description of Work: iC fCfel } ' `S
s d ' y0 inoIn s-c sr e I",
Plan Review Contact Person: " V 6ly" - 1- 4 !n Title: t't ! v < " b ' Phone• `
4 0 570 S 3 2- O Fax: Email: %AIN et or t< yam;,
Property
Owner Information Name
j n) ` 1& 6 N Phone: q j' l / 7 Street: '
3® Resident of property?: Y?6 City,
State Zip: : Ja 2y7 Contractor
Information 2 }
Name
i' l Phone: Street:
LAV e atC_ AOLG C'° City, State
Zip: ov,,el woo t' _ • 51i Architect/Engineer
Information Name: Street:
City,
St,
Zip: Bonding Company:
Address: Fax:
40
State
License
No.: C 5 --7 S (oPhone: 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
FBC t05.3 Shall be inscribed with the date of application and the code in effect as of that dale: 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 Samford requires payment of it 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 ofsubmittal. The actual construction value
will be figured based on the current ICC Valuation fable 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.
OWNS IDAVIT: 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
Signature of Contractor!
VAarV
Signature of Notary -State of Florida
N ItAry Puptte Stato of Floridac
Owner/Agent is rsonalu n^ Roy Germain Pe! n n to Am,asion GG tst2ts ot?tractor/Agent is Personally Known to Me or xp
r•s a rsu2a22 ProducedIDTypeofI Pro iced ID Type of ID 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: 1 1° t - ' i' t UTILITIES: Fire
Alarm Permit: Yes No WASTE
WATER: ENGINEERING.
FIRE: BUILDING: ' I ' r0.11 COMMENTS:
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SWORD
FLORIDA HISTORIC PERMIT
All Work mum be done in strict &CCGMU= with the
AWroved Certifwatc Of ApproprWawn
APPLICATION # I ing &" not e any wmt outside this scocpiIf , * FOR
A
CERTIFICATE OF APPROPRIA&approv k%
Vw
is 'y muftl4nc)c Answerall
the questions on this form and submit all required attachments. Incomplete applications will not be reviewed. If
you have questions about application requirements contact the Historic Preservation Officer at 407.688.
5145 to ensure your application is complete. General Information
Downtown Commercial
Historic DistrictO Residential Historic District W Is this a retroactive request? YesE] NoE] Is this
application filed in response to a Notice of Violation from the Code Enforcement Department? Yes® Non Proposed improvements
will affect the following elevations: North 9 SouthEJ East El west 0 Property Address:
Property Owner
Print Name: <-
Mailing Address:
1,7 tt 7 Phone*? -31l "
q , 7/0 1Email: Applicant/Agent
Information Print Name:
Mailing Addr
1 - Phon -
A , BY SIGNING
BELOW YOU ACKNOWLEDGE THAT A BUILDING PERMIT MAY BE REQUIRED FOR THE SCOPE OF
WORK LISTED BELOW. YOU MUST CONTACT THE BUILDING DEPARTMENT TO DETERMINE IF
A BUILDING PERMIT IS REQUIRED. FAILURE TO OBTAIN A BUILDING PERMIT WILL RESULT IN
A STOP WORK ORDER, DOUBLE PERMIT FEES, AND POTENTIAL FINES. BY SIGNING BELOW, YOU
ALSO ACKNOWLEDGE THAT THE INFORMATION CONTAINED IN THIS APPLICATION IS TRUE AND
ACCURATE TO THE BEST OF YOUR KNOWLEDGE. Signature: Date:
Would you
like to receive emails regarding Historic Preservation and Community Planning within your community? Description of
proposed work Completely describe
the entire scope of work, including changes in material and color, and methods that will be used to accomplish the
proposed work. For large projects an itemized list is required. Use the reverse side if necessary. HISTORIC PRESERVATION
BOARD - 300 S. Park Avenue - Sanford, Florida 32771 - 407.688.5145 - www.sanfordfl.gov/HP
APPLICATION #
FOR A CERTIFICATE OF APPROPRIATENESS
Supplemental Information - Please use the space below to provide additional details regarding proposed work.
Description of proposed work (continued from previous page):
ONLY WORK SPECIFICALLY INDICATED ABOVE 13 PERMITTED. ANY CHANGES
TO THE BUILDING NOT LISTED ABOVE ARE NOT PERMITTED AND REQUIRE AN
ADDITIONAL CERTIFICATE OF APPROPRIATENESS.
Site Details
Please use the space below to Illustrate site details.
ifISTORIC PE"IT
All Woric MAt bt d0ac in strkt acc"40im with the
Apprw4ed Certificate of ApriroriristenM
Bumin dm m4 approve any work oftide this sc*Pc
PPamftAppk=t is soky respamib* for cmrt lianct
HISTORIC PRESERVATION BOARD - 300 S. Park Avenue - Sanford, Florida 32771 - 407.688,5145 * www.sanb d.gov/HP
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