1165 W 16 St - E19-000072 - ELECTRIC GATErorrbrCITY OF
d SXi4FORD
BUILDING DIVISION
PERMIT APPLICATION
Application No:
Documented Construction Value: $ ` -"c)G? , z-,)-)
Job Address: 12 S i Ac CZ. .. Historic District: Yes N00 Parcel
ID: Residential Commercial Type
of Work: New 0 Addition [] Alteration Repair Demo Change of Use Move Description
of Work: 7 5 tC. (({ , f ke
Plan
Review Contact Person: C f l I`4!2 L-' 5 , Title: L1,AJ L e-1, - Phone:-
0-7- ", ( rt ` ` " Fax: Email: 915. t c'lRio i- 4-_, t w
Property
Owner Information U
Name
Phone: C L - `,' `Z Street:
Resident of property?: C City,
State Zip: Contractor
Informaiion Name
Z.. Pho e'. t
s Street:
Fax: City,
State Zip: State License No.: Architect/
Engineer Information Name:
Phone: Street:
Fax: City,
St, Zip: 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 andinstallations as indicated. I certify that no work or installation has commenced prior to
the issuance of apermit and that all work will be performed to meet standards of alllaws 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 ofapplication and the code in effect as ofthat date: 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 ofpermit is verification that I will notify the owner of the property of the requirements ofFlorida Lien Law, FS 713.
The City ofSanford 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 ofsubmittal. The actual construction value.
will be figuredbased on the current ICC ValuationTable in effect at the time the permit isissued, in accordance with local ordinance. Should calculated
charges figured offthe 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 ofOwn Agent Date
Name
I(t
Signature ofNotary -State
Signature ofContractor/Agent Date
PrintContractor/Agent'sName
Signature ofNotary -State ofFlorida Date
as "arj R bhc - SW# Y F1
Commisslor a GG 1 f
MY Comm Exams jar 16, 2C22
Owner/Agent is Pe owwta Contractor/Agent is Personally Known to Me or
Produced ID Tyke' Produced ID Type of ID
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building Electrical Mechanical El 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 Sprinldei Permit: Yes No # of Heads
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
UTILITIES:
Fire Alarm Permit: Yes []No
WASTEWATER:
FIRE: BUILDING: