1811 W 15 St -E19-000050 - ELECTRICALCITY OF
NFOR PERMIT APPLICATION
BUILDING DIVISION
Application No: C —
Documented Construction Value: $
Job Address: Historic District: Yes [J Na [I
Parcel ID: Residential Commercial
Type of Work: New Addition[] Alteration Repair Demo Change of Use Move
Description of Work:l t-
Plan Review Contact Person: Title:
Phone: Fax: Email:
Property Owner Information
Name Phone:
Street: Resident ofproperty?
City, State Zip:
Contractor Information
Name Phone:
Street: Fax:
City, State Zip" t7' P 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 and installations as indicated. I certify that no work or installation has commenced prior
to the issuance ofa permit and that all workwill 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: 61 Edition (2017) Florida Building Cod
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 ofthe 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 urill 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 Table in effect at the time the permit is issued, in accordance with local ordinance. Should calculated
charges figured offthe executed contract exceed the actual construction value, credit willbe 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 ofOwner/Agent
Print Owner/Agent's Name
Signature ofNotary -State ofFlorida
Date Signature o _ Z[tSY/A iii"" Date
Pr' tContractor/AgenPs Name
Date Signature a£ to ofNOWT 7 B LAN tyate
Notary Public - State of Florida
e1i 111
t Commission # GG 060623
My Comm. Expires Jan 16, 2018
Owner/Agent is Personally Known to Me or Cont a =ersonM177MMM to Me or
Produced ID Type of ID Produced 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 ofBldg: Min. Occupancy Load:
Flood Zone:
of Stories:
New Construction: Electric - # of Amps Plumbing - # of Fixtures
Fire Sprinkler Permit: Yes No # of Heads
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
UTILITIES:
Fire Alarm Permit: Yes No
WASTE WATER:
FIRE: BUILDING:
CITY OF
SANFOR.D Building Division
FLORIDA Receipt
Permit #: E19-000050
Amount: 111.00
Date: 01/31/2019
Receipt #: 1116
Reference