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1006 E 2 St - E17-003064 - METER LUGSCITY OF SANFORD OCT BUILDING & FIRE PREVENTION J 01 PERMIT APPLICATION D ICY '- ^ 0 - A,pplication No: I Documented Construction Value: $ Job Address: (J ( G C, % `/ 5'a R or Historic District: Yes No Parcel ID: Residential Commercial R Type of Work: New Addition Alteration Repair Demo Change of Use Move Description of Work: ^9-e fol t r 1-tie e r hoc :e_ lGf A f Plan Review Contact Person: f [)cctr 1 d yct17» / Title: // Phone: e `lr 7- q a3-sy °1 Fax: Email: v Yu/7/7 elei 7` ( r c oti, Property Owner Information Name C L©clG Y / Phone: Street: f DO G L-- 2 ` Sf Resident of property? City, State Zip: x G6itractor Information Name ,i / r r- Phone: 7•- 2 s Street: /6 ( 7o CO-0 &a Fax: City, State Zip: v t zf a, 2 ` t,' 5—State License No.: 7 Name: Street: City, St, Zip: Bonding Company: Address: Architect/ Engineer Information Phone: 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. i V 5 . (e5 FBC 105. 3 Shall be inscribed with the date of application and the code in effect as of that date: 51h Edition (2014) Florida Building Code vff I f Gchfig/ dl eleclrtc Co- /,7C. ct' 7 Rise ne 30,01 ermi Apphcati n own Y rr a r -r 7e- ZL _ l lc L aaj ` e - O /Gr i /tee i^ e lr a s .4 r .'P.`orJ. ems' 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 ofthis 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 ofFlorida 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 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. rZ16? / 7 Signature ofOwner/Agent Date Signature of Contract gent Date David Print Owner/Agent's Name Pri ntractor/Agent's"'Dame ' L a J Signature of Notary -State of Florida Date Signa y of*_ '. npaN . *mot f to t ; o."'"ANNETTE BLAND Notary Public State of Florida Commission #r GG 060623 My Comm. Expires Jan 16, 2018 nun Owner/Agent is Personally Known to Me or own to Me or Produced ID Type of ID Produced ID Type of ID Permits Required Construction Type: Total Sq Ft of Bldg: BELOW IS FOR OFFICE USE ONLY Building Electrical Mechanical Plumbing[:] Gas Roof Occupancy Use: Min. Occupancy Load: New Construction: Electric - # of Amps Fire Sprinkler Permit: Yes No APPROVALS: ZONING: ENGINEERING: COMMENTS: Flood Zone: of Stories: Plumbing - # of Fixtures of Heads Fire Alarm Permit: Yes No UTILITIES: WASTE WATER: FIRE: BUILDING: Revised: June 30, 2015 Permit Application