1201 W 7 St - E17-002694 - TEMP POLE1
CITY OF SANFORD
BUILDING & FIRE PREVENTION
r. Application NO l.C/
Documented Construction Value: $ 0
Job Address: ' Historic District: Yes No
Parcel ID: a5-) q = 3c)- 5-191 -0115 —r ow Residential 0 Commercial
Type of Work: New W Addition Alteration Repair Demo Change of Use Move
Description of Work: l eG+e I u ( s I f 7 -^ - -I %-, f
Plan Review Contact Person:
Phone: 414"16e_3039 X W q
oa p{ any e Title: N" , .111 /)-,3
Fax: Email: d4'r 9n e - G'%ir-k co-,
Property Owner Information
Name Qe-n H_01'4 u", Phone: 3,)^ )b,)- i 7YS
Street: y VIIIIaA cSi«ice Resident of property? : n D
City,. State Zip: F'a 1q. c ><' ! D `f ? s I
Contractor Information
Name I / - C , I7 tv i g ,Ir'au-r -Tnc' Phone: L400-10-:3 D51
Street: H 3'_- VA54 Fax: lob- D38- -bo9
City, State Zip: State License No.: Eco'DoDg81
Architect/Engineer Information
Name: P 14
Street:
City, St, Zip:
Bonding Company: On
Address:
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.
FBC 105.3 Shall be inscribed with the date of application and the code in effect as of that date: 5" Edition (2014) Florida Building Code
Revised: June 30. 2015 Permit Application
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 ofpermit 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 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 th 11 work will
be done in compliance with all applicable laws regulating construction and zoning.
Signature ofOwner/Agent Date Signature of Contractor/Agent Date
Print Owner/Agent's Name
Signature ofNotary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
I
bINWER LYNN LANDERIr AY
MY COMMISSIOM 0 FF IW436
EXPIRES February 15. 2019
Contractor/Agent is '& Personally Known to Me or
Produced ID Type of ID
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building Electrical Mechanical Plumbing[] Gas Roof
Construction Type:
Total Sq Ft of Bldg:
Occupancy Use:
Min. Occupancy Load:
New Construction: Electric - # of Amps
Fire Sprinkler Permit: Yes No # of Heads
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
UTILITIES:
FIRE:
Flood Zone:
of Stories:
Plumbing - # of Fixtures
Fire Alarm Permit: Yes No
WASTE WATER:
BUILDING:
Revised: June 30, 2015 Permit Application
70-H1, C
Electrical Contractors, Inc. 430 West Drive • Altamonte Springs, FL 32714 P: (407) 788-3500 F: (407) 788-2007
POWER OF ATTORNEY
Date: September 7, 2017
Reference: ,1201- W. 7" St. & 1010 Willow Ave
To Whom It May Concern:
r
I Rance Borderick State Certified Electrical. Contractor, License EC
F'0000981, h'" with'grant authority to: Clemente Paez to sign onmy behalf as Power
of Attorney, to obtain permits and related documents on behalf of Tri- City
Electrical Contractors, Inc. 4 s
dw Respectfully,
Rance
Borderick f
Vice President NOTE:
This notice is voidafter siXty (60) days from the above date. f a , State
of
Florida Countof Seminole-'
Rance Borderick who
is personally - known to me acknowledged the foregoing instrument before
me' this September 7 2017' ' 1 t f . ' Not
a'
Public St to of Florida Offipi tp to : ROLYN MORGAN MY OtdMISSION # FF
165603 EXPIRES December-13,
2018 e x"OF
F oeO: - Bonded Thru Bud0l,N6;ry Services ABCACCREDITED QUALITY CONTRACTOR