2535 Poinsitta Ave - M17-002993 - HVAC AND DUCTWORKok
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BUILDING DIVISION
PERMIT APPLICATION
Application No: % % `` oL g 0
Documented Construction Value: $ r K _, 0
Job Address: S ' .S P 0 L V\ S i iCA k V`Q— Parcel
ID: Historic
District: Yes No ] Residential ®
Commercial Type
of Work: New 91 Addition Alteration Reepair Demo Change of Use Move Description
of Work: S 4TA f New P"b r In) u 1 ` L j% C/U w 5\
J S-T w\ Plan
Review Contact Person: Phone:
Fax: Email: Property
Owner Information Name
C -S''t Phone: Street:
City,
State Zip: Title:
A
56=Ci3 1 Resident
of property? : Contractor
Information Name
V U Street:
35 q [C_' 04 City,
State Zip: Name:
Street:
City,
St, Zip: Bonding
Company: Address:
Phone:
4--c3a g o 6 6y Fax: State License
No.:
C(A (- 0` y I ) I 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. Revised: June,
2018
Permit Application
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 of permit is verification that I will notify the owner of the property ofthe 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 tocalculateaplanreviewchargeandwillbeconsideredtheestimatedconstructionvalueofthejobatthetimeofsubmittal. The actual construction valuewillbefiguredbasedonthecurrentICCValuationTableineffectatthetimethepermitisissued, 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.
Signature of Owner/Agent
Print Owner/Agent's Name
Date
Signature ofNotary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
Signature of Contractor/Agent Date
Print Contractor/Agent's Name
r , 4Y
Signature ofNotary -State
wYYj 4 DEBBIE BLANT0
Ml` COMMISSION 6 Fr ??Sfi 3 I
EXPIRES: February, 2 ?9
Bonded Thru Notary Public undanvraer; i
Contractor/Agent
Produced ID Type ofID
eon.
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 Fire Alarm Permit: Yes No
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
UTILITIES: WASTEWATER: WATER:
FIRE: BUILDING:
Revised: June, 2018 Permit Application