2025 William Clark Ave - BR17-002964 - ROOM ADDITIONyP ,t(
1
ITY OF SANFORD
l CT 17 Q Q ti BUILDING & FIRE PREVENTION
77;;r
ON
Application,No: 1'
Documented Construction Value: $ —10J, e7 D
Job Address: S l{,tyx F`j V Historic District: Yes No
Parcel ID: Residential Commercial
Type of Work: New 0 Addition Alteration Repair Demo Change of Use Move
Description of Work: O pyli +, D l
Plan Review Contact Person: ki ; l e 6z %' 1 Title: Phone:
aa - fG% Z Fax: Email:/111 o t Q p Property
Owner Information Name
W,j1`, t e.i\ o-f 1 PhonV g7) 934-5792- u9°.
F: '..+L 4. Si Y LP9N: G"L•SL 113f3 YP a -.-. f• Street: )
D 225 y Resident
oflproperty?,° C (
f , City, State Zip: lb4E-cl 'Y , 3011 , ° U:ir rG ` rC"j 4 rd Contractor
Information, Name
Phone: Street:
Fax:. City,
State Zip: State Architect/
Engineer Informatio OL Name:
Phon Street:
Fax:, / City,
St, Zip: w
E-
m; r
Bonding
Company: Mortgage I r Address:
Address: WARNING
TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF CC PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A N( RECORDED
AND POSTED ON THE JOB SITE BEFORE THE FIRST INSYLi- i ivi,4. ju 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 of permit 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 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.
Signature of Owner/Agent Date
Agent's Name
Signature of N
ANNETTE BLAND
Notary Public - State of Florida
Commission # GG 060623
My Comm. Expires Jan 16, 2018
Signature of Contractor/Agent Date
Print Contractor/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or Contractor/Agent is Personally Known 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: Flood Zone:
Total Sq Ft of Bldg: Min. Occupancy Load: # of Stories:
New Construction: Electric - # of Amps Plumbing - # of Fixtures
Fire Sprinkler Permit: Yes No # of Heads Fire Alarm Permit: Yes No
APPROVALS: ZONING: UTILITIES: WASTE WATER:
ENGINEERING: FIRE: BUILDING: IF ID-9- / 7
COMMENTS:
Revised: June 30, 2015 Permit Application
2025 William Clark Ave
Sanford, FL 32771 RE:
STRUCTURE AFFIDAVIT
To Whom It May Concern:
I _WAYNE GANDY have personally inspected the room addition at 2025 William Clark Ave and certify
that t e tructures were built in compliance with the current Florida Building Code.
111 llll/////
z
E
Wayn G 1 , d.
NQ. 3313 ; P.E. No. 91
Inn G7
gJ DING
DPFoR'j
AKA
2964
ti