1010 Willow Ave - E17-002693 - TEMP POLECITY OF SANFORD
BUILDING & FIRE PREVENTIONi
PERMIT APPLICATION
r" Application No:(p
Documented Construction Value:
Job Address: 1010 \A%f'I Historic District: Yes No
Parcel ID: 5 - 11- 30--5/9 G -1 )o •fr- 00)0 Residential [ Commercial
Type of Work: New N Addition Alteration Repair Demo Change of Use Move
Description of Work: I ealr, ti f S isk Mly h c j e p ale
iJ cL, Plan Review Contact Person: , Title:
Phone: '-1Dq -q9- 3)s1'x l/6 Fax: ly)-88 - '1 Email: y/ J e, blotk p 4ce e(-4r, , c , of
Property Owner Information
Name Oe-, 14011 Phone:
Street: LqO `1'j. w ! 1, a cSi lc'y
City,, State Zip: 1/v J F I A^.e PaliL 3 y
J_5s2 - -) ,9 - 63gS
Resident of property? : p
Contractor Information
Name rt - C.4y ie r lc* / C,., yv}o .s n.t Phone: 1/0- 88- 3.
Street: 1130 0 ri vC.; Fax: L4 0 - 9
City, State Zip: ! 4--'-° 7e- r l.. State License No.: 1SC-030':) 9
Name: IV )q-
Street:
City, St, Zip:
Bonding Company: N
Address:
Archltect/Englneer 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
CONEVIENCEMENT.
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 conditioaers,.etc.
FBC 105.3 Shall be inscribed with the date or application and the code in effect as of that date: 5'h Edition (2014) Florida Building Code
Revised: June 30, 2015 1 Pennit 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 ofthe 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 ofthe 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 work will
be done in compliance with all applicable laws regulating construction and zoning.
9 /7
Signature of0wner/Agent Date Signature of Contractor/Agent Date
Print Owner/Agent'sName
Signature ofNotary -State of Florida Date
Print Contractor/Azeat&e
ofFlorida
1111
JENNIFER LYNN LANDERWAY
MY COMMISSION # F)",99430
EXPIRES February 15, 2019
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 fD
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 AIarm Permit: Yes No
APPROVALS: ZONING: UTILITIES: WASTE WATER:
ENGINEERING: FIRE: BUILDING:
COMMENTS:
Revised: June 30, 2015 Permit Application