1507 W 14 St; 18-3757; ELECTRICAL REPAIRCITY OF
PERMIT APPLICATIONSkNFORD
BUILDING DIVISION 3-1 -IIApplicationNo:
Documented Construction Value: $ zo
Job Address: 'e,% S ,5!'d Historic District: Yes No[]
Parcel ID: Residential ® Commercial
Type of Work: New Addition Alteration EZKRepair Demo Change of Use Move
Description of Work: o
f4 S e /(/D poLCZGY
Plan Review Contact Person: Title:
Phone: Fax: Email:
Property Owner Informationsq `" y — 5 L11 — Name Phone: Street:
t 5 D 7 we sT 1 # S Resident of property?: City,
State Zip: 5RFoYd Contractor
Information`L
G
C, tt nnnr f Phone:
4,v Namet- , 1, c 1 Street:
Fax: City,
State Zip: t
zz /- State
License No.: Architect/
Engineer Information Name:
Phone: Street:
Fax: City,
St, Zip: E-mail: Bonding
Company: Mortgage Lender: Address:
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 apermit 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: 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 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 ofthe 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
Print Owner/Agent's Name
Date Signature of C tractor/Agent Date
Print Contractor/Agent's Name
Signature of Notary -State of Florida Date Signature ofNotary -State ofFlorida 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:
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
APPROVALS: ZONING:
COMMENTS:
UTILITIES:
Fire Alarm Permit: Yes No
WASTE WATER:
ENGINEERING: FIRE: BUILDING:
SEMINOLE COUNTY MUL TIJUR ISDICTIONAL
Altamonte Springs, Casselberry, Lake Awry, Longwood, Sanford,
Semknote County, Wintier Springs
l bereby.name and appoint:
an argent af;
to be my lawful attorney -in -fact to act for me to apply for, receipt for, sign for and do all things necessary to this
appointment for (check only one option):
All permits and applications submitted by this contractor.
The specific permit and application for work Vocated at:
1'5a n kt N 4- 5f 6a k(d f1d,
Street Address)
Expiration Date for This Limited Power ofAttorney: t
License Holder Name:
State Ucense JNuntbi
Sircpature of4cense
STATE OF FLORIDA
COUNTY OF ` r —--
The foregoing instrument was acknowled, ,led before me this
20 , by
0 who has produced
and who did (did not) tak an oath.
61 S'n rrai f vtary
JOREAN F. WASHINGTON
Notary Public - State of Florida
Commission:# GG 040753
My Comm. Expires Oct 23, 2020
Bonded through National Notary Assn.
day of ,
who is personally known to me or
as 0e0ficatiork
Print or We Notary twine
Mdtary PPt,i is - State 4f F' l Old! d '
Commission No. ad- O'`i`O 7E2
My'Com, mission Expires: r b 3 v 2, a
Proposal
PROPOSAL N0.
SHEET NO.
DATE
PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT:
NAMiE %
1.. l
i
v
ADDRESS I
ADDRESS
DATE OF PLANS
PHONE NO. O ) 1 -Oj
ARCHITECT
We hereby propose to furnish the materials and perform the labor necessary for the completion of
nal-t
l
a
lJti O • / /
All material is guaranteed to be as specified, and the above work to be performed in accortlan a with th drawing and specifi atios^submi fora ove work and
completed in a substantial workmanlike manner for the sum of
Dollars ($ ) with payments to be made as follows.
Any alteration or deviation from above specifications involving extra costs
will be executed only upon written order, and will become an extracharge Respectfully
over and above the estimate. All agreements contingent upon strikes, submitted
accidents, or delays beyond our control.
Per
Note — this proposal may be withdrawn by us if not accepted within days.
ACCEPTANCE OF PROPOSAL
The above prices, specifications, and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments will be made as
outlined above.
Signature
YZ
Date Signature
a>_ adams° D8118 V 3-12