1102 10 St - E18-004296 - UPGRADE ELECTRIAL SERVICES3F,QRp4fi CITY OF
SAMAJ`Rlt
rP
BUILDINGDIVISION
PERMIT APPLICATION
Application No: 1 Q ` H a9 LD
Documented Construction Value: $ ,? r (i 0
Job Address: / 10 0 / L Historic District: Yes No
Parcel ID: Residential Commercial
Type of Work: New Addition (Alteration [IRepair Demo Change of Use Move
Description of Work: Rp r a I S (f V! t 2 f "oacG l e e 'T7) r SGI eo P
Plan Review Contact Person:
Phone: Fax: Email:
Property Owner Information
Name 4 e -To c, Phone:
Street: 5 Te cc, PI Y Z n , Resident of property?:
City, State Zip: u cry 3 a 3 7
Contractor Information Name [•
S Phone: Street:
13 L ,k e 91 d U c 6A Fax: City,
State Zip: 6 ( l i/l,j/l R , State License No.: Name:
Street:
City,
St, Zip: Bonding
Company: Address:
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.
FBC 105.3 Shall be inscribed with the date ofapplication 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 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.
r i
Signature ofOwner/Agent Date
F,4
Print Owner/Agent's Name
WZL-U, /0
Signature of Contractor/Agent Date
Name
Signature of Notary -State of Florida Date Signat ,
Y Pu - Tate ofFlorANNETTE SLAN ates Notary Public State of Florida
Commission # GG 060623
Comm. Expires Jan 16, 20is
Owner/Agent is Personally Known to Me or Cont ctbWAWnt isy
Produced ID Type of ID Prod ce 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:
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:
Me or
SEMINOLE COUNTY MULTI%URISDICTIONAL
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date:
I hereby name and appoint:
an agent of:
Name of Company)
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.
Or
The specific permit and application for work located at:
110 In1,
Street Address)
Expiration Date for This Limited Power of Attorney:
License Holder. Name: Z. (r l ,`, I [. % b S
State License Numbe
Signature of License
STATE OF FLORIDA
COUNTY OF OY A--t i
The foregoing instrument was acknowledged before me this
20 , by
who has produced
and who did (did not) ake an oath.
Signatur of Notary
v_
JOREAN F. WASHINGTON
r10 Notary Public - State of Florida
Commission # GG 040753
qtF F ".
MynFo
Comm. Expires Oct 23, 2020
Bonded through National Notary Assn.
day of
who is personally known to me or
as identification
J 1AA,
Print or type Notary name
Notary Public - State of r1 ?44j 'f'
Commission No. ID .2 -? Z0,L o
My Commission Expires: 0 Y D 7 5-3
JOB CONTRACT
L&C Electrical
Contractor: L&C Electrical Owner: Andrea Sibley
Phone: (407)468-1307 Phone (407)300-0595
LABOR
Remove and replace all light fixtures
Remove and replace all switches and outlets
Remove and replace 2 inside 125amp sub panels
Remove and replace outside electrical service
TOTAL
Owner agrees and obligates him/herself to pay Contractor the sum of $3,200 for work performed at 1102 11`" St.
Sanford FL. Total amount shall be paid to Contractor from owner immediately upon completion of project. A
deposit of 1,000 That leave a balance of 2,200 to be paid when Contract is completed. Property debris and
surplus material created by the operation will be removed by contractor. Material will be supplied by owner.