2519 Poinsetta Ave - P18-004568 - REPIPE AND REPAIR DRAIN LINESo4
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PERMIT APPLICATION
Application No: 17 ` 8
Documented onstruction Value: $ +S C/ 05
Job Address: - // E' Historic District: Yes No
Parcel ID:
Type of Work: New
Description ofWork.
e; /IV. /
Residential 9'C"ommercial
Alteration U Repair Demo
Q
ofUse Move
G( /iv ( 1, %"uL-':--f
Plan Review Contact Person: Title:
Phone: Fax: Email:
Name
Street:
City, State Zip:
Name
Street:
City, State Zip:
Name:
Street:
City, St, Zip: _
Bonding Company:
Address:
Property Owner Information
Phone:
Resident ofproperty? :
Contractor Information
i- Phone: L",
Fax:
State License No.
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 heieby made to obtain a permit to do the workand installations as indicated. I certifythat no work or installationhas commencedprior
to the issuance ofa permit and that all work will be performed to meet standards ofall 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: 60, 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 pub,
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 of the executed contract is required in order to
calculate aplanreviewcharge and tivill beconsidered the estimated construction value ofthe job at thetime ofsubmittal: The actual construction value-. will befigured based on the current ICCValuationTable in effect atthe timethepermit is issued, inaccordancewith localordinance. Should calculated
charges figured offthe executed contract exceed the actual construction value, creditwill be applied to your permit fees when thepermit is issued.
OWNER'S AFFIDAVIT. I certify that all ofthe foregoing information is accurate and that all work will be
done in compliance with all applicable laws regulating construction and"ng.
Signature ofOwner/Agent Date
Print Owner/Agent's Name Print Contractor/Agents Name
l fi'
NTON
Signature ofNotary -State ofFlorida Date Signature of flfF1& MMISSION # FF a
8% EXPIRES: February 25, 2019
Bonded Thru Notary Public Underwriters
Owner/Agent is Personally Known to Me or Contractor/Agent is Personally Known to Me or
Produced ID Type ofID Produced ID Type ofID
l
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building Electrical Mechanical Plumbing Gas Roof
Construction Type: Occupancy Use:
Total Sq Ft ofBldg: . Min. Occupancy Load:
Flood Zone:
of Stories'
New Construction: Electric - # of Amps Plumbing - # of Fixtures
Fire Sprinkler Permit: Yes No # ofHeads Fire Alarm Permit: Yes No
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
UTILITIES:
FIRE:
WASTE WATER:
BUILDING:
AS`
407-558-0982111KLUKE, LLE P.O. Box #43
x Gotha, FL 34734
PLL *"INR SARVICES pleplumbing@gmail.com
No. 8
I
License #CFC 1426 8 i
Date: J , / I
BILL TO
STR ,
F' Cy G ALLY STREET
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CITY
l!I
STATE -`ZIP CITY STATE ZIP
HOME PHONE WORK PHONE HOME PHONE WORK PHONE
1
1ITEM OR PART DESCRIPTION
7i7
DESCRIPTION OF WORK
1 /, fl Axy Al"
TOTAL PARTS PARTS WARRANTY
All parts as recorded are warranted as
per manufacturer specifications.
LABOR GUARANTEE
The labor charge as recorded here
relative to the equipment services as;
noted is guaranteed for period of 30
days.
We do not, of course, guarantee other
parts that those we install. If repairs
later become necessary do to other
detective parts, they will becharged
separately.
TECHNICIAN HELPER
WORK ORDER #
AUTHORIZATION #
CHECK #
LABOR- HRS@ - /HRS=
CHARGES
TERMS DUE UPON1 1
1 hereby accept the work performed as satisfactory and in compliance with any aforementioned
estimate. The liability of Pat's Plumbing, for damages to the property if any, is limited to that caused OTHER
by the sole negligence of the employees of Pat's Plumbing. In the event that at the discretion of CHARGES
Pat's Plumbing. I agree to pay all attorney's fees and costs incurred, if any. I agree to pay $50,00
service charge for each returned check. I understand that any.unpaid.balances are'due within 30 SALES
days of invoice date, and are subject to finance charges as allowed by the state law if delinquent. TAX
TOTAL
MA ERIAL
AUTHORIZED SIGNATURE r Dr
NET 30 DAYS 20 DAYS 15 DAYS
CREDIT CARD #
l
TRAVEL TIME
TIME
ARRIVED
TIME
DEPARTED
TRAVEL
TIME
ABOVE ORDERED WORK HAS BEEN COMPLETED AN I ACKNOWLEDGE RECEIPT OF MY COPY. t J
X
DATE
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