108 Wild Elm Ct - BR08-001674 (FENCH) DOCUMENTSA
CITY OF SANFORD PERMIT APPLICATION
Application # : 0 s— I l S Submittal Date: S Y
Job Address: O tU: Z 0 E L' C-7' Value of Work: $ 3 o U
Parcel ID: ,
p ' / _
Zoning: Historic District:
Description of Work: r-e ti e e 1 V C.- Square Footage:
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool Sign
Electrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Cale. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets Plumbing Repair —Residential Commercial
Occupancy Type: Residential Commercial Industrial Occupancy Use Group(s):
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required)
Property Owner: y S Contractor:
Address: l O y W l L- 0 E L- M- C— 7' Address:
A , t--- uy _r L. 3 .-:;? -7 7 3 Phone:
d7 - f 3 yE-mail: Phone: State License Number: Bonding
Company: Mortgage Lender: Address:
Address: Architect/
Engineer: Address:
Plan
Review Contact Person: Phone: Fax: Phone:
Fax:
E-
mail: 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. 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: 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. 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 otify the owner of the property of the requirements of Florida Lien Law, FS 713. l,
5 l `lv Signature
of Owner Agent Date Signature of Contractor/Agent Date Priwner/
Agent's Name 68 Signature
of
Notary -State of Florida Date Owner/Agent
is Personally Known to Me or Produced ID
APPROVALS: ZONING:
UTIL: FD: Print Contractor/
Agent's Name Signature of
Notary -State of Florida . Date Contractor/Agent
is _ Personally Known to Me or Produced ID
ENG: BLDG:
Special Conditions:
Rev 07.
07
re
OWNER BUILDER STATEMENT/AMDAVIT
Altamonte Springs, Casselberry, Lake Mary, Longwood, Oviedo, Sanford,
Seminole County, Winter Springs
Florida Statutes are quoted here in part for your information to indicate the authority for exemptions for homeowners
from qualifying as contractors and to express any applicable restrictions and responsibilities.
OWNERS MUST PERSONALLY APPEAR AT THE BUILDING DIVISION TO SIGN THIS DOCUMENT
FSS 489.103 Disclosure Statement
State Law requires construction to be done by licensed contractors. You have applied for a permit under an exemption
to that law. The exemption allows you, as the owner of your property, to act as your own contractor with certain
restrictions even though you do not have a license. You must provide direct, onsite supervision of the construction
yourself. You may build or improve a one -family or two-family residence or a farm outbuilding. You may also build or
improve a commercial building, provided your costs do not exceed $75,000. The building or residence must be for
your own use. -or occupancy. It may not be built or substantially improved for sale or lease. If you sell or lease a
building you have built or substantially improved yourself within 1 year after the construction is complete, the law will
presume that you built or substantially improved it for sale or lease, which is a violation of this exemption. You may not
hire an unlicensed person to act as your contractor or to supervise people working on your building. It is your
responsibility to make sure that people employed by you have licenses required by state law and by county or
municipal licensing ordinances. You may not delegate the responsibility for supervision work to a licensed contractor
who is not licensed to perform the work being done. Any person working on your building who is not licensed
must work under your direct supervision and must be employed by you, which means that you must deduct
F.I.C.A and withholding tax and provide workers' compensation for that employee, all as prescribed by law.
Your construction must comply with all applicable laws, ordinances, building codes, and zoning regulations.
BY SIGNING THIS STATEMENT, I ATTEST THAT: (Initial to the left of each statement)
Al
I UNDERSTAND AND AGREE TO THE EXEMPTION PROVISIONS OF FLORIDA STATUTES 489.103
AS LISTED ABOVE.
I HAVE ACCESS TO THE ADOPTED CODES.
I AM FAMILIAR WITH THE CODE PROVISIONS.
I HAVE ADEQUATE KNOWLEDGE AND QUALIFICATIONS TO SAFELY PERFORM AND DIRECTLY
SUPERVISE THE WORK.
eW THIS PROPERTY IS NOT AN APARTMENT, CONDOMINIUM OR RENTAL PROPERTY.
THIS STRUCTURE IS NOT BEING BUILT WITH MY INTENTION TO SELL, RENT, OR LEASE.
IV I UNDERSTAND THAT THERE IS NOT STATED A TIME FRAME TO SELL, RENT OR LEASE AN
OWNER BUILDER STRUCTURE WITHOUT BEING INVESTIGATED.
1 UNDERSTAND THAT FOR ANY UN -LICENSED PERSON I HIRE, I MUST DEDUCT F.I.C.A.,
WITHHOLDING TAX, AND PROVIDE WORKERS' COMPENSATION INSURANCE.
Property Address: 10 S /-5 .w F—o r- Z FL,
do hereby state that I am qualified and capable of
performing the requested construction involved with the permit application filed.
ICXII'le
Form of Identification
Must be Photo ID)
Date 77,