HomeMy WebLinkAbout2824 Grove Dr 04-644 Gas water heater replacementPermit #: (_
Job Address:
Description of Work:
Historic District:
M CITY OF SANFORPg-,E MI(YAPPLICATION
1 n _
Date:
u -
Zoning: Value of Work: $ _w
Permit Type: Building Electrical Mechanical Plumbing Cw Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/Altemtion 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 or Commercial
Occupancy Type: Residential P Commercial Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than %)
Parcel #:
Phone -&-F x:(J:3
Bonding Company:
Address:
Mortgage Lender: .
Address:
Architect/Engineer:
Address:
Attach Proof of Ownership & Legal Description)
Phone:
Fax:
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. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR A\
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 notify the owner of the property of the requirements of Florida Lien
Lj? to 12 118 / 03
Signature of Owner/Agent Date Signature of Contractor/AgenF Date
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is _ Personally Known to Me or
Produced ID
APPLICATION APPROVED BY: Bldg:
Initial & Date)
Special Conditions:
Zoning:
Donald E. Kitner
Print contractor/Agent . s Name,
Signature of N tary- rate of 1742* ..P.Mad tJackson HartmanY. Commission #
DD244694 T*
y Expires: Oct 10, 2007 vcPContractor/Agent is XXPersori9 h jpa n to Me oBonded Thru Produced ID
Atlantic Bonding Co., Inc. Utilities: FD:
Initial & Date) (
Initial & Date)
p r
POWER OF ATTORNEY
Date: M03
I, 9wal d 64f)er do hereby authorize K*)D4 T I s 4ed
to pull the QVWURO permit for NZ-`T G-Dve Dri ve, Pol'd
type of permit address
Signature
L ,f ;2o YP e; Martha Jackson Hartman1 /.P.,v -.• , Commission #DD244694
0 Expires: Oct 10 2007
Martha Jack Hartman
uF' c,
AtlantipondedcBonding Inc.
Personally known to me or drivers license # known to me
State of Florida, County of Volusia on 18th day of
December 200