HomeMy WebLinkAbout103 Grovewood Ave (3)CITY OF SANFORD PERMIT APPLICATION
Permit # : 0,S- 0006 �j,�-� b Date: —P—
Job Address: l O -j G-r/o V -e Wd a cA A v g—
Description of Work: A,I f 3 ve, 4-s `-- AA• tl O&
Historic District:
Zoning:
Value of Work: $ &6) 1 �—
Permit Type: Building Electrical Mechanical t- Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service – # of AMPS
Mechanical: Residential I✓ Non -Residential
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets _
Occupancy Type: Residential t/ Commercial
Construction Type:
Addition/Alteration Change of Service Temporary Pole
Replacement New (Duct Layout & Energy Calc. Required)
# of Water & Sewer Lines # of Gas Lines
Plumbing Repair – Residential or Commercial _
Industrial
# of Stories: # of Dwelling Units:
Total Square Footage:
Flood Zone: (FEMA form required for other than X)
Parcel #: ,t (Attach Proof of Ownership & Legal Description)
Owners Name & Address: �'c 2 e hO3 G rO-��J OCA Q `'e ,
Phone:
Contractor Name & Address: / `C,
o.ao)( I&S-5 o��� FC, 3Z7C
(/ State License Number:
Phone & Fax: -I o 7 �3�5 IZZZ - L o - 7C.s -3/35 ontact Person:
Bonding Company: .
Address:
Mortgage Lender: _
Address:
Architect/Engineer:
Address:
Phone:
Fax:
59 76
No7-a yam_ yy7L1
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 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 pennit is verification that I will notify the owner of the property of the requirements of Florida Lien Law, 713.
Signature of Owner/Agent Date Signature of Contractor/Agent Date
Print Owner/Agent's Name
Signature of Notary -State of Florida
Owner/Agent is Personally Known to Me or
Produced ID
Print
Contractor/Agents Name -2 --/JO `/\�
Date Sr r ature otar S te
pit\' t;0'fj7,41SSION # DD 188491
„u`< L •^n 5:February 25, 2007
�iSCP}1nt ASSOC CO.
Con autorbfntsir'n't"pis 'Pers 'iral'ly r� aMlYtwri
APPLICATION APPROVED BY: BI Zoning:
(I itial •9 te)
Special Conditions:
Utilities:
(Initial & Date) (Initial & Date)
X51
FD:
(Initial & Date)