HomeMy WebLinkAbout2412 Grandview Avez- N
CITY OF SANFORD'PERMIT APPLICATION'
Permit #; a _ n Date:
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Job Address: ® '.
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Description of Work:
Historic District: Zoning: Value of Work: .2- ic
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service - # of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water sets Plumbing Repair - Residential or Commercial
Occupancy Type: Residential Commercial Industrial Total Square Footage:
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than x)
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Parcel #: (Attac Proo of Ownersht Legal Descriptio*0
Own^Name &jAddress� CWY_t�.� .11 L v o0 ttut a4A0_,.
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Phone & Fax: `J
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer
Address:
Phone:
State License Number:
Contact Person: Phone:
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 ofthe 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 permit is verification that I will notify the owner of the property of the q)r ents of F r a
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Signature of Owner/Agent Date ignature of Contractor/Agent Date
c� �tra-t?LPrint Owner/Agent's Name Pri c /Agent's Name
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Signature of Notary -State of Florida Date StgnatIreTstateDEME BLANTON Da
MY COMMISSION # DD 188491
EXPIRES: February 25, 2007
OTARY FL NotM Discount Assoc. Co.
Owner/Agent is _Personally Known to Me or Contrais._.-12
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_ Produced ID Produced ID
APPLICATION APPROVED BY: Bldg:
(Initial & Date)
Special Conditions:
Zoning:
Utilities:
FD:
(Initial & Date) (Initial & Date) (Initial & Date)