HomeMy WebLinkAbout2001 Grandview Ave (2)CITY OF SANFORD PERMIT APPLICATION
Application # : OI-- 33 (a_�r -1
c Submittal Date: "//-xr_5�
—7
Job Address: g001 a4AUD i/IeaV AV& ✓1�'i Vkj. R 3.)%`7Value of Work: $
Parcel ID: Zoning: Historic District:
Description of Work: SVC_ idgt"c pe_A;�Q& /Y td{7tr; Square Footage: _
Permit Type: Building ❑ Electrical Qi Mechanical ❑ Plumbing ❑ Fire Sprinkler/Alarm ❑ Pool ❑ Sign ❑
Electrical: New Service — # of AMPS 010 Add ition/AIteration Change of Service $L Temporary Pole ❑
Mechanical: Residential ❑ Non -Residential ❑ Replacement ❑ New ❑ (Duct Layout & Energy Calc. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets Plumbing Repair —Residential ❑ Commercial ❑
Occupancy Type: Residential 0 Commercial ❑ Industrial ❑ Occupancy Use Group(s):
Construction Type: ? # of Stories: # of Dwelling ftAUnits:_ Flood Zone: (FEMA form required)
............................................................................ ......... ..........................
Property Owner: 711,1 L l.. 40 L gx�v Contractor: l'l t-rn E9_ ��jj2Cj/L 1G
Address: C3 Qp4,D V t '�— Address: 'UP 9 'Z A I L'1t C A V A° e1
SbySo Ktsstmtftee- F"G 3cl>Yc-/
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Phone: lg$ 4 , E-mail: Phone: 4107 bS7te License Number: EG /�✓
Bonding Company: Mortgage Lender: "V,
Address: Address:
Architect/Engineer:
Address:
Plan Review Contact Person:
Phone: Fax:
Phone: 1{07 & 44, &F 73
Fax:
E-mail:
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 certify that no work or installation has commenced prior to the
issuance of a permit and that all work will be performed to meet staidards 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 permit is verification that I will notify the owner of the property of the requirements of FloridieoZw, FS 713.
Signature of Owner/Agent Date Signatufe of Contractor/Agent Date
—R&beat N. AOP_ei_
Print Owner/Agent's Name nt ContractorJA e 's
Signature of Notary -State of Florida Date S g ature of Notary -State
Owner/Agent is Personally Known to Me or Contractor/Agent is
Produced ID Produced ID
APPROVALS: ZONING: UTIL: FD:
Special Conditions:
Rev 02/2007
ENG:
Florida Date
DANIELLE 1. ROUSE
MY COMMISSION # DD486944
EXPIRES: Oct. 30,2004
,671 na-01 53 rrdtd&MtWv SWA00.00tn
BLDG:
PALMER ELECTRIC COMPANY
875 Jackson Avenue
Winter Park, FL 32789
POWER OF ATTORNEY
I hereby name and appoint - k' e I ' Y 0
of 875 Jackson Avenue, Winter Park, Florida to be my lawful attorneys in fact to act for
me and apply to the C -IT y
fora Z(e
necessary to this appointment.
permit and to sign my name and all things
PALMER ELECTRIC COMPANY
Signature of Certified Contractor, Robert N. Parker, III - EC0001858
875 Jackson Avenue Winter Park, FL 32789
State of Florida, County of 0S0 eaIq
Sworn to and subscribed to before me this o2S y of
G
'—po)
Signature of Notary ViCiblic
Personally known:
LAFormsTOWER OF ATTORNEY (fire alarm).DOC
6/11/2007
VAIN,
DANIELLE 1. ROUSE
MY COMMISSION # DD486944
OI �a EXPIRES: Oct. 30.2009
(w) 304 -0153 Florida Notary SOMIce.com