HomeMy WebLinkAbout2070 Grandview AveCITY OF SANFORD PERMIT APPLICATION
Application # : _ 0
Job Address: <g/?V eaa ld r> '4 4
Parcel ID:
Description of Work:
Zoning:
Submittal Date:
Value of Work: $
Historic District:
Square Footage:
Permit Type: Building ❑ Electrical ❑ Mechanical ❑ Plumbing ❑ Fire Sprinkler/Alarm ❑ Pool ❑ Sign ❑
Electrical: New Service — # of AMPS Addition/Alteration ❑ Change of Service D 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 ❑
Construction Type:
Commercial ❑
# of Stories
Industrial ❑
# of Dwelling Units:
Occupancy Use Group(s):
Flood Zone: (FEMA form required)
........................./..........................................................................c^......................
Property Owner: !/i, ��1� f)(,�( g Contractor: l�rl JLc
Address: ;�Z170 tjj4',a.c d r-rzm) Awe Address:
Phone: % 'S/SJ E-mail: Phone: 3R6-7J`�/ �Z4q State License Number; 0-74 Y F
Bonding Company:
Address:
Architect/Engineer:
Address:
Plan Review Contact Person:
Mortgage Lender:
Address:
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. 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 requirem s of Flori Lien Law, FS 713.
Signature of Owner/Agent Date Si nature f Contractor Agent Date
AU Ll
Print Owner/Agent's Name Print Contractor/Agent's Name
Signature of Notary -State of Florida Date Signature of Notary -State of Florida Date
Owner/Agent is _
Produced ID
APPROVALS: ZONING:
Special Conditions:
Rev 02/2007
Personally Known to Me or
UTIL: _ _ _ FD:
Contractor/Agent is Y_ Personally Known to Me or
_
Produced ID
ENG:
IM �I.�u11 IY1
I Vincent Polizzi_hereby authorize
(License Holder)
J
to obtain a gas plumbing permit
(Authorized Person)
in my behalf under my license # CFC057948
for the job described below
DESCRIPTION
Owner ��i,, Sai.� e-#
Site Address 4070 GA ,,2 v4j1,) FYv C
Tax Parcel #
l(License Holder signature)
Date J /
State of Florida
County of M a l k
Affirmed and subscribed before me this day of 20 n_ by
Who isrsonally known to me or has produced (type of ID) as identification
Signature of Notary Public, State of Florida Print, Type or Stamp Name of Notary
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Notary Pubft • Ska d FbWft&
Notaries Seal = ��• � �uNConumwEgMSiP25.Z01Q
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