HomeMy WebLinkAbout119 Grove Hollow CtCITY OF SANFORD PERMIT APPLICATION
Permit # : 0 `t -
Job Address:
Description of Work:
Historic District:
Zoning:
Value of Work: $ Y?. f%
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/Alteration Change of Service Temporary Pole
Mechanical: Residential X 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 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)
Parcel #:
Owners Name & Address:
Contractor Name & Address:
RSD �,, tfdg�
Phone & Fax: o—
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
(Attach Prgof of Ownership & Legal Description)
Phone: yo -
7 -IRF -
1"( yid /0 / State License Number: CSN(— U Y
0 Contact Person: Uif/t &d, Phone:
If
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 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 notif he owner of the property of the requirements of Florida Lien -Law, FS 713.
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Signature of caner/Agen Date Signature of Contractor/AgentP ` Date
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Print Owner/Agent' Name Print Contractor/Agent's Name
Signature of Notary -State of Florida Date 4OSignature of Notary -State of Florida Date
Owner/Agent 4;E
Known to Me o
Produced ID
APPLICATION APPROVED BY: Bldg:
(Initial & Date)
Contractor/Agent is
Produced ID _
Zoning: Utilities:
(Initial & Date)
rsonally Known to Me
FD:
(Initial & Date) (Initial & Date)
Special Conditions: ------- .......•oo.wu.nu....gnp..� '"'""^"'.....................5
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COMO OD0424343 r Commtl DD0424343
Etmlres 5112009E)Oms 5/1/2008
( m................. Bonded thru 800 32-4254 > 'f Bonded thru (800)132-4254Florida Notary Assn., Inc
Florida No...n., lncu:l...u...........................•n..............