HomeMy WebLinkAbout322 Borada Rd (3)CITY OF SANFORD PERMIT APPLICATION
Permit # : d 5' e7q
Job Address:
Description of Work:
Historic District: Zoning:
1 D,
Date: 1 0S—
v
Value of Work: S I T5. 0-M
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
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets _
Occupancy Type: Residential Commercial
Replacement New
of Water & Sewer Lines
Industrial
Construction Type: # of Stories: # of Dwelling Units:
Duct Layout & Energy Calc. Required)
of Gas Lines
Plumbing Repair - Residential or Commercial
Total Square Footage:
Flood Zone: (FEMA form required for
Parcel #: 10 - ZD» J. S 1' R - Qmo - i 191r.) (Attach Proof or Ownership & Legal Description)
Owners Name & Address: ,/Qi 7' AlCfW4&!i 3 Z OlzA{A oeD . 5 %9-NFoRD
icL. 3 ;)773 Phnne- 1-1,n7- :_fin - .597/
Contractor Name & Address:
r5AGeW90,rL. ,
Phone & Fax: J401 W 9 91 to y 3 Contact Person:
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer: Phone:
Address: Fax:
4017
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
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 sepa
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 i
construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR I
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR Ar
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 re
this county, and there may be additional permits required from other governmental entities such as water management districts, state agencies, or federal
Acceptance of permit is verification that ill noW the owner of the property of the
Signature of Owner/Agent - Date
Apr crtARAS
Print Owner/Agent's Name
j r•I 0$
Signature of Wtary-StatE of F&fida Date
Owner/Agent is )e Personally Known to Me or
Produced M
b of Florida Li
w 1 P dO s
re Contractor/ [
4t,
Date
Jan 1 % frfv.ad
Print Contractor/Agent's Name
Ll% '-` 3`a5
Signature Notary -State of Mida Date
Contractor/Agent isx_ Personally Known to Me or
Produced ID
APPLICATION APPROVED BY: Bldg: Zoning: Utilities:
Initial & Date) (Initial & Date) Initial & Date) (Initial & Di
Special Conditions:
HUG H WIGA10RE_ HU6H W16M ENotarypublic; S18*o#<florida 1 Notary
UGH
µ>F;ceamt:.tl t;-i; 2086 My • , of Florida
Comm- Nb:- DD 155550 Comm. No. DQj555
Roland Grigley's Electric Company
Richard Roland Grigley
251 Lakeridge Ct. Winter Springs. FT 32708
407-695-2522 407- 832-8008
ER 0012433
Oct.213, 2004
I, Richard Roland Grigley, of Roland Grigley's Electric Company
hereby give limited power of attorney to Janice Rothermel of
Aquatic Innovations Inc. to pull permits in my name. If you have
any questions please feel free to call me at the above phone
numbers.
Sincerely yours,
1 R. P —_ / / . /I
l
R. Roland Grigley. V
Sworn tome and subscribed before me this daylof JCt/1 XWq . goo S
t
Public,
Orange County, State of Florida
HUGH WIGMORE lr c 146 n
Notary Public, Stab d FWr*
My comm. exp. Oct. T. 2=
Comm. No. DD 155550