HomeMy WebLinkAbout1206 E 29 St Electricalt CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: Documented Construction Value: $ Jd
Job Address: 1�i +Zet Historic District: Yes ❑ No
Parcel ID:D t7C�[� Zoning:
Description of Work:
(-e—
Plan
�,, �► Ski
Plan Review Contact Person: Title:
Phone: Fax: E-mail:
Name
Street:
City, State Zip:
Property Owner Information
Phone:
Resident of property? :
Contractor Information/
Name I f'�c C(A �,✓t n S +vw".S Phone: �S� `-f '�
Street: r o ; (o Fax:
City, State Zi E C _
C��?�
p: �i�j �[_ : �,� j � (� State License No.:
Name:
Street: '
City, St, Zip:
Bonding Company:
Address:
.Building Permit
Square Footage:
Architect/Engineer Information
Phone:
` Fax:
E-mail:
Mortgage Lender:
Address:
PERMIT INFORMATION
Construction Type: No. of Stories:
No. of Dwelling Units: Flood Zone:
Electrical X
New Service –No. of ALPS:—
Mechanical 0 (Duct layout required for new systems)
Plumbing 0
New Construction - No. of Fixtures: —
Fire Sprinlder/Alarm L No. of heads:
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no
work or installation has commencedrior to the issuance of a permit and that all work will be performed to
meet standards of all laws regulating c construction in this jurisdiction. I understand that a separate permit
roust 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. A NOTICE
OF COMP/IENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
FIRST INSPECTION. 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 Florida
Lien Law, ITS 713,
The City of Sanford requires payment of a plan review fee. A copy of the executed contract is required in order
to calculate a plan review charge. If the executed contract is not submitted, we reserve the right to calculate the
plan review fee based on past permit activity levels. Should calculated charges exceed the documented
construction value when the executed contract is submitted, credit will be applied to your permit fees when the
permit is released.
Signature of Owner/Agent Date nature ofContractor/Agen/t Date
Print Owner/Agent's Name Prmt Contractor/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
Rev 11.08
UTILITIES:
FIRE:
Signature of Notary -State of Florida Date
Contractor/Agent is Personally Known to Me or
Produced ID Type of ID
WASTE WATER:
BUILDING:
m,4 -
ELECTRICAL ENERGY SYSTEMS INC
PO BOX 816 ELECTRICAL CONTRACTORS
NEW SMYRNA BEACH FL 32170 EC0003075
386-423-6700 ♦ FAX: 386-423-5621
EES ','Committed to Excellence"
Date: 9, a o
I hereby name and appoint:
an agent of Electrical EnergySystems, Inc
to be my lawful attorney-in-fact to act for me to apply for, receipt for, sign for and do all
things necessary to this appointment for:
Q� All permits and applications submitted by this company.
❑ May also receive personal ID pin #.
❑ The specific permit and application for work at location:
I ') o (a r9a(`ff_ f-ee�
Expiration Date for this Limited Power of Attorney: 3 /, aUl
License Holder Name: W j 11 0 nn M_ (_1j wL)e vcj
State License Number: E G 00030') ,r"'
Signature of License Holder: ZALM Z
STATE OF FLORIDA
COUNTY OF Vo U.
The foregoing instrument was acknowledged before me this /?"-day
of L,, , 20 ja , by W i 1 I a Yb1 • C�ual.2,�� who is personally known
to me or who has produced as identifica io
who did (did not) take an oath.
Signature
Print or Type name
MYTABITHA COW
ti[WARREN
Not Public -State of
v c:o�uttsS[or[ � es[ [sme Notary
w—j EXPM :AvsW0k2D15 Commission No. Ef—11920[o
op
1+°'4"N"RY AM A" Cb.
My Commission Expires: Ll ois-