HomeMy WebLinkAbout101 B W 1 St 03-2838 ElectricalCITY OF SANFORD PERMIT APPLICATION =' >
Permit # :
S
Date: / p)200 , i
Job Address: 1 W !
cc
S J
Description of Work: M ,'a J
Historic District: Zoning: Value of Work:
Permit Type: Building Electrical _y1_ Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS j 00 Addition/Alteration Change of Service 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 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 #: Attach Proof of Ownership & Legal Description)
Owners Name & Address: tK a a 1. S T41 A S Y
01Lii F—1 POST S Phone: --.- Contractor
Name & Address: T1- Z P%7 IF & i cwz I c / _ V
0+ ac) K 6 0q State License Number: F— G— Coo a S 39 Phone
Contact Person: 00i4y 140 ;r-AO "' Phone: 3 Zt'7 Z ci Bonding Company:
Address: Mortgage
Lender:
Address: Architect/
Engineer:
Address: 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 fNt 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 a rca o this property that this county,
and there may be additional permits required from other governmental entities ch as water anagym,nt disy Acceptance of
permit is verification that I will notify the owner of the property of the Signature of
Owner/Agent Date Print Owner/
Agent's Name Signature of
Notary -State of Florida Date Owner/Agent
is _ Personally Known to Me or Produced ID
APPLICATION APPROVED
BY: Bld Zoning: Initi 1 &
Date) Special Conditions:
of found
in
the public records of s to
agencies, or federal agencies 3. i
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g 2, 003 Date41
ig
IJ JContractor/Agen
a
R aLtu2es ,l
lgeary-State FLORENCE A. DE GRAVE Date MY
COMMISSION
M DD 164280 EXPIRES: November
12, 2006 Contraci'OF/
ghat°is yNlft tg9cry sMe or Produced ID
Utilities: FD:
Initial & Date) (
Initial & Date) (Initial & Date)