HomeMy WebLinkAbout113 Garrison Dr 04-65 (electrical)Permit # : do OLA tv
Job Address:
Description of Work:
Historic District: Zoning:
CITY OF SANFORD PERMIT APPLICATION
Date: lQ - 0 ' ® 3
n .
Value of Work: $ ?CYO -to—
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — of AMPS Addition/Alteration Change of Service L-"i emportry 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: Z.0 r Bi4 5 e'1.^
yJ Phone: 409- 3 z2' 406 u
Contractor Name & Address: L40 %--
State License Number: "100W 3M
Phone & Fax: 4o I - 3 J0 — 0 0 9' Contact Person: L er/N J J h 4.5O H./ Phone: 46 /- 3ZZ —OCCI
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 J /
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 separateW z
permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, and /777
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 rida i La , S 713. >
I ?.03
Signature of Owner/Agent Date ignatut of Contract 9 Agen Date
Print Owner/Agent's Name Print Contractor/Agent's Name
44 AAk/2,L/-. &kvlv., In .A- 0 3,
Signature of Notary -State of Florida
Owner/Agent is
Produced ID
Personalh Known to Me or
APPLICATION APPROVED BY: Bldg:
Initial & Date)
Special Conditions:
Date iSignature of Nota -
oF rlo BARBARA HURLER
9
NOTARY o My Comm Exp. l!1/05,
a PUBLIC s No. CC99M70
Con tractor/Agenty 1Fj a I.D.
Produced ID
Zoning: Utilities: PD:
Initial & Date) (Initial & Date) (Initial & Date)