HomeMy WebLinkAbout190 Bolivia Ct 04-680 Electrical for hot tubCITY OF SAN: &RD PERMIT APPLICATION
Permit # : Date:
Job Address: NO &o I A Lr- _
Description of Work: 7-VA
Historic District: Zoning: Value of Work: $ `/DO
Permit Type: Building Electrical x Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/Alteration K 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 (Duct Layout & Energy Calc. Required)
of Water & Sewer Lines # of Gas Lines
Industrial
Construction Type: # of Stories: # of Dwelling Units:
Plumbing Repair — Residential or Commercial
Total Square Footage:
Flood Zone: (FEMA form required for other than X)
Parcel #: 31. (q• 31 ,3UU : C 0 9A 4 0000 (Attach Proof of Ownership & Legal Description)
Owners Name & Address: A.IeW j9-I 8&3 M 1551 GrrV
ato • 1 t' S-r- 5'Wf-- W F1_ 3277/ Phone: W 7 - 330 -15o 5
Contractor Name & Address: 'Dt'Zl6 *r EEC.Tg4L
C t-
State License Number: C.G L 3U27 I-J s `-'
Phone & Fax: Contact Person: Phone:
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer: Phone:
Address: 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 II notify the owner of the property of the requirements of Florida Lien Law, FS 713.
oe
ignature of Owner/Agent Date S n re of Contractor/Agent Date
Z,G[ *1ej> L PJJ 'tcy—
Print Ownor Print Contractor/ nt's Natt?e
3043
n Date
KENNETH PAUL FROST
MY COMMISSION #bD D2046754
Ag _WAWi}ft1wn teo Me oar 5
d,,,&WaWTARY FL NOt4N Servloe & WndIng, Inc.
APPLICATION APPROVED BY: Bldg:
Initial & Date)
Special Conditions:
Zoning:
Si ature - to of Florida
7(&KEN7NETH:PAUL FROST
DD
046754Contractor/Agent is Personallyber 22,
2005ProducedID &
Bonding, Inc -
Utilities: FD:
Initial & Date) (Initial & Date) (Initial & Date)