HomeMy WebLinkAbout708 Laurel Ave 04-546 Electrical upgradeCITY OF SANFORD PERMIT APPLICATION tea'
Permit #: i/- o y 66 L-
Job Address:
1,769
Description of Work:
Date: / 2 — 9_- 0 3
Historic District: Zoning: Value of Work: $
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 Replacement New (Duct Layout & Energy Cale, 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 #:
Owners Name & Address:
Contractor Name & Address:
Attach Proof of Ownership & Legal Description)
ne: 396 - 5-9 - 3 941
2 SzZ /%/ ,di' , /al L State License Number: EI B tO 3
Phone & Fax: 4d%" 2 2 i 5 GZ Contact Person: GJ;/VY k #1 SO #V Phone: 2- 3 2 2_LSOZ
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 will notify the owner of the property of the req
Signature of Owner/Agent Date
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
Owner/Agent is _ Personally Known to iNle or
Produced ID
APPLICATION APPROVED BY: Bldg:
Special Conditions:
Zoning:
n n Law, kFg 713.
of Con tor/ nt Date
Print Contractor/Agent's N
gnature of Notary -State of Florida Date
0F rto BARBARA KUBLER
Contractor/Agent is9 I yt 1I1/09
Produced (D N PueuC > No. CC 9gu70
I ty Itnown C 1 Otlpr I D.
Utii{ties: FD:
Initial & Date) (Initial & Date) Initial & Date) (Initial & Date,