HomeMy WebLinkAbout801 W 20 St 04-169 electrical upgradePermit #: 0 ( b' 1
Job Address:
Description o
Historic District:
CITY OF SANFORD PERMIT APPLICATION
Date: D •-02 0 - v
Zoning: Value of Work: $ /oCJ
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 Owner bip & Legal Description)
Phone:
Phone &Fax:lContact Person: eTQ 2 Phone: Bonding
Comvanv: AX
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. Za
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 1 will notify the owner of the property of the requirements of Florida Lien Law, FS 713. Signature
of Owner/Agent Date Signature of Contractor/Agent Dat Print
Owner/Agent's Name tnt tractor/Agent's Name i
o•-c'3 Signature
of Notary -State of Florida Date Signature oT Kotary-State FI rida Date Owner/
Agent is - Produced
ID Personally
Known to Me or APPLICATION
APPROVED BY: Bldg: Initial &
Date) Special
Conditions: Zoning:
Contractor/
Agent is Personally Known to Me or Produced
ID Initial &
Date) Utilities:
FD: Initial &
Date) (Initial & Date) 4P
REBECCA LOPEZ MY
COk9MISSION # CC 942389 1: !`')"
RES: Jun 5, 2004 t-
80P&NOTARY FL Notary Service & Bonding, Inc.
10/20/2003 13:42 4072600712 SCOTT L EASTERBROOK PAGE 02
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Tauuovied 39v3g3aoS BETS Lt8 LiL YYri 86:8T I18 tOos,20160
0456999 STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION r
I \ ELECTRICAL •Z`ONTAACTORS LICENSING BOARD SEQ#L0206130182
s The .ELECTRICAL CONTRACTOR
Name&,below:IS CERTIFIED w
Under='the proviaiona..of Chapter 489 FS.
Expiration date: AUG 31, 2004
EASTERBROOK, SCOTT LATHAM
D & E-ELECTRICAL SYSTEMS INC
744 INDUSTRY RD STE B
LONGWOOD FL 32750
JEB BUSH KIM BINKLEY-'SEYER...-
GOVERNOR DISPLAY AS REQUIRED BY LAW SECRETARY =
3/03 e.W3O.L.# 04-07750
I
STATE#
EC 0003096
1878 OCCUPATIONAL LICENSE
LICENSE FEE $ 20(b• 00 a
EST.
xxlaR
7 10. 00ADMINISTRATIVEFEE $ ,
LOCATION: '
744 INDUSTRY RD B t. TRANSFER FEE $ .00
For The Occupation oPENALTY /o $
CONTRACTOR/OVER '30 EMP - ` a
fr
00
COUNTY TAX
D L E ELECTRICAL SYSTEMS, INC. , ,ahA as 0.
45. t 0
P.O. BOX 520398
LONGWOOD FL. 3' 752 a;j$ v f
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y
TO AL.
255.00 I
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EASTERBROOK, SCOTT L. CITY CLER ? e
LICENSE MUST BE CONSPICUOUSLY DISPLAYED AT BUSINESS LOLCI',IOVEAR
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