HomeMy WebLinkAbout819 W 1 St - E05-002942 (SERVICE CHANGE) DOCUMENTSPermit # :
Job Address:
Description of Work: _
Historic District:
Zoning:
CITY OF SANFORD PERMIT APPLICATION
Date: 10<
Value of Work: S
Permit Type: Building Electrical Mechanical Plumbing Fine Sprinkler/Martz Pool _.
Electrical: New Service — # of AMPS Addition/Alteration Change of Service 4 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 #:
Owners Name & Address:
�;o %.\% � o.
Contractor Name & Addr
(Attach Proof of Ownership & Legal Description)
p 1111111
M-1 NO 1XVIN 11-01 Moma =000-14
Phone & Fax: LkCYA �°l c�.oi . 111 Contact
Bonding Company:
Address:
Mortgage Lender:
Address:
Architect/Engineer:
Address:
State License Number: F_C_ O C6R 9
k`C-4 V N Phone: 401 `6N 1Z
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 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 re ents of Florida Lie aw S713.
Signature of Owner/Agent Date ture R Con ctor A —Date --
,:!_
ate_`:!_ �k e P - girl i 1 Lo-,
Print Owner/Agent's Name Pri Contractor/Agent's Name
,W Notary Public State of FlotiE,;_
Karen Zozula
Signature of Notary -State of Florida Date Signature of No' ry 't'te bf Florida My Commission OD382827
or a Expires 01/0212009
Owner/Agent is _ Personally Known to Me or Contractor/Agent is _Pe� Wally Known to or
_ Produced ID _ Produced ID
APPLICATION APPROVED BY: Bldg: Zoning: Utilities: FD:
(Initial & Date) (Initial & Date) (Initial & Date) (Initial & Date)
Special Conditions:
ELECTRICAL SERVICES INC.
2153 PREMIER ROW ORLANDO, FL 32809
(407) 648-8540 FAX (407) 812-7171
July 5, 2005
Subject: Temporary Power of Attorney
1, Steve Miller authorize Samantha Dye to apply for electrical permit for Miller Electrical Services Inc.
In the City Of Sanford for the following house
Lot l 1. n t -n Ck� r-)
Subdivision Q, n J ..not,, o
Addressl:li�'\v\ SArQj
Permit # 0Z) `- ca�9 4 a
Thank you
'i A
�' � �-- -
m,,t
President
Signed before me.this 5 day of July 2005, in Orange County Florida by Steve Miller who is personally
kno to me
Nott PubtacC� o(Florida
Karen Z zula Karen.Zoau►a
Notary " MY Cmmsm DDU2827
�+� �Expues Ofi0A5
State of Florida Certified Electrical Contractor EC 0000594