HomeMy WebLinkAbout102 Boulder Ct(� CITY OF CANFORD PERMIT APPLWATrnN
Permit # : �/ � — I z � s
Job Address: /O -a Q Ove i;; COtlr+
Description of Work: S,
Historic District:
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Zoning:
- - - - Date: 0 u
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� t , I 1 lrqn Total Square Footage
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Value of Work: $ Z/ O 0 •
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 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 _1z"Commercial Industrial
Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required )
Owners Name & Address: Aft �� SS ` Crf' R_
Phone: �f b7,302 --T--) 0
Contractor Name&Address: LC1 AI( E(eC.-k,C�;� STVS
[Ocf commCfCe- 9-• CqK2 Mot(tq fL '7,L'7
7Z,'7 y G State License Number:
Phone & Fax:4d%333'-�6b5 oOZ Contact Person: M irl%e611L Sf cl c SK ` Phone:-,0-7-3333-IAAe 5 X- TZ oa
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 perfortned 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 requirements of Florida en Law, FS 713.
Signature ofOwner/Agent Date `Signature of C Uactor/Agent Date
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Print Owner/Agent's Name Print Contra r/Agent's Name""'t"'
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Signature of Notary -State of Florida Date S gnatureof Notary -State of FloriDate
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Owner/Agent is_ Personally Known to Me or Contractor/Agent is c/Personally Known to Me or
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Produced ID _ Produced ID
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APPROVALS: ZONING: UTIL: FD: ENG: BLDG:
,
Special Conditions:
Rev 032006
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DEL -AIR
ELECTRICAL SERVICES, INC.
109 COMMERCE ST, LAKE MARY, FL 32746-6206
POWER OF ATTORNEY
July 6, 2006
Dear Sir/Madam: ��. p
This letter is written to give authorization for
v /� • / /�Y to pull an
electrical permit for Del Air Electrical Services for 102 Boulder Coiff
Daniel Puglisi
Electrical Contractor
EC 0001663
Del Air Electrical Services,
Inc.
THIS INSTRUMENT WAS ACKNOWLEDGED BEFORE ME
THIS _DAY OF J� ZoolD
BYi--kJOJh'Sl
WHO IS PERSONALLY KNOWN TO ME.
MY 011JUMj2010
�D DW%93
o�ftN*p" o�
SIGNATURE OF NOTARY PUBLIC