HomeMy WebLinkAbout701 W 24 StCITY OF SANFORD PERMIT APPLICATION
Permit # : D1p— 3284
lob Address. zl
Description of Work: O yew- IfIA.
Historic District: Wing: Value
Date: !Z — CCU — o,6
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Total Square Footage_
Work: ShO_, eP&
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t
Permit Type: Building Electrical` Mechanical Plumbing __ Fire Sprinkler/Alarm Pool
Electrical: New Service - # of AMPS . -14 Addition/Alteration Change of Service Temporary Pole _
Mechanical: Residential Non-Residcntiat Replacement New (Duct Layout & Energy Ca1c. Required)
Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines
Plumbing/New Residential: # of Water Closets Plumbing Repair - Residential or Commercial
Dccupancy Type: Residential _0— Commercial Industrial
Construction TypeW&M# of Stories: --/-- # of Dwelling Units:.[ Flood Zone: JD (FEPfA form required )
owners Name & Address:/iW/c
I
Phone: w'
contractor Name & Address: _
State License Number 490 7-7_
hone & Fax: Q
3onding Company:
kddress:
4ortgage Lender:
ddress:
rchitect/Engincer:
ddress:
Contact
Phone.
Fax:
application is hereby made to obtain a perntit to do the work and installations as indicated. 1 certify that no work or installation has commenced prior to the
suance 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
ermit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, and
dR CONDff [ONERS, etc.
WNER'S AFFIDAVIT: t certify that all of the foregoing information is accurate and drat all work will be done in compliance with all applicable laws regulating
onstruction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOT[CE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
WICE FOR IMPROVEMENTS TO YOUR PROPERTY_ 1F YOU INTEND TO OBTAIN FINANCING, CONSULT W(TH YOUR LENDER OR AN
TI'ORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
OTICE: 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
tis county, and there may be additional permits required from other governmental entities such as water management districts, state agencies, or federal agencies.
eceptance of permit is verification that 1 will notify the owner of the property of the
Signature of Owner/Agent
Print OwnedAgent's Name
Date
Signature of Notary -State of Florida Date
Owner/Agent is _ Personally Known to Me or
Produced [D
PPROVALS: ZONING: UTIL: FD:
pedal Conditions:
ev 03/2006
Florida Lien Law, FS 71,3.
01' /
Signat re of Contractor/Ageht/ \\\\\1tj N NF
PrmtC onnttractor/Ag` ame ` a/nuary
Jj N
Signature of Notary -State of Florida US o m
Contractor/Agent is Personally Known to My or///
Produced iD El S 0 -.5 Z I J` •7
ENG: BLDG:
jorERONLECTR/C, inc. Limited
Power of Attorney Date:
9/20/06 I
hereby authorize Leslie Small of Heron Electric, Inc. To
sign his/her name on my behalf in order to apply for an Electrical Permit. For
the work to be performed at: Lot
Subdivision Address
701 W. 241h Street Heron
Electric, Inc. EC-0002687 Type
r print name of company and License # of Contractor Si
ature of Licensed Contractor If
applicable only! Type
or Print Owner's Name Signature
of Owner State
of Florida Orange County The
foregoi i trument wa owledge before me this day of/ 20 (_,
by (Name of person acknowledging) Signature
of Not y Public -State of rida) G.
N M y ,11' lic State of Florida It
ty Print, Type or Stamp Commission Name)` ;;,xru+
ssionDD487773 12;
15/2W9 Personally
known or produced identification Type
of identification produced. 4708
West Concord Avenue Orlando, Florida 32808-8124 Phone:
407-296-2550 Fax: 407-296-9114 Lic. EC-0002687 email: heronelectric@cfl.rr.com