HomeMy WebLinkAbout1105 Laurel Avee,
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Permit #
Job Address: i % 6 0- /A- (/ECG
Description of Work: — Gv 1 L a
Historic District: Zoning:
CITY OF SANFORD PERMIT APPLICATION
Vc
Date: 3 I z' 0
Value of Work: $ Z z00
Permit Type: Building Electrical
ll
Mechanical Plumbing Fire Sprinkler/Al/PoolSprinkler/Alarm
Electrical: New Service — # of AMPS ddition/Alteration Change of Service i 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 WaI Closets Plumbing Repair — Residential or Commercial
Occupancy Type: Residential Commercial Industrial Total Square Footage:
Construction Type: __Q_ # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than x)
Parcel #: S / Q S ( 0o -7 0 (Attach Proof of Ownership & Legal Description)
Owners Name & Address:
Phone:
Contractor Name & Address: 'N J r ` e c.:t-r t L . C',Z7 2 e -7 0 , 1
C. r S S (tJ State License Number: Uy Phone &
Fax: Contact Person: Phone: 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 YOU]-", 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
ermit isrificatio th t notify the own r o the property of the require o Flo ida Lien FS 713. tgnature
of Owner/Agen Date Signature of Contractor/Agent 47 Date 7-
1 d Print
Owne Age is N e L` b , Print
Contractor/Agent's NaKy o.
uno..nnuomPH
oo.
n / Si
t e of N State of Florida a J.
CSomr
R _ atu f Notary fate orida Date EW_
rc 3 oft"
uvY/ Owner/
Agent is _ Personally Known to Produced
ID f `
O
APPLICATION
APPROVED BY: Bld O—b / —Zoning: Initial &
Date) Special
Conditions: Agent
is = Personally Known to Me or Produced
ID Utilities:
Initial &
Date) Initial & Date) FD:
Initial &
Date) i
o ty+v vt%s,_ JOSIE FAYE FORE Commission #
DD0145785 4
Expires 8/28/2006 o`
Bonded through 800-
432-42s4) Florida Notary Assn., Inc. a ..................................................
1'11. 4u7JG71.12 f. FAX 407-767-W tj
t'.l). IIUX 3WZ27 ELECTRIC CO. 1C 71CYI ER&S WAY
FERN PARK. i'I. 32730 ® ® `
3
g
C'ANSELHERRY, 17.327u7
ELECTRICAL CON RAC I'ORS
Richard DeFazio
N. J. Electric Co.
EC-0002730
Date aZd
I hereby grant permission for I _ - I L-. 5— Q ;
to obtain the Electrical permit for-.tbe property, listed at
6 in the city of
for which I am sending a signed application.
Tbank you
C
icbard DeFazio/N. J. E ctric Co.
State of Florida
County of Seminole
The foregoing instrument was acknowledged before me this
day of 20 `5 , y -
who is personally known by me, and that be being duly autb'dVized
to do so, executed the foregoing instructions for the purpose
therein contained.
11
Signature of Notary
My commission expire's;
7—
N..............................................
JOSIE FAYE FORE ;
jAl"O- -1a % C: Commi§sion # DD0145765 ;
a; Bonded through
06
000-a32-4254) Florida Notary Assn., Inc. J