HomeMy WebLinkAbout2105 E Lake Mary Blvd`CI° OF�SANFOx;R ,1awePEf� IT... .PPLIC
Permit Number:�3 Date:
The undersigned hereeb�by'�apppli/es for a permit to install the following electrical:
Owner's Name:
Address of Job:
AlpElectrical Contractor: 1,,r --AJ ( C-,
Residential: Non -Residential:
Number Amount
Addition, Alteration, Repair Residential & Non -Residential)
1:
New Commercial:
AMP Service
Change of Service:
From AMP Service to AMP Service
Manufactured Building
Other.
Description of Work: T W S I0L
C 1
SL vc c,
u TL eTS .
Application Fee: $10.00
TOTAL DUE.
By Signing this application I am stating that I am in
State License Number
POWER OF•A.TTORNEy
Date:
I hereby name and a000int
of ((a `� % u �'� to be my lawful attorney
in fact to act for me and apply to the C -4-r Y aTF
Building Department for a A/ 62,6z� l �l G,(f -Zj pmt
for work to be performed ata location described as:
Section —/- Township age 3 Lot 3d" --EQV4
Subdivision 1" 4-GAA(,c.4
I06- F- . 46ZI✓t)-
(Address of Job)
(Owner of Property and Address)
and to sign my name and do all things necessary to this appointment.
i
L ovvi� � C,�ziy�-Y
T�3- r Print Name of Certified Cwtraator and Conuacw es License NU
The foregoing instrument was aolmowledged before me this A4,f day of 2012-31
by — —1oivA,°b 12.
Cii�%L t
who is ersonallknown to me/who produced
as identification and who did not take oath.
State of Florida
County of
Notary Public, Orange County, Florida
F(9 -
LIVID OSCAR MONTERO
MY . 4110/W rye, cc 926266
I Ft�spiaYy 14rown 11 Other I.D.
Seal
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