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' PER,
PLC
Permit Number:��' 11
Date: O 3
The undersigned here
by applies for a permit to install the following electrical:
FTVOwners Name: ' wr
-1
Address of Job: 5.e27 ujI t -roti G t P
Electrical Contractor:
Residential:
Non -Residential:
Number Amount
Addition, Alteration, Repair Residential & Non -Residential
New Residential.
AMP Service
New Commercial:
AMP Service
Change of Service:
From AMP Service to AMP Service.
Manufactured Building
Other-
Description of Work:
e-
1
E S
Application Fee: $10.00
TOTAL DUE:
By Signing this application I am stating that I am in
Slate License Number
. .j
1
POWER OF-ATToRNE'Y
I hereby name and appoint
(I
to be my lawful attoraey
in fact to act for me and apply to the C C'� ✓y� ��-����
Building Department for a
permit
for work to be performed at a location described as;
Section - Township Range
Subdivision kh<40 1-, A-er
(f,esE.
J01))
Loth4#1UP
(Owner of Property and Address)
"95;-
and to sign my name and do all things necessary to this appointment.
i
L OiyNi .,E
C or Pant Name of Certified (bat<aator and Coatractoes Licem
Signature of Caltiried
The foregoing instrument was acknowledged before me this?L".4/t day of 20 6.7
by Za N/v Dc
�4 a.Ns
who isersonall known to melwho produced
as identification and who did not take oath.
State of Florida
Countyof V2 ^. 04
Notary Public, Orange County, Florida
p
LIVIO OSCAR MONTERO
MY Comm Exp. 4/10/04
No. CC 926266
�' -ak K -W -n 1 I Olhe, I.D.
Seal
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