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CI'TY�OF�SANFO"RD;�L .E�3CMA1.rEfiAITArrL�CCJO,� --
Permit Number: Q3" NSr) Date: 03
The undersigned hereby applies for
a permit to install the following electrical:
Owner's Name: K G Rfo/ f 1 V U'S e-
4 p,�, n/j Q p
Address of Job: O I I �EN-rN'� n D� �` K
Electrical Contractor: C E Y -&- - E c %-ri
Residential: Non -Residential: X
Number I 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:
n of Work:
Application Fee: $10.00
TOTAL DUE:
By Signing this application I am stating that I am in corn Nance with City f ode.
State License Number
Date:
I hereby name and appoint
of
POWER OF -ATTORNEY
to be my lawful attorney
in fact to act for me and apply to the G/Z� rfi 7t b -
Building Department for a.4Z permit
for work to be performed at a location described as:
Section
Township
Rangej�
Lot �—
Subdivision_
Ny�-7� �S
i Jfl
.T g,
of
(Owner of Property and Address)
and to sign my name and do all things necessary to this appointment.
i
L vl.,v;.L
it Name of c
o
and Contractor's License
The foregoing instrument was acknowledged before me this,? Fs A a day of 20 O_ 3
by LoAlAli! c
who isersonall known to me(who produced
as identification and who did not take oath.
State of Florida
Countyof �2is,JG
Notary Public, Orange County, Florida
E
OSCAR MONTJI.D.
om '. 4/1C
No. CC 9262
14bovm I l
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