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2203 S Oak Ave 04-547 Electricalf CITY OF SANFORD PERMIT APPLICATION c Permit # : ©q -5 ` -7 Date: Job Address: 21-A S 0,4e tg u iG Description of Work: Historic District: Zoning: Value of Work: $/ .3 / S ©d Permit Type: Building ElectricalMechanical Plumbing Fire Sprinkler/Alarm _ Pn61. Electrical: New Service — of AMPS 200 Addition/Alteration Change of Service _Temporary Pole _ Mechanical: Residential Non -Residential Replacement New (Duct Layout & Energy Cale. R.c quired) Plumbing/ New Commercial: # of Fixtures # of Water & Sewer Lines # of Gas Lines Plumbing/ New Residential: # of Water Closets Plumbing Repair— Residential or Commercial Occupancy Type: Residential commercial Industrial Total Square Footage: Construction Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form; required for ots,,er than X) Parcel #: Attach Proof of Ownership & Legal Description) Owners Name & Address: aYYO/V S a7yy IC c QT;9pwly1 , Phone: 46 1) - G 91) - 3 Contractor Name & Address: (0 J'U[ SZ L S i J/iY ra/ State License Number: Phone & Fax: qoi 3ZZ - I5(e Z Contact Person: Fy ieie Ck F1 HBO AJ Phone: d%'. ZC "350 S Bonding Company Address: Mortgage Lender: Address: Architect/ Engineer: Address: Phone: 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 common_ccci prier 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 la srr regulating construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT' M ),'OJ J-<.1' PAYINGTWICE 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 of permit is verification that I will notify the owner of the property of the requ'reme F'da,'/w, 713. Signature of Owner/Agent Date re of ontr oDatee0t JPrint Owner/Agent's Name Pri t Contractor/Agent's Name 12 - . a3 Signature of Notary -State of Florida Date ignature of Notary -State of Florida Date Owner/ Agent is Personally Known to Me or Produced ID 12, - 03 APPLICATION APPROVED BY: Bldg: J Zoning: Initial & fe) Special Conditions: Contractor/AgeR( 11 yfgnpttVte or ProducedL&D 705CC 90570Utiw IMOtherI.D.(Initial & Date) tial ate Date,