2442 Mellonville Ave 04-487 electrical upgradeG )^ . . •l . f '=a't-r +i'°P"N"+Y 1 T i yrx, au{ E r Tn-:,y s a+ . ,; ;'e mr...ti r ;;vs M .t ',., z i _ - . CITY
OF SANFORD PERMIT APPLICATION Permit #:
LA —1 Date: Job
Address: 2447- me-Laconw i tle Aue- Description
of Work: Historic
District: Zoning: Value of Work: $ -#210d Permit
Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool Electrical:
New Service — # of AMPS _AISCj Addition/Alteration Change of Service p"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 Water Closets Plumbing Repair — Residential or Commercial Occupancy
Type: Residential wl Commercial Industrial Total Square Footage: Construction
Type: # of Stories: # of Dwelling Units: Flood Zone: (FEMA form required for other than X) Parcel #: (
Attach Proof of Ownership & Legal Description) Owners
Name & Address: Ran, a AG Phone: -
3Z3-=3159 Contractor
Name & Address:-5-A,(% FO r'd 6LOC•'r(e Co Tru! State
License Number: fj /Qcccp 3 / q Phone &
Fax: 40- Contact Person: yT,Ta411 SeN Phone: 07' 3Z2 /442, 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 commenced pi.`ioe 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 he 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, `'OUrt 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
of permit is verification that I will notify the owner of the property of the requirem rida FS 713. Signature
of Owner/Agent Date r to of ontra Agent Date Print
Owner/Agent's Name Print ontractor/Agent's Nam Z
2 • a3 Signature
of Notary -State of Florida Date S , ature of Notary -State of lorida Date Owner/
Agent is Personall% Known to Me or Produced
iD APPLICATION
APPROVED BY: Bldg Zoning: initial
Special
Conditions: Contractor/
Agent is - Personally Known to Me or Produced
ID BARBARA
HURLER Uiilities:
Initial &
Date) I( ))/
No(&it ate) Z
l Personally K w m I l Other I.D.