402 Orange Ave 04-40 Electrical upgradeCiTY OF SANFORD PERMIT APPLICATION
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Permit # : (/ f — 1,0 Date:
Job Address: 462. O Y' "e A uG
Description of Work: 173 t5riylll! (Jp
Historic District: Mo Zoning: Value of Work: $ 0 24 35. e)O
Permit Type: Building Electrical {.-Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/Alteration Change of Service lk"' Tempor"dry Pole
Mechanical: Residential Non -Residential
Plumbing/ New Commercial: # of Fixtures
Plumbing/New Residential: # of Water Closets _
Occupancy Type: Residential Commercial
Replacement New (Duct Layout & Energy Cale. Required)
of Water & Sewer Lines # of Gas Lines
Plumbing Repair— Residential or 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: %VtN 6Od #/'Q/%1 / /OA-J
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Phone: '447 32g'
Contractor Name & Address:-%Y/li%%
25 Z Z^ P,4 DyrvG sfi/U d/L FL —State License Number:
Phone &Fax: ? 3 /7 4 Contact Person: c)LYT_ !1/'ISO/fJ Phone: Z2_/- Z
Bonding Company:
Address:
Nlortgage 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 prior to the 45r
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 laws regulating
construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESUI;I' IN YOURPAYING
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 requirement da ien 3.
Signature of Owner/Agent Date Signature of Co ct r/Agen Date
Print Owner/Agent's Name Print Contractor/Agent's Narrke
Signature of Notary -State of Florida
Owner/Agent is Personally Known to Me or
Produced ID
APPLICATION APPROVED BY: Bldg:
Initial & Date)
Special Conditions:
Date iignature of Notary-S
Contractor/Agent is
j_ /AJ'roduced ID
Zoning:
Initial & Date)
Utilities:
BARBARA HUBVEW
My Cm, E P. 1/1105-
No. CC 990570
L". C n..ti,,na ove l l otlo t.0.
F D:
Initial & Date) (hrtial & Date)
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