613 Sanford Ave 03-1662 electrical repairPermit # :_
Job Address:
Description of Work:
Historic District: Zoning:
CITY OF SANFORD PERMIT APPLICATION
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Date: 4
Value of Work: $ '600
Permit Type: Building Electrical Mechanical Plumbing Fire Sprinkler/Alarm Pool
Electrical: New Service — # of AMPS Addition/Alteration _ V Change of Service 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: Residenti I/ Commercial Industrial Total Square Footage: d 000 s' 0—
Construction Type: U)Qft # of Stories: d # of Dwelling Units: Flood Zone: (FEMA form requires+ for other than X)
Parcel #: ;) S
Owners Name & Address:
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of Ownership & Legal Description)
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Phone:
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Contractor Name & Address: oul r J1 • 1tL /N?M Te 1 b Q+ .r / ' IA),AI
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State License Number: L r OG S g'O /
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Phone & Fax: L(O? t 1 a 7 —0 L(47 Contact Person: Phone: 40 7— Y-) 7_J C(Y
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 prior 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 laws regulating
construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT I:N Y011li j,A7ING
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 requiremgn4Florida Lien Law FS 713.
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Date Si aturtof ontractor/Agent Dat
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Signature of Owner/Agent
Print Owner/Agent's Name Print Con n s a
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Signature of Votary -State of Florida
Owner/Agent is _ Personally Known to Me or
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Date Sig to -State of Florida Date
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Contractor/Agent is Personall Known to e eo rr ° N o
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APPLICATION APPROVED BY: Bldg: Zoning: Utilities: FD:
Initial & Date) Initial & Date) (Initial & Date) Initial & Date)
Special Conditions: