123 Lee Ave 03-1706 FenceApr 29 03 04:44p Charlene 407-679-0614 p.l
CITY OF SANFORD PERMIT APPLICATION
Permit No.: �/ 6
Job --Address: �` /3 Le C _ s r ,
Permit Type: Y�
bescription of Work
Building Electrical
.1,�L5� Zq y2
Date:
Plumbing Fire AlarudSprinkler
Additional Information for Electrical & Plumbing Permits
Electrical: Addition/Alteration `Change of Service Temporary Pole New AMP Servicc (0 of AMPS )
Plum bing/Residential: Addition/Alteration New Construction (One Closet Plus AddidonW)
PlumbineCommercial: Number of Fixtures Number of Water & Sewer Drainage Lines Number of Gu Lim
Occupancy Type: Residential yCommercial _ Industrial Total Sq Fig. Value of Work: 5
Type of Construction: Flood Zone: Number of Stories: Number of Dwelling Units:
Parcel No.::30 ( 9 ? t1b)nAnt) �_3 O (Attach Proor of Ownership & Legal Description)
Owner/Address/Phone:_ t,16 w T2 " t?15S M-vs s c i oo o E• izi a s r s r 5�4a_d XL, 327 7 f
Contractor/Address/phone: cJ $ `J F t?xto C �k I q B tr
S to License NumbBer.
Phone &Fax Number. �o �1 �Y 2�t / 3 7
Title Bolder (If other than Owner):
Address:
Bonding Company:
Address:
Mortgage Lender.
Address:
Arcbitect/Engineer Phone No.:
Address:
Fax No.:
A ror Que x,�„s Prerese caar: 3 permit to do the work and installations as indicated I certify that no work or installation has
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crrtene t0 permit d that work will Cbpe< anat al be performed IO meet standards Of all laws re
gulating construction
separate permit must be secured for ELECTRICAL WORK, PLUMBING. SIGNS, WELLS,
P - S ATERS, TANKS. and AIR CONDITIONERS, etc.
UF
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 Iaws regulating construction and zoning WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMIvENCEMENT MAY RESULT IN YOUR PAYING TWICE FOP, AeROVEMENl'S TO YOUR PROPERTY. IF YOU
INTEND TO OBTAIN FINANCING, CONSULT WrM YOUR LENDER OR AN ATTORNEY BEFORE RECORDWO YOUR
NOTICE OF COMMENCEMENT.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this propary that may be
found in the public records of this county, and there may be additional permits required from other go�rrnmenl rntities such as
water management districts, state agencies, or federal agencies. 1
Acceptance of permit is verification that I will notify the owner of the property
Signature of Owner/Agent Date
Print Owner/Agent's Name
m S,),
Signature of Notary -State of Florida Date
rr
F�� a RONALD H. BODIN
'A MY COMMISSION # DD 124159
EXPIRES: September 25, 2006
1-906&NOTARY FL Notary Service d Bordng, Inc.
Owner/Agent is X Personally Known to Me or
Produced ID
of Florida l.Xfi LAw.-FS 713.
'Agent's
Florida Notary Assn., Ito.
Contractor/Agent is Personally Known to MC or
Produced ID
APPLICATION APPROVED BY.
Special Conditions:
Date: L2 �S3
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