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Permit Add Bath/Remodel 795 Plaza 2011
JuI - 0r - Zb11 (rWE) 11: Schuman Electric, Inc. (FAX) 8043964104 P. 001/001 5 _.L'!'y:.. ' ;i EARLY POWER AGREEMENT & RELEASE _!% CITY OF ATLANTIC BEACH ; Electric power is requested now under the conditions and terms of this fully executed Agreement & Release Job Address: ...7 til i Permit No. \ ` - I Ci "l Q Service Type (Circle One • Over ypC ' ( } he, Underground We, the undersigned General Contractor and Electrician, understand and agree: 1. "Early Power" is urely for our construction convenience, it is not required by Codes and does not substitute for Final Inspections or the C/O (Certificate of OccupancyrEat must be issued before occupancy, and as such is at the discretion of the Building Official, 2. The City of Atlantic Beach will make a special inspection prior to the early power energizing. M rough inspections must have prior Approval, including meter base connections. 3. Occupancy or use of the new construction before a formal C/O constitutes fraudulent use of the early electric service. Such action is expressly prohibited and penalized by The City of Atlantic Beach Ordinances, A violation of this Agreement shall result in a request for prompt removal of electric service after a twenty -four hour notice. 4. "Early Power" release authority is the Electrician and /or the Contractor and must not occur before: a. Equipment, devices and fixtures are installed (or blanked off) safely. b. Panel is complete with breakers and cover, and (labeling required at final inspection). c. Service connection and grounding is complete. d. The electric system has safely passed through electrical check, f. Temporary is numbe sl with d address. ent nurnbers are required for C /O). 5. This fully completed form is to be submitted to the Building Department by hand, mail or fax. 6. Future such Agreements will Oat be accepted from those who violate any one of the above items. __.,_,---• ,°t / 737 -- /p e CONTRACT • R (. • ` /h ".c 1 , �-� DATE / PRINT NAM ' ,. • . WAMarrj...7 E" l ELECTRICIAIQ CA/ . ,.,—) DATE ,..,4:/,,, PRINT NAME F;',Arrilliir i 800 Seminole Road, Atlantic Bench FL 32233 Phone: (904)247 -5826 Fax: (904)247 -5845 httpJ /www.coab. revised 01 30 09 } CITY OF ATLANTIC BEACH k 'r jS 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5814 Application Number 11- 00001948 Date 4/28/11 Property Address 795 PLAZA Application type description RESIDENTIAL ALTERATION Property Zoning TO BE UPDATED Application valuation . . . 30000 Application desc INTERIOR REMODEL AND ADD BATH Owner Contractor CORNER LOT PROPERTIRES SHAYCORE ENTERPRISES INC 10169 GENI HILL CIR TEMPLE TERRACE FL 33617 JACKSONVILLE FL 32225 Permit RESIDENTIAL ALT /OTHER Additional desc . Permit Fee . . . 200.00 Plan Check Fee . . 100.00 Issue Date . . . Valuation . . . . 30000 Expiration Date . 10/25/11 Special Notes and Comments *2007 FLORIDA BUILDING CODE W/2009 REVISIONS NATIONALELECTRIC CODE *REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING DEPARTMENT IMMEDIATELY. Other Fees STATE DCA SURCHARGE 3.00 STATE DBPR SURCHARGE 3.00 Fee summary Charged Paid Credited Due Permit Fee Total 200.00 200.00 .00 .00 Plan Check Total 100.00 100.00 .00 .00 Other Fee Total 6.00 6.00 .00 .00 Grand Total 306.00 306.00 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. APR -21 -2011 12:14 FROM: CLERK OF COURTS 904 270 1512 TO:92475845 P:2•2 :,. Pprrrl r-/- /1-/9s- .., NOTICE OF COMMENCEMENT Stata of 4p __Qt0, _._.... _ —__ Tax. Folio No. County of Do g.1 To Whom It May Concern: The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713 of the Florida Statutes, the following information is stated to tbi.s NOTICE OF COMMENCEMENT_ Legs], Doscriptinn of property being improved: r>"'s: d ck f.1 5-,,: ems. (i -.. . Adclress of property being improved: '715 Qua .% General description of improvements: 9,e/..v1.4•1 ; Rekjc ; NL*J.a@ , Slcc& l/rRC - , Owner: C,amec « pro f1�ct` Address: 605$ sole ' /..r . 3""r Fr s2.2.17 Owner's interest in site of the improvement: t�e.59.),- - Fee Simple Titleholder (if other then owner): • ...____ .- - -- . Name: -- Contractor: 7*n, cv G fOriN.�gcc ti..) C .._.. .- - — A.ddress: 'I'A Mina Pv ;Dw.l C . mw. t= 3Zl -- V\ `Telephone No.: Sal `71N) Fax No: 942 Wm Sur* Of any) _ _ _ A.ddress• - a omit of Bond $ '.l No: —_ _ Fax No: _ _ t U Name and address of any person making a loan for the construction of. the i pr r t cr Z Je p 0 x 'A "Z1 Address: r _ _ ; z qq Fax No: • E z d phono No: Namo of person within the State of Florida, other than himself', designat . b . r + . • r , r:• r or o i er .91 A 1 Amay a served: Nam �,+ e: _ A 'Address: - Z . - — �'\ Telephone No: Fax No: • 0 In addition to himself, owner designates the following person. to rocs .v4 .� w : he n.91�)a ,tice : - pi i � ec i . ` . 713.O6(2)(b), Florida Statues. (Fill in at Owner's option) V A a 5 r4 Name: ._ Mr it W 9 Address: _.. 1.. — — Telephone No: Fax No: ��" — - iration, date is one (1) year from the date of recording unl.. s ifferent dat - . yee R 0 :1 {MI 4 J38 , u R t o< 2 557'5.-/ Page Sb4, Number Pages'. 1 - _ - - -` Recorded 04/21/2011 at 12:22 PM. JIM FULLER CLERK CIRCUIT COURT DUVAL M ' j y „ C 0 ' OUNTY �lgned 7 X�J RECORDING $1000 Date: Before me this IS' day of rt. 1 in the County of Duval, State Of Florida, has personally appeared t I ti{' & , 3 V . 11. f..1 f 11 Notary Public at Largo, State ofFk,i -ida, Catnty of Duval. �.� 5� '� My commission expires: ii MICHELLE KAY PRICE Personally Known: -_ -. . err , � , " Comm! DD0807477 Produced Identification: F L ..L)r i att Lee -•, C i4) Expires 11/7/2012 w Noa i t m 4W Florida NotaryAssn., inc ,t � Lll .11 0", j '� <S ‘ CITY OF ATLANTIC BEACH l 800 SEMINOLE ROAD . �. ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5814 .1'� ( 3131 9 '14 Application Number 11- 00001948 Date 4/29/11 Property Address 795 PLAZA Application type description RESIDENTIAL ALTERATION Property Zoning TO BE UPDATED Application valuation . . . 30000 Application desc INTERIOR REMODEL AND ADD BATH Owner Contractor CORNER LOT PROPERTIRES SHAYCORE ENTERPRISES INC 10169 GENI HILL CIR TEMPLE TERRACE FL 33617 JACKSONVILLE FL 32225 Permit ELECTRICAL PERMIT Additional desc . REWIRE HOME - UPGRADE SERVICE Permit Fee . 149.00 Plan Check Fee . . .00 Issue Date . . . Valuation . . . . 0 Expiration Date . 10/26/11 Special Notes and Comments *2007 FLORIDA BUILDING CODE W/2009 REVISIONS NATIONALELECTRIC CODE *REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING DEPARTMENT IMMEDIATELY. Other Fees STATE DCA SURCHARGE 3.00 STATE ELEC DCA SURCHARGE 3.59 STATE ELEC DBPR SURCHARGE 3.59 STATE DBPR SURCHARGE 3.00 Fee summary Charged Paid Credited Due Permit Fee Total 149.00 149.00 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 13.18 13.18 .00 .00 Grand Total 162.18 162.18 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. 1.AN t f �, 4 f° CITY OF ATLANTIC BEACH r, t s ;t 800 SEMINOLE ROAD ,. - ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5814 Application Number 11- 00001948 Date 4/29/11 Property Address 795 PLAZA Application type description RESIDENTIAL ALTERATION Property Zoning TO BE UPDATED Application valuation . . . 30000 Application desc INTERIOR REMODEL AND ADD BATH Owner Contractor CORNER LOT PROPERTIRES SHAYCORE ENTERPRISES INC 10169 GENI HILL CIR TEMPLE TERRACE FL 33617 JACKSONVILLE FL 32225 Permit ELECTRICAL PERMIT Additional desc . TEMP POWER POLE Sub Contractor . SCHUMAN ELECTRIC INC. Permit Fee . . . 90.00 Plan Check Fee . . .00 Issue Date . . . Valuation . . . . 0 Expiration Date . 10/26/11 Special Notes and Comments *2007 FLORIDA BUILDING CODE W/2009 REVISIONS NATIONALELECTRIC CODE *REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING DEPARTMENT IMMEDIATELY. Fee summary Charged Paid Credited Due Permit Fee Total 90.00 90.00 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 90.00 90.00 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. _;.- ,:ef, ` CITY OF ATLANTIC BEACH , ` ) 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5814 Application Number 11- 00001948 Date 5/11/11 Property Address 795 PLAZA Application type description RESIDENTIAL ADDITION Property Zoning TO BE UPDATED Application valuation . . . 30000 Application desc INTERIOR REMODEL AND ADD BATH Owner Contractor CORNER LOT PROPERTIRES SHAYCORE ENTERPRISES INC 10169 GENI HILL CIR TEMPLE TERRACE FL 33617 JACKSONVILLE FL 32225 Permit PLUMBING PERMIT Additional desc . Sub Contractor . M & A PLUMBING INC Permit Fee . . . 97.00 Plan Check Fee .00 Issue Date . . . Valuation . . . . 0 Expiration Date . 11/07/11 Special Notes and Comments *2007 FLORIDA BUILDING CODE W/2009 REVISIONS NATIONALELECTRIC CODE *REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING DEPARTMENT IMMEDIATELY. Other Fees STATE PLBG DCA SURCHARGE 2.00 STATE PLBG DBPR SURCHARGE 2.00 Fee summary Charged Paid Credited Due Permit Fee Total 97.00 97.00 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.00 4.00 .00 .00 Grand Total 101.00 101.00 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. s PLUMBING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd Atlantic Beach, FL 32233 Ph (904) 247 -5826 Fax (904) 247 -5845 JOB ADDRESS: %. 'apt PERMIT # // " NEW OR REPLACEMENT INSTALLATION: Project Value $ TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY 13athtub Septic Tank & Pit C lothes Washer Shower Dishwasher Shower Pan 1 Drinking Fountain Slop Sink Floor Drain Three Compartment Sink Floor Sink Toilet / Hose Bibs / Urinal Kitchen Sink Vacuum Breakers Laundry Tray Water Connected Appliances 1,avatory 2 Water Heater / Other Fixtures Water Treating System RE -PIPE: TYr'T OF FIXTURE QTY TYPE OF FIXTURE QTY I %,;!;tub Septic Tank & Pit I.) tcs V`.'ashen Shower i,,nN∎ ashcr Shower Pan I )rinking hountain _ Slop Sink I.Ioor° Drain Three Compartment Sink Floor Sink Toilet I I ,sc Bibs Urinal I:itchen Sink Vacuum Breakers Laundry Tray Water Connected Appliances I .avatory' Water Heater Other Fixtures _ Water Treating System MISCEL r,A NE O US: ❑ Sewer R' ,!< ‘_.mcnt ❑ Back Flow Preventer ' 1 Grease Interceptor (Trap) gallons (Requires 3 sets of plans) ❑ Lawn Si , .' r ; s cm- Number of Heads ❑ Well ** ** SJRWD r ''c: ,-'lotion Form. Completed form to be submitted to the Building Department for final inspection zfri) Other Permit become , oid f \\ ,)!,; does not commence within a six month period or work is suspended or abandoned for six months. I here. ■ certify that I have read this application Id b ..)hs • ,t c same to be true and correct. All provisions of laws and ordinances governing this work will be compl •d with whether specified or not. The per ut ci.‘ :,i yive authority to violate the provisions of any other state or local law regulation construction or the p: formance of construction. Property O',: ncrs N:. :ne ,� Arti5/ /h, ,'b ' . ; - e ,7v Plumbing (- 1 v / ' I /, , r4 ' Office P one 11j S ,/ x ‘, P,5-11 - 7 / 2 , 9 Co. Addre - /l, : -, ,-*F4 City ' /' State C' Zip---4 Iii ri: ['1,;11): At.,,v. . rt-{ , 1 /Ziw,vt�irc./ State Certification/Registration # © 57 ( 3 y...4,0,, 4o v& b 'F�-bi° G (055 50 \— x-13.. _ '' 0 -- Notarized ;,,f e ofL enAeHolder , Sworn a p subscribed before me this ‘ t`"- day of 20 t r `'Y n . t MARY L. ROBERTS ' [ X ( a / * � t �jC * MY COMMISSION # EE045721 Signature of Notary Public i T EXPIRES: February 24, 2015 � r " or � `o. Bolded The Budget Notary Services I CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD I ATLANTIC BEACH, FL 32233 ____"" INSPECTION PHONE LINE 247 -5814 Application Number 11- 00001948 Date 5/11/11 Property Address 795 PLAZA Application type description RESIDENTIAL ADDITION Property Zoning TO BE UPDATED Application valuation . . . 30000 Application desc INTERIOR REMODEL AND ADD BATH Owner Contractor CORNER LOT PROPERTIRES SHAYCORE ENTERPRISES INC 10169 GENI HILL CIR TEMPLE TERRACE FL 33617 JACKSONVILLE FL 32225 Permit MECHANICAL HVAC PERMIT Additional desc . Sub Contractor . A/C MASTERS HVAC INC Permit Fee . . . 99.00 Plan Check Fee .00 Issue Date . . . Valuation . . . . 0 Expiration Date . 11/07/11 Special Notes and Comments *2007 FLORIDA BUILDING CODE W/2009 REVISIONS NATIONALELECTRIC CODE *REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING DEPARTMENT IMMEDIATELY. Other Fees STATE MECH DCA SURCHARGE 2.00 STATE MECH DBPR SURCHARGE 2.00 Fee summary Charged Paid Credited Due Permit Fee Total 99.00 99.00 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.00 4.00 .00 .00 Grand Total 103.00 103.00 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. 44`" siiww� irk CITY OF ATLANTIC BEACH + BOO SEMINOLE ROAD, ATLANTIC BEACH, FL 32233 ' OFFICE (904)247.6828 • • FAX NO.:(904)247.5845 ito J BUILDING•DEPTCCOAB.U8 t 1,11 MECHANICAL PERMIT APPLICATION DUVAL COUNTY -ViORA ., , >,, a1°� T n - it t 1; lima ADD. powy .,,, / „ � ' , , , ;,,- - 3, DD V � A :' "7 5 )),-.,v - ... q5 PJ & BEES PERMIT I/ „' jq- O li /l j '' iyy ki,A 1 41 ?,pr;, w l' .F . :, , -, , , --: , ~" ^ RQPDI OWNER♦ 4. NAME: 5. I DD 88 - R I JO8 D : ✓ [wc 0.� Tri ,dfi M ADR l �cri�' " 6. PHONE 63r-C... -C... n qq k c3 aa, ay q`or 161-1 �^n ,,, n , • �' M HANICAL N it: 7. M OF NY; � 8. ADb RE8S.: - ---�' ( t q 6,r PV i . T..rc. z/z1..5 T✓cs e a 4, S k d 4 9 J i; . 9. STA Q � iCE�1= i o ` , 10. CELL PHONE 11. FAX/40. -1.)�` ^q 9 /J 12. EMAIL -C /1, DD W y 19 l4 i S.) A, h(4 1 3. I lI Q c ` �5'/- 14 y/ d! Application is hereby made to obtain a permit to do the work and Installations as indlcated. I certify that all work will be performed to et the standards of all laws regulating construction In this jurisdiction. This permit becomes null and void if work is not comps ed wit in six (6) months, or if construction or work is suspended or abandoned for a period of six (6) months at any ti a after is cotf ! d CONTRACTORS SIGNATURE: '-- t t..^ . 1. f 15. OF WQ #.," -4 16. WILDING: " 17. RVICE: 18. CURRENT CODE: E INSTALLATION CI NNW PI RESIDENTIAL 0 '06 FLORIDA BUILDING CODE- 0 REPLACEMENT OF EXISTING SYSTEM D'EXISTING ❑ COMMERCIAL MECHANICAL ❑ ALTERATION / ADDITION TO EXIST SYSTEM ❑ REPAIR ❑ OTHER 1 - . "gin a 0 , " , :' MIIICMANICARQUIPMENTTO�SE STALLED: 19. HEAT: ❑ SPACE 0 RECESSED {,n; ❑ FLOOR BURNERS: 20. AIR CONDITIONING: ❑ ROOM a6ENTRAL 21. DUCT SYSTEM: MATERIAL: THICKNESS: MAX CAPACITY: 1400 cfm 22. REFRIGERATION: MAX CAPACITY: cfm 23. COOLING TOWER: CAPACITY: gpm 24. FIRE SPRINKLER: NUMBER OF HEADS: _,,, 25. LIFT SYSTEM: ELEVATOR: MANLIFT: ESCALATOR: AUTOLIFT: 26. COMMERCIAL HOOD NUMBER: 27. FIREPLACE: PREFABRICATED: , MASONRY: 25. IRRIGATION: ❑ PUMP ❑ WELL ❑ PIPING 29. GAS PIPING: # OF OUTLETS: ❑ GAS AMU: ❑ GAS WATER HEATER: 30. OTHER - SPECIFY: SOLAR HEATING, BOILERS, UNFIRED PRESSURE VESSEL, HEAT EXCHANGER OR COL IN DUCTS ETC. VALUE FOR OTHER ITEMS: 1 , '31, MOLINE lQUIPMENTI ' ' r .' a s ' ' ' '' '''' r AIR `CONDITIONIN(I,E REFRIGERATIOfI EQUIPMENT. CONOENSORS. ETC, NUMBER - APPROVING OF UNITS DESCRIPTION MODEL. # MANUFACTURER TONS AGENCY I t iOVIAen.Sal CSLi 3C361A 6 00/1 an 3 32,51)5.)/ FURNA BQ ERS. FIREPJ,ACES AIR HANDLERS ETG, NUMBER' APPROVING A 1 OF NITS DESCRIPTION MODEL # MANUFACTURER BTU AGENCY 4;,, I- .�, 4c.,o R C d� . t 6 K) - 3 g5 10541 , ,i ,�;', , I 33.TANKS: 1 YPE LIQUID APPROVING ' NUMBER GALLONS CONTAINED MANUFACTURER SERIAL# AGENCY COAB FORM BLDG04: REVISED: 1/102008 Iy' -Ltl' !"l F`y CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD re4 ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5814 Application Number 11- 00001948 Date 4/29/11 Property Address 795 PLAZA Application type description RESIDENTIAL ALTERATION Property Zoning TO BE UPDATED Application valuation . 30000 Application desc INTERIOR REMODEL AND ADD BATH Owner Contractor CORNER LOT PROPERTIRES SHAYCORE ENTERPRISES INC 10169 GENI HILL CIR TEMPLE TERRACE FL 33617 JACKSONVILLE FL 32225 Permit ELECTRICAL PERMIT Additional desc . REWIRE HOME - UPGRADE SERVICE Permit Fee . . . 149.00 Plan Check Fee . . .00 Issue Date . . . Valuation . . . . 0 Expiration Date . 10/26/11 Special Notes and Comments *2007 FLORIDA BUILDING CODE W/2009 REVISIONS NATIONALELECTRIC CODE *REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING DEPARTMENT IMMEDIATELY. Other Fees STATE DCA SURCHARGE 3.00 STATE ELEC DCA SURCHARGE 3.59 STATE ELEC DBPR SURCHARGE 3.59 STATE DBPR SURCHARGE 3.00 Fee summary Charged Paid Credited Due Permit Fee Total 149.00 149.00 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 13.18 13.18 .00 .00 Grand Total 162.18 162.18 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. ELECTRICAL PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd, Atlantic Beach. H. 322 33 Ph (904) 247 -5826 Fax (904) 247 -5845 3 ADDRESS: 7615 1:)\ ouZ4 PERMIT # 1 1- 1 g q JEA INFORMATION REQUIRED ON ALL PERMITS ) 5D AMPS a `( 0 VOLTS I PHASE VALUE OF WORK$ 10611)/- NEW SERVICE 1 Overhead 1 Underground nl Underground up Pole Residential (Main) Service 0 -100 amps 101- 150amps 151- 200amps amps # of Meters Commercial (Main) Service 0 -100 amps 101- 150amps ! :151- 200amps amps CT Service amps Conductor Type Size 1Multi Family (Main) Service 110 -100 amps 101- 150amps Li 151- 200amps amps # of Unit Meters l'emporaryPole to (l amps SERVICE UPGRADE ` 15 amps Li CT Service amps 0 1) G' 44-e A-0 NEW FEEDER (ADDITIONS, ACCESSORY STRUCTURES, ETC.) 1 00 amps 150amps ❑ 200amps L] amps 1 iCT Service amps / j� ` /9 / ADDITIONS, REMODELS, REPAIRS, BUILD -OUTS, ACCESSORY STRUCTURES, ETC. Outlets /Switches: i 3-• 0- 30amps 31- 100amps 10l - 200amps 5C 6 (S v Appliances: 0- 30amps 31- 100amps 101- 200amps • A/C Circuits: 0 60amps 61 100amps UY Heat Circuits: # circuits @ kw Number of Lighting Outlets, Including Fixtures: 3 _ OTHER ELECTRICAL PROJECTS LJ Swimming Pool [ 1 Sign ❑Smoke Detectors Qty . ]Transformers KVA ❑Motors hp FIRE ALARM SYSTEM (Requires 3 sets of plans & Fire Alarm Checklist) Qty volts /amps VALUE OF WORK $ REPAIRS/MISCELLANEOUS ❑ Replace Burnt /Damaged Meter Can I lSafety Inspection ; ;Panel Change L -1OH to UG 'Ckther: 60(})1l tSvM ONA.4.kevn — Emit"-..- r I 0 ' ktT oC' -c-r3wt 0 '-pA, e.. s Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for six months. 1 hereby certify that 1 have read this application and know the same to be true and correct. All provisions of laws and ordinances governing this work will be complied with whether specified or not. The permit does not give authority to violate the provisions of any other state or local law regulation construction or the performance of construction. 1 C. Property Owners Name 46 Mort a)(t.S. Phone Number Electrical Company �(? \tArngo y 2Of N C , I y c . Office Phoner73 7 4 f61-7a Fax 96 - (ad y '/ Co. Address: .P(QO . R @\ in\Q S CityY0LC)45' UI) Le State F- Zip .3.2:2e7 I' nseHolder (Print): e lf,.) c i{,A (AA. t State Certification /Registration #T'/d)24 ? utarized Signature iceny DOD �,,lder MICHELLE YOUNGeL ;= 1 NOTARY PUBLIC Sworn and subscribed before me this :t, `, day of le ' 1 20 STATE OF FLORIDA ,. ~ ! - + ' ` Comm #EE0 Signature of Notary Public 11, 4 18/2014 p��ilb!