2446 Seminole Rd EP ltr 2014 BUILDING CONTRACTOR AND OWNER jF
1'OP PORTION MUST BF.COMPLETED FIRSTWe will not allow the building to be occupied until the electrical has been final inspected and final Building Irior P C 0 is approved Violation of this agreement will result in an immedtate disconnection of electrical power �Q14
We at c aware of betesubject to rosccu at under Chapter 1 of the Florida Building Code and the associated I
-- Building Qualifying Agent(Print) (nernonl — Property Owner Nam(Print)I person I
Signature Siiptature
Address Plaine N
Slue of State of
The County of The Counts of
Sworn to and subscribed before me Sworn to and subscribed before me
that day of this day of
20 20
Personally known—ID Personally known__ID
Notary Publc Notary Public
State of Florida State of Florida
My Commisuon Expires My Commissirm Expires
NOTARY PUBLIC J NOTARY PUBLIC
ELECTRICAL CONTRACTOR
BUILDING OCCUPIED yes no
DATIi:—qJ � Electrical Ca`,, ��t\�(r�l CCifl
Mr.Jimmy Douglas,Supervisor Name of Job
Electrical Inspections1 ;
Ed Ball Building Address: �4 y to se"1(\t� Rd
214 Hogan St N.Room 285
Jacksonville,Florida 32202 Permit a y
Dear Sir
I respectfully request that temporary power for the address listed above be cut on for testing purpose only.
1 acknowledge by my signature below that 1 will be responsible for anything that may occur due to the energizing of the service prior
to the final electrical inspection,and the approval and completion of the job.
It Is the ruuomer responsibility to make application for power with the Utility Company.
M•
Electrical Qualifying Agent Name(Printed or Typed) Signature
State of
Tide County of
Sworn to and subscribed before me
this day of
20
Personally known ID—
Notary
D` -- /00000,Notty Public
o
State of Florida
My Commission fxpires
g VrdnU�I«vrcVmm`Janp doe '.