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Permit# <br /> Workers Comp.Verified; <br /> ula%-s 1F�..0 Ci,�-�cfL BUILDiNc Dt visioN <br /> RESIDENTIAL PERMIT APPLICATION <br /> 'dow <br /> Aller/411-4. <br /> W'1W.:7W_W <br /> Attach proof of ownership:Tax record from Seminole County Property Appraiser's Office,Tax Receipt o/Deed,etc <br /> J b Street Address: 2148 Bonanza Avenue Date: <br /> ci4\&zip: Winter Park, 32792 Bldg/Complex: <br /> ParceID: 34 - 21 - 30 - 517 - OCOO 0010 <br /> Subdivikn Name: Eastbrook Subd-Unit No 16 Plat Book: <br /> Owner Na : Richard Ortega <br /> Address: 21M Bonanza Avenue city: Winter Park state: FIJI zip: 32792 <br /> Phone: (407) M9-1297 J Fax: <br /> Contractor Company. 313 Solar LLC <br /> License Holder Name:IDavid Ringo License Number. tVVC56949 - <br /> ,Address: 13266 Byrd!Rive# 1071 Odessa state/ FL I Zip: 33556 <br /> Phone: (727) 868-0110:� ' I Fax: <br /> Architect/Engineers Name: A112)%,,Gezelman I Phone: (8131909-1956 <br /> Address: 18865 State Road K# 176 city: Lutz ate: _FL [zip., 33558 <br /> CONTACT PERSON: David Ring x___ - =PHONE: (727) 868-0110 <br /> EMAIL: admin@3-dsolar.com FAX: <br /> Work Valuation-for project(Estimated.)4 $2N452 <br /> Square ft.of Living/Cond.Space: Total Square It.: Affected Square ft: <br /> Will trees be removed? NO El YES 0(if yes,Nknplete an Arbor Permit Application) 1 <br /> Description of Work:Solar install (ph tovoltaic-"'Nollop), 8.85 W, 30 oane)6 <br /> New Construction [3 Addition 0 \Alteratiori [31 Demolish [3 Roof 13 <br /> Electrical -0 Plumbing 0 Wvaniciil [3'1 Well 0 1 Security Alarm E3 <br /> Utilities:Check all iterns that apply;if other than Seminol4counihj­f,ater&sewer,a Utility Letter is required <br /> Septic Tank 0 Well 0 Existing Well E3 ublic Water ,171 .-Public Sewer 0 <br /> Subcontractors . License# Business name and! Icense Holders Name Est-Work Valuation <br /> 941POTIBN I'LiM. (ji,&tf JHCJ�Jf�C" $23,4r.9 <br /> Lr 52 <br /> MECHANICAL <br /> PLUMBING <br /> ROOFING <br /> LOW VOLTAGE Z <br /> GAS <br /> IRRIGATION <br /> WELL <br /> NOTICE:This application becomes null and void-180 days a the date of filing,unless such application has can pursued in good faith or <br /> pennit has been issued.Extensions may be granted 4§the Building Official if requested in writing and I 'flable cause Is shown. <br /> I HEREBY CERTIFY THAT I HAVE READ-AND E)(AMINED THIS APPLICATION AND KNOW,THE SA TOBE TRUE AND <br /> B <br /> CORRECT.ALL PROVISIONS OF LAWS AND 0 INANCES GOVERNING THIS TYPE OFVVORKWIH EtcoMPLIEDWITH <br /> C WHETHER SPECIFIED HEREIN OR NOT.TH GRANTING OF A PERMIT DOES NOT PRESUME TO GI AUTHORITY TO <br /> Y <br /> VIOLATE OR CANCEL THE PROVISIONS OF?NY OTHER STATE OR LOCAL LAW REGULATING CO\NSTCTION OR THE <br /> OF <br /> OF CONSTRUCTION. <br /> The valuation for this permit will be calculatedy6ing the ICC Building Valuation Data. By my.signature, I acknowledge is fact and waive <br /> ag0rights to appeal said valuation and/or permit fees. <br /> ELECTRONIC SUBMISSION STATE NT:Under penalty of perjury,I declare that all the information contained in this-building <br /> permit application is true and correct. <br /> Printed Name: David ' go <br /> Signature of Contrfior: - ®ate: <br /> 1101 EAST FIRST STREET SANFORD FL 32771-1468 PHONE(407)665-7050 FAX(407)665-7486 <br />