HomeMy WebLinkAbout1750 WP Ball Blvd - 12-409pro
FEg d 2012
____CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
Application No: 12- ` 9 J Q Documented Construction Value: $ s 5.9 Z 8 v
Job Address: 1 S D c.t, A I`7�/l Sin -�4 r Historic District: Yes ❑ No ❑
Parcel ID: zoning: 1
Description of Work: F /aet `c �, V �� ` 4 d C1 +e a41 [ern
Plan Review Contact Person: Title:
Phone: Fax: E -mail:
Name
Street:
City, State Zip:
Property Owner Information
Phone:
Resident of property?
Contractor Information
Name ���PcTr'c SC�/� G ir���� Phone: Yo -2 262- ( �
Street: l 0 1 y & nr1 P// /?,0 S %F /A2 3 Fax: L(0 7 S' 6 ( St 3
City, State Zip: 4 (�,g.,w ✓. 4e, _'-SZ? (7 State License No.:
Architect/Engineer Information
Name: Phone:
Street: Fax:
City, St, Zip: E -mail:
Bonding Company:
Address:
Mortgage Lender:
Address:
PERMIT INFORMATION
Building Permit ❑
Square Footage: Construction Type: No. of Stories:
No. of Dwell* nits: Flood Zone:
Electrical
New Service — No. of AMPS:
Mechanical ❑ (Duct layout required for new systems)
Plumbing ❑
New Construction - No. of Fixtures:
Fire Sprinkler /Alarm ❑ No. of heads:
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R.D. MIC;HA.ELS, II C,
L'tiaurtlC.rco:uvt • t:aunsr.nuSUm {cr+
SUBCONTRACTOR CHANGE ORDER SC # 50329 -16100 CO #3
This Order No. t,1UST Appear on Bill of Lading and all correspondence
TO: Electric Service Group LLC Date: 1/31/2012
1010 Bunnell Road, Ste 1103 Project #: 50329
Order #: 16100
Altamonte Springs, FL 32714 Change #: 3
Attention: Greg Seigel / Heather Adkins Return Date: 2/14/2012
Phone: (407) 862 -1901 Fax: (407') 862 -1931
PROJECT: Ulta and Shoe Carnival Fagade Renov
ORIGINAL CONTRACT SUM
$4,820.00
NET CHANGE BY PREVIOUS CHANGE ORDERS
$61,187.31
CONTRACT SUM PRIOR TO THIS CHANGE ORDER
$66,007.31
CONTRACT SUM WILL BE INCREASED BY THIS CHANGE ORDER
$60,185.00
-ADJUSTED CONTRACT SUM
$126,192.31
Pursuant to the terms and conditions of the Initial Order referenced above the following changes are hereby
authorized.
Please sign all originals and return to our office for execution. Once executed, an original will be returned to you for your
records.
Description: Change Order #3
Qty UOM Description
1 LS Ulta interior build out
1 LS Add light scats, rewire RTU 6, relamp fixtures @ dock, lift rental
Comments:
Change Order #3
Electric Service Group LLC R.D. Michaels, Inc.
Date Accepted: �� — I — 12, Date Approved:
By: yy� By:
Print Name/Title,��!
Unit Cost Net Price
$58,280.00 $58,280.00
$1,905.00 $1,905.00
1I -Iz
SCUM
lectric
ervce GroUPLLC
EC13003592 407.862.9909 POWERING YOUR FUTURE
I hereby authorize
of
LIMITED POWER OF ATTORNEY
r
to sign his/her name on my behalf in order to apply for a(n) fjp yL� l C permit
for the work to be performed at:
Lot Subdivision
Address _il5 1 W:P &[ BW , V(.cq:colc I FL 32-1 -1 I y 1 T6
If applicable only!
STATE OF FLORIDA
SEMINOLE COUNTY
Type or Print Name of
Type or Print Name of Owner
The foregoing instrument was acknowledged before me this day of
20J,2
, by r0.CX Dg ti yt -fir (name of person acknowledgin
,". V. HEATHER K ADKINS
=' MY COMMISSION # D0972734
"" ta- - EXPIRES May 08, 2014
(407) 398 -0153 FlondalloraryService.com
Personally known OR produced identification
Type of identification produced:
Signature of Owner
4 &&
(Signature of Notary Public — State of Florida
well k&& s
(Print, Type or Stamp Commissioned Name)
1010 Bunnell Road, Suite 1103 o Altamonte Springs. FL 32714
phone 407.862.1901 o fax 407.862.1931 a www.ESGFlorida.com
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