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HomeMy WebLinkAbout846 Rosalia DrCITY OF NFORD',`­ FIRE Building & Fire Prevention Division fJI 3_#l1WIWI Application No: . E U Documented Construction Value: $ b , 6 Q 2 • Z- w Job Address: 16`tW JC oc_-,o li ck-- 6 \ `J,_ Historic District: Yes❑NoF__� Parcel ID: �(- (�(' 3 Q C-) C) c7 Residentialg-tommercialF] Type of Work: New[] Addition❑ AlterationaRepair 11 Demo ❑ Change of Use❑ Move ❑ Description of Work: 14-y PrC Chuv)Ue, o Lk - U t­,�ux_-i w' 0 r:f,% Plan Review Contact Person: Title: Phone: Fax: Email: I Property Owner Information Name C 1 i d-cu bocci 1(c� Phone: 0'+ Street: VZ(_:7-:;a( I Gl Del Resident of property?: 0upc &_Q City, State Zip: Contractor Information Name -DCw1 6 M o 5s , l (`> � f' (_, . PhoneC?����� Street: t'• ). 2�DK qq-7715(p Fax: City, State Zip: M CA I.4 (Al I d -4-A G1 State License No.: r AC -1 CC( tPD Name: Street: City, St, Zip: Bonding Company: Address: Arch itectlEngineer Information Phone: Fax: E-mail: _ Mortgage Lender: Address: WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for electrical work, plumbing, signs, wells, pools, furnaces, boilers, heaters, tanks, and air conditioners, etc. FBC 105.3 Shall be inscribed with the date of application and the code in effect as of that date: 6' Edition (2017) Florida Building Code Revised: January I, 2018 Permit Application This combination qualifies for a Federal Energy Efficiency tax Credit when placed in service between Feb 17,2009 and Dec 31, 2016. AHRI Certified Reference Number: 9157126 Date : 05-03-2018 Model Status: Active AHRI Type: HRCU-A-CB Outdoor Unit Brand Name: CARRIER Outdoor Unit Model Number (Condenser or Single Package) : 25HCC530A'030' Indoor Unit Model Number (Evaporator and/or Air Handier): FV4CN(B,F)003L The manufacturer of this CARRIER product is responsible for the rating of this system combination. Rated as follows in accordance with the latest edition of ANSI/AHRI 210/240 with Addenda 1 and 2, Performance Rating of Unitary Air -Conditioning & Air -Source Heat Pump Equipment and subject to rating accuracy by AHRI-sponsored, independent, third party testing: Cooling Capacity (A2) - Single or High Stage (95F), btuh : 28200 SEER: 15.50 EER (A2) - Single or High Stage (95F) : 12.50 Heati HSPF ng Ca PaCitY(H12)-Sin le or High Stage (47F)27600 (Region IV) _8.50� _ VIVI) Fl. k, i �- (� t"Active" Model Status are those that an AHRI Certification Program Participant is currently producing AND selling or offering for sale; OR new models that are being marketed but are not yet being produced."Production Stopped" Model Status are those that an AHRI Certification Program Participant is no longer producing BUT is still selling or offering for sale. Ratinas that are accompanied by WAS indicate an involuntary re -rate. The new published rating is shown along with the previous (i.e. WAS) rating. DISCLAIMER AHRI does not endorse the product(s) listed on this Certificate and makes no representations, warranties or guarantees as to, and assumes no responsibility for, the product(s) listed on this Certificate. AHRI expressly disclaims all liability for damages of any kind arising out of the use or performance of the product(s), or the unauthorized alteration of data listed on this Certificate. Certified ratings are valid only for models and configurations listed in the directory at www.ahridirectory.org. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRI. This Certificate shall only be used for individual, personal and confidential reference purposes. The contents of this Certificate may not, in whole or in part, be reproduced; copied; disseminated; MM entered into a computer database; or otherwise utilized, in any form or manner or by any means, except for the user's individual, personal and confidential reference. AIR-CONDITIONING, HEATING, CERTIFICATE VERIFICATION & REFRIGERATION INSTITUTE The information for the model cited on this certificate can be verified at www.ahridirectory.org, click on "Verify Certificate" link we make life better" and enter the AHRI Certified Reference Number and the date on which the certificate was issued, which is listed above, and the Certificate No., which is listed at bottom right. ©2018Air-Conditioning, Heating, and Refrigeration Institute FCERTIFICATE NO.: 131698359025784388 Job:23848572 Page 1 of 6 II'llll""I' �I' Offce Location: ORLANDO Proposal Date 05/02/2018 lJob Number 23848572 swrs Sears Home Improvement Products, Inc. Customer Name P.O BOX 522290 SHIRLEY GOODING 1024 FLORIDA CENTRAL PARKWAY LONGWOOD, FL 32750-7579 PHONE (800) 469-4663 Ph Customer's Home Phone Custom Customer's Work Phone 9Home 7 (321) 377-5094 Street Address Contractor License/Registration Number 846 ROSALIA DR ESTIMATE AND PROPOSAL FL (CGC012538, CMC1249510) City State p Code Is installation within city limits? (YeSINO): YES SANFORD FL 32771 Installation Address County SEMINOLE Billing Address (if differentfrom above) City Code Project Consultant Name & License No. (if applicable) TT ORVILLE 0 GORDON Description of the Project and Description of the Significant Materials to be Used and Equipment to be installed Interior Products / Exterior Products Home Warranty ❑Vinyl Siding QRoofiing Q✓ HVAC ❑Kitchen Remodeling OCountertop Whole House Elcoating Elvvinclows atticinsulation ❑Cabinet Refacing Flooring System F-JPainting QDoors [—]Garage Doors Bathroom Appliance SPECIAL INSTRUCTIONS: INSTALL HVAC ON 5/4/18 MOLD REMEDIATION: This Estimate and Proposal assumes that no mold remediation will be needed during installation work. If, upon inspection by the contractor or others, it is learned that mold remediation is necessary then Customer must arrange and pay for such remediation by a qualified person prior to the start or continuation of work. If Customer fails to arrange for necessary mold remediation within thirty (30) days, Sears may cancel this contract upon written notice to Customer. ASBESTOS ABATEMENT: This Estimate and Proposal assumes that there are no asbestos containing materials ("ACMs") that would be disturbed in the performance of the installation work. If upon further inspection by the contractor or others it is learned that ACMs have to be disturbed to perform work, then Customer must arrange and pay for abatement of asbestos by a qualified person prior to the start or continuation of work. If Customer fails to arrange for necessary asbestos abatement within thirty (30) days, Sears may cancel this contract upon written notice to Customer. The TOTAL PRICE including all labor, material, taxes and any applicable discount is $ 6, 502.26 Contract Price $ 6, 502.26 Earnest Money $ State Sales Tax $ 0.00 *INITIAL PAYMENT (Not to exceed 30% of TOTAL PRICE; payment is due prior to Local Sales Tax $ 0.00 ordering of product; excludes HVAC in which the INITIAL PAYMENT is 100%.) $ Initial Payment Subtotal $ 6, 502.26 FINAL PAYMENT (balance payable upon completion of job) $ 0. oo Total Amount Due 6, 502.26 *The Initial Payment is due prior to Sears ordering products. A Cancellation Fee of up to $ plus any incurred materials costs, up to 30% of the Total Price, may be assessed. Financing: The form and method by which the Customer(s) will pay is described in a separate Cash/Credit Card Payment Addendum made a part of and incorporated into this contract by reference. All of the above check boxes (and associated Product Addendum(s)), "Work NOT to be done:", "Additional work to be done:", "Special Instructions:", "Mold Remediation", "Asbestos Abatement," and "Financing:" sections have been reviewed by and explained to me. Product Addendum(s) is/are made a part of and incorporated into this contract by reference. initials "~4R� Customer(s) NOTICE TO BUYER: YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD(3) BUSINESS DAY, FIVE (5) BUSINESS DAYS IN MARYLAND, (FIVE (5) BUSINESS DAYS IN ALASKA, SEVEN (7) BUSINESS DAYS IN MARYLAND, FIFTEEN(15) BUSINESS DAYS IN NORTH DAKOTA IF YOU ARE 65 OR OLDER) AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. SK1- (Dig.) Rev 10/16/17 Job:23848572 Page 2 of 6 Heating and Cooling Addendum Lead Number: 23848572 Date: 05/02/2018 Sales Rep: ORVILLE 0 GORDON Customer Name: SHIRLEY GOODING Phone: 3219263907 Address: 846 ROSALIA DR City. SANFORD State: FL Zipcode: 32771 SYSTEM INFORMATION: AHRI #: 9157117 NSTALLATION TYPE: (Split System/Package/Dual Fuel/Straight Cool/Heat Pump/Furnace): HP -AIR HANDLER EQUIPMENT BRAND: CARRIER FURNACE FUEL: (Gas/Oil/LP Gas/Electric): ELECTRIC HEATING BTU: SEER (up to): 14.50 Cooling BTU: 27,800 KW: AFUE (up to): BOILER INFORMATION: EQUIPMENT BRAND: New/Replacement/Conversion: TYPE INSTALLATION: Q REMOVE AND DISCARD OLD BOILER Q CONNECT TO EXISTING SUPPLY & RETURN PIPING Boiler type (Water/Steam): BTU: AFUE (up to): FUEL: (Gas, LP Gas. Oil*): 0 Replace oil Filter* *Oil Tank removal and replacement is the responsibility of the owner The work to be done under this contract includes the following (where checked): Specifications ( 0✓ Included 0 Not Included) NEW EQUIPMENT COMPONENT: ELECTRICAL: MISCELLANEOUS: ❑✓ FURNACE/FAN COIL Q CONNECT TO EXISTING LINE SET 0 CONDENSER UNIT 0 INSTALL NEW DRAIN LINE 0 EVAPORATOR COIL 0 FURNACE/FAN COIL AUXILIARY DRAIN PAN 0 PACKAGE UNIT Q CONDENSER UNIT PAD EVAP COOLER Q INSTALL NEW MAIN PANEL Q CONDENSATE PUMP 0 THERMOSTAT INDOOR AIR QUALITY: FLUE VENTING AND/OR CHIMNEY: 0 HUMIDIFIER INSTALL NEW VENTING OR CHIMNEY 0 AIR CLEANER 0 RE -USE EXISTING VENTING OR CHIMNEY UV LIGHT DUCTWORK: INSULATION: Q INSTALL NEW DUCT SYSTEM (BATT/BLOWN): 0 RE -USE EXISTING DUCT SYSTEM R-Value: DUCT CLEANING PLEASE NOTE that Sears is not responsible for correcting any existing code violations or pre-existing conditions of any ductwork, piping, electrical supplies or equipment not being replaced at this time. If additional work is required, it will be the customers responsibility. Any additional charges will be quoted and approved prior to the start of any additional work. Job:23848572 Page 3 of 6 APPROXIMATE START DATE and APPROXIMATE COMPLETION DATE: The work will start approximately 2 To 3 DAYS (Approximate Start Date) It will be substantially completed by approximately 5 / 4 / 18 (Approximate Completion Date) These dates are subject to change at the time the contract is accepted by Sears Home Improvement Products, Inc. ("Sears") or at any other time by mutual written agreement. Customer understands that the Approximate Start Date is only an estimated date and the Customer will be contacted prior to this date to schedule the actual start date. The TOTAL PRICE including all labor, material, Contract Price $ 6,502.26 taxes and any discount is $ 6,502.26 Initial Payment (not to exceed 30% of Total State Sales Tax ( 0.00 %) $ 0.00 Price unless S Special Order $ 6, 502.26 p ) Local Sales Tax (o . o 0 o/a) $ 0.00 Final Payment (balance payable upon completion of job) $ 0.00 The Initial Payment is due prior to Sears ordering products. Total Amount Due $ 6,502.26 Additional work to be done: NONE Work NOT to be done: Removal or moving or any walls; flooring, painting, wallpaper work; repairs of water or termite damage to sub -floors or walls; electrical or plumbing work outside of this kitchen or bath project. NONE THE CONTRACT PRICE Price A copy of the terms and conditions of the INCLUDES: Master Protection Agreement or the Repair Agreement -Year Master Protection A g 0 $ Protection Agreement (as applicable) have been provided to Customer. -Year Repair Protection Agreement $ Initials: Brayuw� SEARS' LIMITED WARRANTY ON INSTALLATION In addition to any manufacturer warranty extended to you on the product(s) used (which warranty becomes effective the date the merchandise is installed), if the workmanship (or application) of any Sears' arranged installation proves faulty within one year after the completion of installation, then upon notice from you Sears will cause such faults to be corrected by repair at no additional cost to you. If Sears determines that repair is not commercially practicable or cannot be timely made, then, at Sears' sole discretion, Sears may elect to provide replacement or refund. Service under this Limited Warranty is available by calling Sears Home Improvement Products at 1-800-222-5030, Option 4. This warranty gives you specific legal rights, and you may also have other rights that vary from State to State. Job:23848572 Page 4 of 6 ••• Code Description Unit of Measure w ''#n ;,a ,a ... '7 },.t Units •�' ;, a , :v 12670 Carrier, Heat Strip, Fan coil. Model: KFCEH2401C05, 5KW,W/CIRC BRKR,1-PH, ERS Each 1.00 21264 White Rodgers, Tstat. Model: 1 F95-1291 SE, Touchscreen multi- stage w/ humidity control, Each 1.00 21487 Carrier, Fan Coil, Infinity, VS. Model: FE4ANF002L00, 2t, VS, MP, 1 -piece, optional HS, 208-230v, Alum Each 1.00 47921 Carrier, HP Cond, Performance. Model: 25HCC530A003, 15S, 2.5t, Vert, sgI-stg, SS, Louver Guard Each 1.00 H159 REPLACEMENTS. Condenser and Air Handler replacement - Horizontal Each 1.00 H416 DUCTWORK. New plenum/coil box Each 1.00 H505 LINE SETS. F&I line set flush kit (Conversion from R22 to R410) Each 1.00 H643 INSTALL MISC. New float switch Each 1.00 H670 INSTALL MISC. Replace Top Only Wood A/H Stand Each 1.00 H773 INSTALL MISC. Security caps for condenser service valves (up to 3 caps) Each 1.00 H923 ELECTRICAL. Low voltage wire - same location Each 1.00 H942 ELECTRICAL. New whip to condenser Each 2.00 H991 PM Check. 1 st Year PM Check Per Job 1.00 HA120 Heating/Cooling. Install lineset Each 1.00 Job:23848572 Page 5 of 6 ADDITIONAL PROVISIONS Proposal and Approval. Sears offers to furnish the materials and arrange for their delivery and installation as specified on the first page and/or the attached sketches and specif cation sheets for the TOTAL PRICE shown. This offer must be approved by the Installation Department. If this is a credit sale or a payment on completion sale, it must be approved by the Credit Sales Department. If this proposal is not approved or the installation cannot be made in accordance with the law, this offer will be withdrawn and any payments you have made will be refunded to you. Any materials left over after the installation has been completed are Sears property and will be removed by Sears. Installation. I understand that Sears will not install the materials but will arrange for the installation. Sears is not responsible for materials or installation NOT furnished or arranged by Sears. Sears' installation contractor(s) will obtain all building permits required by local law. For homes located in historic or landmark zoning districts, Customer will be responsible for obtaining required approvals and related permits prior to the commencement of work on this contract. Authorization. I authorize Sears to: (1) arrange for a contractor (licensed where required by law) to make the installation of materials; (2) issue a work order for this installation to a contractor; (3) inspect the installation; and (4) pay the contractor when the installation is complete if I have signed a certificate that the installation has been completed to my satisfaction. Delays in Installation. I agree that Sears is not responsible for delays in delivery or installation due to weather, fire, strikes, war, government regulations or any causes beyond Sears' control. Oral Agreements and Chances in Contract. I understand that there are no oral agreements between Sears and me. Everything I expect Sears to do has been included in writing in this contract. Nothing can be changed in this contract unless it is in writing on a separate form accepted by me and Sears. Responsibility of Buyer. I agree that any information or measurements that I give to Sears are correct and complete. I am responsible for any special work described in this contract. Electrical & Plumbing Service. I will provide adequate electrical and/or plumbing service(s) to run any newly installed appliances or other furnishings. If the electrical and/or plumbing service(s) do not meet the standards of the utility company or electrical and/or plumbing codes, I will make the necessary changes at my expense unless Sears has agreed in this contract to make the changes. Payment. I will pay Sears the cash price that covers the price of material and installation as shown on the first page. Warranty Information. Appropriate product warranty documents will be given to me by Sears. Sears' Warranty on Installation is displayed in the Product Addendum. (Dig.) Rev 06101717 Job:23848572 Page 6 of 6 FLORIDA HOMEOWNERS' CONSTRUCTION RECOVERY FUND PAYMENT MAY BE AVAILABLE FROM THE FLORIDA HOMEOWNERS CONSTRUCTION RECOVERY FUND IF YOU LOSE MONEY ON A PROJECT PERFORMED UNDER CONTRACT, WHERE THE LOSS RESULTS FROM SPECIFIED VIOLATIONS OF FLORIDA LAW BY A LICENSED CONTRACTOR. FOR INFORMATION ABOUT THE RECOVERY FUND AND FILING A CLAIM, CONTACT THE FLORIDA CONSTRUCTION INDUSTRY LICENSING BOARD AT THE FOLLOWING TELEPHONE NUMBER AND ADDRESS: CONSTRUCTION INDUSTRIES RECOVERY FUND, 1940 NORTH MONROE STREET, TALLAHASSEE, FL 32399; TELEPHONE: (850) 921-6593. ACCORDING TO FLORIDAS CONSTRUCTION LIEN LAW (SECTIONS 713.001-713.37, FLORIDA STATUTES), THOSE WHO WORK ON YOUR PROPERTY OR PROVIDE MATERIALS AND SERVICES AND ARE NOT PAID IN FULL HAVE A RIGHT TO ENFORCE THEIR CLAIM FOR PAYMENT AGAINST YOUR PROPERTY. THIS CLAIM IS KNOWN AS A CONSTRUCTION LIEN. IF YOUR CONTRACTOR OR A SUBCONTRACTOR FAILS TO PAY SUBCONTRACTORS, SUB - SUBCONTRACTORS, OR MATERIAL SUPPLIERS, THOSE PEOPLE WHO ARE OWED MONEY MAY LOOK TO YOUR PROPERTY FOR PAYMENT, EVEN IF YOU HAVE ALREADY PAID YOUR CONTRACTOR IN FULL. IF YOU FAIL TO PAY YOUR CONTRACTOR, YOUR CONTRACTOR MAY ALSO HAVE A LIEN ON YOUR PROPERTY. THIS MEANS IF A LIEN IS FILED YOUR PROPERTY COULD BE SOLD AGAINST YOUR WILL TO PAY FOR LABOR, MATERIALS, OR OTHER SERVICES THAT YOUR CONTRACTOR OR A SUBCONTRACTOR MAY HAVE FAILED TO PAY. TO PROTECT YOURSELF, YOU SHOULD STIPULATE IN THIS CONTRACT THAT BEFORE ANY PAYMENT IS MADE, YOUR CONTRACTOR IS REQUIRED TO PROVIDE YOU WITH A WRITTEN RELEASE OF LIEN FROM ANY PERSON OR COMPANY THAT HAS PROVIDED TO YOU A NOTICE TO OWNER." FLORIDAS CONSTRUCTION LIEN LAW IS COMPLEX, AND IT IS RECOMMENDED THAT YOU CONSULT AN ATTORNEY. NOTICE TO BUYER 1. DO NOT SIGN THE AGREEMENT IF ANY OF THE SPACES INTENDED FOR THE AGREED TERMS TO THE EXTENT OF THE AVAILABLE INFORMATION ARE LEFT BLANK. 2. YOU ARE ENTITLED TO A COPY OF THIS AGREEMENT AT THE TIME YOU SIGN IT. KEEP IT TO PROTECT YOUR LEGAL RIGHTS. 3. YOU MAY PAY OFF THE FULL UNPAID BALANCE DUE UNDER THE AGREEMENT AT ANY TIME, AND IN SO DOING YOU SHALL BE ENTITLED TO A FULL REBATE OF THE UNEARNED FINANCE AND INSURANCE CHARGES. 4. YOU MAY CANCEL THIS TRANSACTION, WITHOUT ANY PENALTY OR OBLIGATION, WITHIN THREE (3) BUSINESS DAYS, FIVE(5) BUSINESS DAYS IN MARYLAND, (FIVE (5) BUSINESS DAYS IN ALASKA, SEVEN (7) BUSINESS DAYS IN MARYLAND, FIFTEEN(15) BUSINESS DAYS IN NORTH DAKOTA IF YOU ARE 65 OR OLDER) FROM THE ABOVE DATE. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. FAILURE TO EXERCISE THIS OPTION, HOWEVER, WILL NOT INTERFERE WITH ANY OTHER REMEDIES AGAINST THE RETAIL SELLER YOU MAY POSSESS. IF YOU WISH, YOU MAY USE THIS PAGE AS NOTIFICATION BY WRITING "I HEREBY RESCIND" AND ADDING YOUR NAME AND ADDRESS. A DUPLICATE OF THIS RECEIPT IS PROVIDED BY THE SELLER FOR YOUR RECORDS. 5. CANCELLATION FEE. I UNDERSTAND THAT SEARS, UPON ENTERING INTO THIS AGREEMENT, WILL PROMPTLY INCUR SIGNIFICANT COSTS TO START MY PROJECT. FOR THIS REASON, I AGREE THAT SEARS HOME IMPROVEMENT PRODUCTS WILL RETAIN AS A CANCELLATION FEE THE "EARNEST MONEY" AMOUNT SHOWN AS PART OF THE TOTAL PRICE IN THE EVENT THAT I ELECT TO CANCEL THE AGREEMENT AT ANY TIME AFTER THE EXPIRATION OF ANY LEGAL RIGHT OF RECISION. THIS CANCELLATION FEE WILL BE IN ADDITION TO ANY AMOUNTS I MAY OWE, AND WHICH I AGREE SEARS MAY RECOVER DIRECTLY FROM MY INITIAL PAYMENT, FOR MATERIALS ALREADY ORDERED BY SEARS PRIOR TO CANCELLATION. 6. IT SHALL NOT BE LEGAL FOR THE SELLER TO ENTER YOUR PREMISES UNLAWFULLY OR COMMIT ANY BREACH OF THE PEACE TO REPOSSESS GOODS PURCHASED UNDER THIS AGREEMENT. p—�7 05/02/2018 F 05/02/2018 Customer Signature Date Customer Signature Date Accepted by Sears Home Improvement Products, Inc. ("Sears") on 05/02/2018 by Date Management Representative NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional permits required from other governmental entities such as water managemetit districts, state agencies, or federal agencies. Acceptance of permit is verification that I will notify the owner of the property of the requirements of Florida Lien Law, FS 713. The City of Sanford requires payment of a plan review fee at the time of permit submittal. A copy of the executed contract is required in order to calculate a plan review charge and will be considered the estimated construction value of the job at the time of submittal. The actual construction value will be figured based on the current ICC Valuation Table in effect at the time the permit is issued, in accordance with local ordinance. Should calculated charges figured off the executed contract exceed the actual construction value, credit will be applied to your permit fees when the permit is issued. 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 laws regulating construction and zoning. Signature of Owner/Agent Print Owner/Agent's Name Date Signature of Notary -State of Florida Date Owner/Agent is Personally Known to Me or Produced ID Type of ID 1 ignature of Contractor/Agent D to f/ltv 11` l q ai-S Prin ontractor/Agent's Name Signature of Notary -State of florida Date ANNETTE M BLAND �.` Notary Public — State of Florida Commission, # GG 17L '•. %: ; ` My Comm. Expires Jan 22 9crceeContracto .b to Me or Produced ID Type of ID BELOW IS FOR OFFICE USE ONLY Permits Required: Building ❑ Electrical ❑ Mechanical ❑ Plumbing[] Gas❑ Roof ❑ Construction Type: Total Sq Ft of Bldg: Occupancy Use: Min. Occupancy Load: New Construction: Electric - # of Amps Fire Sprinkler Permit: Yes ❑ No ❑ APPROVALS: ZONING: ENGINEERING: COMMENTS: # of Heads UTILITIES: FIRE: Flood Zone: # of Stories: Plumbing - # of Fixtures Fire Alarm Permit: Yes ❑ No ❑ WASTE WATER: BUILDING: Revised: January 1, 2018 Permit Application