HomeMy WebLinkAbout133 Pinecrest DrRECEIVED
DEC 15 2010
CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
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Application No: sU Documented Construction Value: $ of / (_ cc
Job Address: 1'2 p i{]r-P rP. f r .- Historic District: Yes No
Parcel ID: 6I • aQ• .n 2-5 -7- nqo_r• n) W
Description of Work: krX,,L_D un l kf Cff t l (n
Plan Review Contact Person:
Phone: Fax:
Zoning:
E-mail:
Title:
Property Owner Information
Name l -
i_ 11'1S+I W k Cu It )SC (D E S. SliovcmGne: 441 i • D
Street: Resident of property?
City, State Zip: Y i
Contractor Information
Name nVIVM I 1'1 I n O Phone: • 5I U _C LI QQJ
Street: I ty I m rl o y.I A.G (u0- Fax: laa is c City,
State Zip: f ,1 T7 , FL-33j-sQr State License No.: EFQOO 117M Architect/
Engineer Information Name:
Street:
City,
St, Zip: Bonding
Company: Address:
Building
Permit Square
Footage: No.
of Dwelling Units: Electrical
Phone:
Fax:
E-
mail: Mortgage
Lender: Address:
PERMIT
INFORMATION Construction
Type: Flood
Zone: Plumbing
No.
of Stories: New
Service - No. of AMPS: New Construction - No. of Fixtures: Mechanical (
Duct layout required for new systems) Fire Sprinkler/Alarm 0 No. of heads:
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.
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.
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.
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 management 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. A copy of the executed contract is required in order
to calculate a plan review charge. If the executed contract is not submitted, we reserve the right to calculate the
plan review fee based on past permit activity levels. Should calculated charges exceed the documented
construction value when the executed contract is submitted, credit will be applied to your permit fees when the
permit is released. , / 4
of Owner/Agent Date
I 41:)a var)d pmh((_ola
Print Owner/Agent's Name , r\
Commw OD959307
Expires 21812014
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
UTILITIES:
FIRE:
TASITHA VAMXMHEEN
NOTARY PUBLIC
STATE OF FLORIDA
Comm# DDW489
Contractor/Agent is Personally KpV&m to Me or
Produced ID !L,,,Type of ID
WASTE WATER:
BUILDING:
Rev 11.08
lop, A o .ALARM SERVICES. CONTRACT IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII
Monitoring Account Number ' _ l
5124UE06
Equipment Type L 1 ` `` ' " - Map Page
You acknowledge that: (a) We have explained the full range of protection, equipment, and. services available to
You, (b) additional protection over and above that provided herein is available and may be obtained from Us at
an additional cost to you (c) You desire and have contracted for only the equipment and. services itemized on
this Contract and (d) the equipment will become your property upon payment of the Purchase Amount Total
including Sales Tax in full. We are not a security consultant.
Estimated Start Date ( a ! C)
Estimated Completion Date b')l to
Rate _% Tax
Purchase J
Amount Total
Less Deposit 00
Balance Due
Affinity Name
Optional Electronic Monitoring Services (Cont.):Monthly Rate
Cellular Backup.
Basic Monthly Service,.Burglary
Service includes: Customer Monitoring Center Signal
Receiving and Notification Service. for Burglary, Manual Investigator Response
Fire, and Manual Police Emergency.
w
MPF (Monthly Processing Fee) i
Basic Monthly Service, Burglary El Monthly Recurring Municipal Fee (Subject to change based on local law)
With Extended Limited, Warranty Customerto obtain and pay for municipal alarm,use permit
Residential Customer Only) otherServiceincludes: Customer Monitoring Center Signal
Receiving and Notification Service for Burglary, Manual ( 1
Fire, and Manual Police Emergency along with, Extended El Other, -yY
Limited Warranty during which you will. be billed $25
for each trip made to the Monitored Location after the
Limited Warranty,period. Other
Optional Electronic' Monitoring- Services . Monthly Rate Total Monthly_Service Charge .
y
Initial/Annual Recurrin Municipal Fee -billed separatelyRemoteAccess/Keyfob g p p Y
Subject to change based on local law)
Customer to obtain and pay for initial/annual municipal alarm use permit.
Fire. Alarm/Smoke Detection Your failure to obtain and provide Us with your municipal alarm use permit
registration number could result in,no municipal fire/police:response to.an ,
alarm from your premises and/or a fine.
Two Way Voice: $
Munici pal Construction Permit Fee
T + i Customer to obtain construction permit
Carbon Monoxide Other. T$
2 Of 6 02010 ADT Security Services, Inc. F5124-06 02 06/10)