HomeMy WebLinkAbout117 Wilson Bay CtRECEYD JUL
18 2011 BY:
CITY
OF SANFORD BUILDING &
FIRE PREVENTION . PERMIT
APPLICATION Application
No: Cl ` Documented Construction Value: $ Woo Job
Address: Historic District: Yes No Parcel
ID• 2Z• 90-0- M - 261D Zoning: Description
of Work:L001100 ({ Plan
Review Contact Person: Title: Phone:
Fax: E-mail: Property
Owner Information Name
W a rah q V i M6 Phone: 52 "458 to- y PAP Street:
P Vt Resident of property? : City,
State Zip: UAnfbrA L 4 222111 ccam^,
rrQ,, Contractor
Information p
Name '
Jt iL. !.1fKPe LA5A L'LC Phone:' l?> _611A -2 g Street:
tO J I-1 bri Aci 6 6i' iE Fax: SW • 1420. \21 10 City,
State Zip: t eL a- 5q q State License No.: G t-i 106CW4 Oy Architect/
Engineer Information Name:
Phone: Street:
City,
St, Zip: Bonding
Company: Address:
Building
Permit Square
Footage: No.
of Dwelling Units: Electrical
New
Service — No. of AMPS: Fax:
E-
mail: Mortgage
Lender: Address:
PERMIT
INFORMATION Construction
Type: No. of Stories: Flood
Zone: Plumbing
New
Construction - No. of Fixtures: Mechanical
13 (Duct layout required for new systems) Fire Sprinkler/Alarm 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.
signature of Owner/Agent Date Signature of Contractor/Agent Date
NOTARY PUBLIC
STATE OF FLORIDA
Comm# EE097298
Expires 2/8/2014
Owner/Agent is V Personally Known to Me or
Produced ID Type of ID
Print C Gactor/ geat'a amc
Signatuue o NotaryState of Florida Date p
cSATE
UBLIC CE
S Comm#
D0960eeg Contractor/
Agent is rssZ,1 qiarsogally Known to Me or Produced
ID Type of ID APPROVALS:
ZONING: UTILITIES: WASTE WATER: ENGINEERING:
FIRE: BUILDING: COMMENTS:
ro.
T ALARM SERVICES CONTRACT
Monitoring P,Scount Number
Section'• of Protection
PREWIRE Yes ®No Wireless Apartment ACCOUNT TYPE: ® Install Takeover System Move
PRODUCT
CODE QUANTITY DESCRIPTION
OFFICE USE ONLY
Cost - Issue Install Return Add
I
J L -
u
Z 5'
additional equipment listed in attached Schedule of Protection
AlSeeConfirmationCode , ..L • y. Cross Street / r
SubtotalfLl I ,s
Equipment Type ` \ J r '' . Map Page
You acknowledge that: (a) We have explained the full range of protection, equipment, and services available to Rate _% Tax,
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 Purchase
this Contract and (d) the equipment will become your property upon payment of the Purchase Amount Total
Amount Total.• • ,_. . , - ,
including Sales Tax in full. We are not a security consultant.
Less Deposit t
Estimated Start Date
Estimated Completion Date Balance Due
Section• be Provided
i i j i ;
Affinity Name _ i i ;.
Optional Electronic Monitoring Services (Cont.) Monthly Rate
Basic Monthly Service, Burglary
Service includes: Customer Monitoring Center Signal
Receiving and Notification Service for Burglary, Manual
Cellular Backup:
Investigator Response
r
MPF (Monthly Processing Fee);
Fire, and Manual Police Emergency.
Basic Monthly Service, Burglary
with Extended Limited Warranty
ElMonthly Recurring Municipal Fee (Subjectto change based on local law)
ElCustomer to obtain and pay for municipal alarm use permit T ,
OtherResidentialCustomerOnly)
Service includes: Customer Monitoring Center Signal
Receiving and Notification Service for Burglary, Manual
Fire, and Manual Police Emergency along with Extended
Limited Warranty during which you will be billed $25
for each trip made to the Monitored Location after the
Limited Warranty period.
Other
El Other RZAIn.#_ q4
Total Monthly Service ChargeOptionalElectronicMonitoringServicesMonthlyRate
Remote Access/Keyfob Initial/Annual Recurring Municipal Fee -billed separately
Subject to change based on local law) „
Customer to obtain and pay for initial/annual municipal alarm use permit.
Your failure to obtain and provide Us with your municipal alarm use permit
registration number could result in no municipal firelpolice response to an
alarm from your premises and/or a fine.
Fire Alarm/Smoke Detection
Two Way Voice
Municipal Construction Permit Fee
Customer to obtain construction permit
Carbon Monoxide' Other
2 Of 6 02010 ADT Security Services, Inc. F5124-07 02 (09/10)