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Home My WebLink About800 E 4 StFRECETV"E-7 j LY JUL i S 2011 BY: ' CITY OF SANFORD BUILDING & FIRE PREVENTION PERMIT APPLICATION Application No: — L u Documented Construction Value: $ I 3D • U U Job Address: -:=0' (-)y E Parcel ID: 2"-,,!) • 1 Cl • 1 & • 51( CCU - L%acb Description of Work: h-UW VO L4CAQ l.L (C CZ Plan Review Contact Person: Phone: Fax: Historic District: Yes No 0 Zoning: n rY Title: E-mail: Property Owner Information Name Y a VA V68S Phone: LA01 • L13b . fM-_2 Street: L'Y, Resident of property? City, State Zip:1)t( L Sa71 "1 Contractor Information r Name `1l X'S Cr uS\0 Phone: Street: J L-Dn t C VI C ( V E Fax: City, State Zip: -t l Z FL State License No.: 1 Name: Street: City, St, Zip: Bonding Company: Architect/ Engineer Information Phone: Fax: E- mail: Mortgage Lender: Address: Address: Building Permit Square Footage: No. of Dwelling Units: Electrical ® New Service - No. of AMPS: PERMIT INFORMATION Construction Type: No. of Stories: Flood Zone: Mechanical 13 (Duct layout required for new systems) Plumbing New Construction - No. of Fixtures: 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 noworkorinstallationhascommencedpriortotheissuanceofapermitandthatallworkwillbeperformedtomeetstandardsofalllawsregulatingconstructioninthisjurisdiction. I understand that a separate permitmustbesecuredforelectricalwork, plumbing, signs, wells, pools, furnaces, boilers, heaters, tanks, andairconditioners, etc. OWNER'S AFFIDAVTT: I certify that all of the foregoing information is accurate and that all work willbedoneincompliancewithallapplicablelawsregulatingconstructionandzoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAYRESULTINYOURPAYINGTWICEFORIMPROVEMENTSTOYOURPROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THEFIRSTINSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOURLENDERORANATTORNEYBEFORERECORDINGYOURNOTICEOFCOMMENCEMENT. 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 requiredfromothergovernmentalentitiessuchaswatermanagementdistricts, state agencies, or federal agencies. Acceptance of permit is verification that I will notify the owner of the property of the requirements of FloridaLienLaw, 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 thepermitireleased. I U "-L Lm' Signan= of owner/Agent Date Signature of Contractor/Agent Date n bQ c cy h I n Print owner/Agent's Natpe STATE OF FLORIDA Comte# EE097298 Expires 2/8/2014 Owner/ Agent is Personally Known to Me -or Produced M Type of ID APPROVALS: ZONING: UTILITIES: ENGINEERING: FIRE: COMMENTS: W1""' oC"1E_V',ires BoITf Honda Date A NbU NOTARY PUBLIC STATE OF FLORIDA COMM# DD960.. 8pv ^ i0/2G1-* Contractor/Agent is Personally to Me or Produced ID ; Type of ID WASTE WATER: BUILDING: AMMOREM DEALM ALARM SERVICES CONTRACT IIIIIIIIIIIIIIIIIIIIIIII IIIIIIIIIIIIIIIIIIII Monitoring Account N'timber J T 5124UE07 Section Schedule of Protection PREWIRE Yes No Wireless Apartment ACCOUNT TYPE: J Install Takeover System Move PRODUCT CODE QUANTITY DESCRIPTION OFFICE USE ONLY CostIssueInstallReturnAdd C) C6 C d H-7vatoo See additional equipment listed in attached I if Schedule of Protection Confirmation Code ().'()WC_ ` rl a _ Cross Street L Subtotal Map Page 1- Equipment Type .lVh .:_ .:. _....._ 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 c desire have for the and services itemized on Purchase, an additional cost to you (c) You and contracted only equipment Amount Total 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. Less Deposit! Estimated Start Date Estimated Completion Date Balance Due Section• be Provided Optional Electronic Monitoring Services (Cont.) Monthly Rate Affinity Name t Cellular Backup; Basic Monthly Service, Burglary Service includes: Customer Monitoring Center Signal Investigator Response Receiving and Notification Service for Burglary, Manual MPF (Monthly Processing Fee); Fire, and Manual Police Emergency. Basic Monthly Service, Burglary Monthly Recurring Municipal Fee (Subject to change based on local law) Customer to obtain and pay for municipal alarm use permit T with Extended Limited Warranty OtherResidentialCustomerOnly) Service includes: Customer Monitoring Center Signal Receiving and Notification Service for Burglary, Manual Fire, and Manual Police Emergency along with Extended Other, Limited Warranty during which you will be billed $25 for each trip made to the Monitored Location after the they t J q' Limited Warranty period. ChargeOptionalElectronicMonitoringServicesMonthlyRateTotalMonthlyService Remote Access/Keyfob Initial/Annual Recurring Municipal Fee -billed separately Subject to change based on local law) Customer to obtain and pay for initiallannual 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 firelpolice response to an alarm from your premises and/or a fine. Two Way Voice Municipal Construction Permit Fee Customer to obtain construction permit Carbon Monoxide , ,' F Other 2 Of 6 02010 ADT Security Services, Inc. F5124-07 02 (09/10)