HomeMy WebLinkAbout2200 French Aver�
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1��91� CITY OF SANFORD PERMIT APPUCATION -
Application N: Submittal Date: •—
Job Address: /003 Value of Work: S
Parcel ID:
Zoning:
Historic District:
Description of Work: WVKV V JIAf !If QW1 —1 /CM 12,, ft -9. 991MAJI�t(.WS4uare Footage:
,ItlN I
I 4
Permit Type: Building O Electrical O Mechanical P&k Plumbing O Fire SprinklevAlurm O Pool O Sign O
Electrical: New Service - N of*AMPS Addition/Alteration
O Change of Service O Temporary Pole O
Mechanical: Residential O Non-Residetitial Replacement JK
Nc%% O (Duct Layout ti. Energy Calc. Required)
Plumbing/ New Commercial: X of fixtures _— — a ofWater & Sewer Lines_ N of Gas Lines
Plumbing/New Residential: a of Water Closets --
Plumbing Repair - Residential O Commercial O
Occupancy Type: Residential O Commercial O Industrial O
Occupancy Use Group(s):
Construction Type: — ____ fl of Stories: q of Dwelling Units:
---_ Flood "Lone ,_ (FEN1 A form required)
...............................1....`.0.......(.........,..'...................................J................................
Snf`+ LLAC
C/�I�1��/���ippl
enY Ax
Property Owner: C
fd IC^/��+,
_
Contractor:
Address: a" J - �e%�U) Ave
Addr,5 �3 &-a
E( :54-7 -7 1
Dt 3a2 s -
PhoneyQE-mail:
P on c1%66-& / State License Number:
Bonding Company:
Mortgage Lender:
Address: I
Address:
Architect/Engineer: — Phone: —_
Address: Fax:
Plan Review Contact Person: Phone: Fax: E-mail:
Application is hereby made to obtain a permit to do the work and installations as indicated. I cenify 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, FIEATERS. TANKS, and
AIR CONDITIONERS, etc.
OWNER'S AFFIDAVIT: I unify that all of the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and coning.
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. CONSULTWITH YOUR LENDE OR AN ATTORNEY BEFORE RECORDING YOUR
NOTICE OF COMMENCEMENT
N 1'1 'E: In addition to the requirements of this permit, there may be additional restrictions applicable is property 1 y c found in the ppblic records of
this county, and there maybe additional permits required from other governmental entities such as v • cr ranagcmcnl a state agen 'es, fir kderal agencies.
7x 44cceptance of permit is verification that I will notify the owner of the pro y n the rcquwrcm m f ida 15 aw, FS 713.
Signature of Owner/Agent Date i • ure o ' niraoifAgcni fate
Print Owner/Agent's Name n Contraclor/A rig's Name
Signature of Notary -State of Florida _ Date Signature of Notary-State�4 Notary Public State of Flonda
aQ Teresa M Mangual
My Commission DD763041
Expires 0 2127 /2 01 2
Owncr/Agent is- Personally Known to Me or Contractor/Agent is �__ Personally Known to Me or <
— Produced II) _ _— — Produced ID
APPROVALS. ZONING: — ll'1'll. — _• FI) __• ENG. --__ BLDG.,_—�
Special Conditions: -- --- ---- — - -- -------------------- — --- d .
Rev 07.07 � \
1060 East Industrial Drive
Orange City, FL 32763
(386) 668.5961 DeBary, Deltona, Orange City
(386) 736.2665 Deland
E -Mail: ancientdi air@aol.com
Web Site: VWVW.ANCIENTCITYAIR.COM
N" CIENT cia
BSB
AIR CONDITIONING & ___r--
H EATI N G Member of Central Florida
Est. 1988
Licensed & Insured
License No. CAC058210
Customer Name t._�fCj t "AA" %-4 (,V 1l G Home Phone Date W4 I /t if
Address ��' 1�--n Q �S • P�(r)c 1 &W- _ Job Address/ 5 Sl� �/
City, State, ZiP SQ4_ X1 a—nP��i �77 / Work PhonejQ*— / 8 —�T'ICell Phone
We will furnish, Install and service the equipment listed below at the price, terms and conditions outlined on this proposal.
Equipment Specifications
Make Model Numbers�10—Cer,94
I t U
SEER
HSPF EER Guth Cooling Buth Heating
Installation shall Include:
New Amp disconnect Remove existing equipment from premises omplete system start up
❑ New Amp electric service ❑ Install energy saving digital thermostat ❑ New return air grille
❑ New low voltage wiring ❑ Make air tight plenum transition ❑ New return filter
❑ New weather resistant equipment stand ❑ New copper wire from to
❑ New reinforced equipment pad ❑ new supply diffuser(s)
❑ New vibration isolation pads ❑ Balance for uniform supply air distribution
0<0-w'—properly sized refrigerant lines ❑ New duct run from to
Insulate refrigerant suction line(s) ❑ Clean work area to customers satisfaction
ml�Year parts warranty
Install refrigerant drier(s) ❑ New condensate drain system
�,� ❑ / ear labor warranty
ljd' E acuate refrigerant system ❑ Install aux Condensate drain pan
��Y'
ear compressor warranty
urge to manufactures specs ❑New high efficiency Electronic air cleaner
// ❑ Year service agreement
QAAeet all federal, state and local laws Permit Included
❑ F.P. Account # VReconnection of ductwork a 20 ,
! Total Investment $ I / Vy
C] F.P. & LAccount # U -t all code requirements Down Payments $
Hurricane Brackets or Strapping
❑ F.P. & L Rebate $
❑ Total Amount $
"BUYERS RIGHT TO CANCEL"
"Thi a home solicitation sale, and if you do not want the goods or services, y may cancel this agreement by mailing a notice to the seller.
,j This notice minuet be pnostmrarked fbefo mid 'ght of the thi usines er you sign this agreement."
Tannc 1�T 1 1 1 l C/ 1; / fd i 1
By IDate: By:
Accep ce (Customer)
LIMITED POWER OF ATTORNEY
Altamonte Springs, Casselberry, Lake Mary, Longwood, Sanford,
Seminole County, Winter Springs
Date: I 1"�)) I I4q
I hereby name and appoint:
an agent of:
a --
to be my lawful attorney-in-fact to act for me to apply for, receipt for, sign for and do.all things
necessary to this appointment for (cbeck only one option):
D All permits and applications submitted by this contractor.
. b .
ISL The specific -permit and applicajiQn fys-work loeatcd pt:
Address)
Expiration Date for This Limited Power of Attorney:
License Holder Name:
State License Number:
Signature of License Holder:
STATE OF FI
COUNTY OF
N
The foregoing ins t was �}c wle�ged before me this o,
200 by by �r,LIC/P / //.P � who is personally lazown
to me or o who has produced �
identification and who did (did not) ake an oath.
VP 4.
(Notary Seal)
EofI,(,.%N�>ary Public State of Flonlia
r Ter -ISO d/ Msngual
0.gyCumrtl,aslon DD763041
n2t7717,3i 2
(Rev 3/27/07)
Signature
yam, U
l�l�� •1r1
Print or type name
Notary Public -State of
Commission No.
My Commission Expires: Z7
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