HomeMy WebLinkAbout320 San Lanta Cir�cEavEn1
OCT 23 2011 I
BY:��
CITY OF SANFORD
BUILDING & FIRE PREVENTION
PERMIT APPLICATION
G
Application No: Documented Construction Value: $ -1 ' i0
Job Address: 3 a o � �. L 3a„ % ❑ ❑
�p G►l��G.. ► f:. Sa�focd _ F Historic District: Yes No
Parcel ID: 31- Vi - 3l -SOS -00'0'0- 1OlO Zoning:
Description of Work: o1.3 VO VVc& 1¢, 1Secwc.6
Plan Review Contact Person:
Phone:
Fax:
E-mail:
Property Owner Information
Title:
Name S? B 1 - a5 LLC Phone:
Street: $3� 1kWkt Dr. Resident of property?
City, State Zip: nk EL 3
Contractor Information
Name N91
Street: u 3 O S�NC.aouaci &Eac, 17(• Sy.: Q a �\
City, State Zip: 0Ckc.'MAt, _ IF L 3a.8JI
�•
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Building Permit ❑
Square Footage: to
Phone: ti -O -I — ci o16 - 3) 33
Fax:
State License No.: E F O 001) a 1
Architect/Engineer Information
Phone:
Fax:
E-mail:
Mortgage Lender:
Address:
PERMIT INFORMATION
Construction Type: No. of Stories:
No. of Dwelling U its: Flood Zone:
Electrical
New Service - No. of AMPS:
Mechanical 13 (Duct layout required for new systems)
Plumbing ❑
New Construction - No. of Fixtures:
Fire Sprinkler/Alarm ❑ No. of heads:
'� 0
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
Print Owner/Agent's Name
Signature of Notary -state of Florida Date
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
APPROVALS: ZONING: UTILITIES:
ENGINEERING: FIRE:
COMMENTS:
Rev 11.08
io/a41aoil
Signature of tractor/Agent Date
G r• Ili
Print Contract gent's lame
Signator a c o ate
MY COMMISSION t EE 118072
?� EXPIRES' August 2 2015 ?
Bonded Thru Notary Public Underwrhers
Contractor/Agent is ✓ Personally Known to Me or
Produced ID Type of ID
WASTE WATER:
BUILDING:
POWER OF ATTORNEY
Date: toiaU/ao11
I hereby name and appoint c..Jcx fn U►Q.1
of ADT Security Services to drop off and pick up permits at the
CA Building Department on my behalf for
a _ OW VOLTAGE SECURTIY permit for work to be performed at a loca'i-)n described as:
Parcel Cj - 3t - 50 5; - 0 000 - 1010
Subdivision bun L a ni c,
Address of job Sao ;50-(\ La,tom C % r , SCS (1 Fir �► , >�-I 1
Owner g 1— a S L L C
Georze Maneinelli EF0001121
Type or Print Name of Certified Contractor
kl'-7 4A'
Sip of Certified Contactor
The foregoing instrument was acknowledged before me this 10 / a u day of 20 11
by C R -QC uA.
who is personallygnown to me/who pro#ced _
as identification and who chd not take oath.
State of Florida
County of 0 r CtnV-
Notary Public, Semilhole County, Florida
+p= �WNArUTH
MY COMMISSION
EXPIRES: August 2, 2015
�7fi B0^ d T +Notary PubGt Undemniteis
Seminole County Property Appraiser Get Information by Parcel Number Page 1 of 2
PARCEL DETAIL
H7 1481146;1" fy u2
,,. es,.o
I 1(I
DAVID JOHNSON, CFA. ASA
„J 16
PROPERTY
" �' �' "" ,"'
APPRAISER
0, ,to
hE
SE MNOLfi'c6iNTy FL
lob IdJ w: IrA ,os ,a 177
III t
1101 E. Flriffr tri
LE
Y-
SANiORO• 832771.1466
407 -abs -7506
61
u u
a 61 &D
28
VALUE SUMMARY
VALUES 2011
2010
Working
Certified
GENERAL
Value Method Cost/Market
Cosl/Market
Parcel Id: 31-19-31-505-0000-1070
Number of Buildings 1
1
Owner: BPBI-25 LLC
Depreciated Bldg Value $63,577
$72,976
Mailing Address: 9836 SPRING LAKE DR
Depreciated EXFT Value $0
$0
City,State,ZipCode: CLERMONT FL 32711
Land Value (Market) 313,000
$15,000
Property Address: 320 SAN LANTA CIR SANFORD 32771
Land Value Ag $0
$0
Subdivision Name: SAN LANTA 3RD SEC
Ju VMa�Set tu_e $76,577
$87,976
Tax District: S1-SANFORD
Portablity AdJ $0
$0
Exemptions:
Save Our Homes AdJ $0
$0
Dor: 01 -SINGLE FAMILY
Amendment 1 Ad) $0
$0
Assessed Value (SOH) $76,577
$87,976
Tax Estimator
2011 TAXABLE VALUE WORKING ESTIMATE
Taxing Authority Assessment Value Exempt Values Taxable Value
County General Fund
$76,577 $0
$76,577
(Amendment f adjustment Is not applicable to school assessment) Schools
$76,577 $0
$76,577
City Sanford
$76,577 $0
$76,577
SJWM(Saint Johns Water Management)
$76,577 $0
$76,577
County Bonds
$76,577 $0
$76,577
The taxable values and taxes are calculated using the current years working values and the prior years approved millage rates.
SALES
Deed Date Book Page Amount Vac/imp Qualified
TAX DEED 12/2010 07489 04417 $26,300 Improved No
SPECIAL WARRANTY DEED 10/2003 05095 IM $95,000 Improved Yes
CERTIFICATE OF TITLE 10/2003 Q5116.1 0_3.87 $56,000 Improved No
QUIT CLAIM DEED 07/2003 04924 1234 $100 Improved No
2010 VALUE SUMMARY
SPECIAL WARRANTY DEED 04/1994 Q2755 1W $60,000 Improved Yes
2010 Tax BIII Amount:
$1,787
SPECIAL WARRANTY DEED 02/1994 03729 QM $38,000 Vacant No
�O��nin@d��dlLl@ VpINe_an�ix@8
QUIT CLAIM DEED 07/1992 QL4- 094 $100 Vacant No
DOES NOT INCLUDE NON -AD VALOREM ASSESSMENTS
WARRANTY DEED 08/1986 01765 Q512 $133,200 Vacant No
WARRANTY DEED 08/1986 01765 QJ. $133,200 Vacant No
WARRANTY DEED 07/1986 01751 = $28,800 Vacant No
SPECIAL WARRANTY DEED 04/1985 QJM 2M $37,500 Vacant No
WARRANTY DEED 02/1984 01530 1829 $220,000 Vacant No
Find Comparable Sales within this Subdivision
LAND
LEGAL DESCRIPTION
Land Assess Method Frontage Depth Land Units Unit Price Land Value
PLATSPick...
LOT 0 0 1.000 13,000.00 $13,000
LEG LOT 107 SAN LANTA 3RD SEC PB 13 PG 75
Building
Sketch
Under construction
BUILDING INFORMATION
Old Num Bid Type Year Bit Fixtures Base SF Gross SF
Living SF Ext Wall Bid Value
Est. Cost
New
1 SINGLE FAMILY 1994 6 1,064 1,496 1,400 CB/STUCCO FINISH $63,577 $67,635
http://www.scpafl.org/weblre_web.seminole_county_title?parcel=31193150500001070&... 10/24/2011
Seminole County Property Appraiser Get Information by Parcel Number Page 2 of 2
Appendage / Sgft OPEN PORCH FINISHED/ 88
Appendage / Sgft BASE/336
NOTE: Appendage Codes included in living Area. Base, Upper Story Base, Upper Story Finished, Apartment, Enclosed Porch Finished, Base
Semi Finshed
Permits
are NOT certified values and there/ore are subject to change before being finalized for ad valorem tax purposes.
http://www.scpafl.org/weblre_web.seminole_county_title?parcel=31193150500001070&... 10/24/2011
Oct 24 11 02:53p Paul Mahan 8888866905 p.1
• RESIDENTIAL SERVICES CONTRACT FOR USAA MEMBERS 110111111111111111111 11
5106UE73
CONTRACTDALEAD
E I' / L Lip ACCOUN NO ` NO SOURCE
ADT Security Services, Inc. ('ADrjCustomer Name
Office Address ('Customer* o; 'I" or 'me' or'my'I " / I. ,
I
Premises' Ly � �►
I Address I •/�t n
I
City
www.MyADT.tom Tax Exempt No. f^i
1.800.ADT.USAA Protected Premises'
-_ (1.800.238:8722) -_ j Telephone
Al.
ernate? /., : • j OHome Cell Owak
Telephone 1 f r, .,
OFill in if billing address is the same
Address -r 1 C i ' / 4` /
Tax Expire Date W
O Tradl6onal FIlone Q Other (Qualdiedl O Other OJoo•Qualified)
LJJ/ LJJ/
Alternate O Home O Ce8 O Work
Telephone 2
ry.._._. ' J. _ _.. ...__. ��.i�--••-•- .... ... __ ._... State�� ZIP. )/
IF FAMILIARIZATION PERIOD IS REJECTED INITIAL HERE
(see Paragraph 14 of the Terms and Conditions for explanation)
EMAIL 1 � + A
Communications Authorization, I authorize ADS to provide me with information and updates about the security system and new ADT and third -parry
products and services to the contact informatl n provided by me. 1 may unsubscrlbe or opt out by emailing denotcontactOADT.Com or by calling
888.DNC4ADT (888.362.4238). Initial here
Confirmationof Appointments: I authorize ADT to call me using an automated calling device to deliver a pre-recorded message to set/confirm.
appointments and provide other information and notices about the alarm system at the telephone number(s) provided by me. Initial here
Alarm System Ownership: O Customer•Owned 19ADT-Owned
I ACKNOWLEDGE AND AGREE TO EACH OF THE FOLLOWING: IA► THIS CONTRACT CONSISTS OF SIX (6) PAGES. BEFORE SIGNING THIS CONTRACT, I
HAVE READ, UNDERSTAND AND AGREE TO EACH AND EVERY ERM OF THIS CONTRACT, INCLUDING BUT NOT LIMITED TO PARAGRAPHS S AND 18 OF
THE TERMS AND CONDITIONS. (8) THE INITIAL TERM OF THIS CONTRACT IS TWO (2) YEARS. (C) ADT IS NOT A SECURITY CONSULTANT AND CANNOT
ADDRESS ALL OF MY POTENTIAL SECURITY NEEDS. ADT HAS EXPLAINED TO ME THE FULL RANGE OF EQUIPMENT AND SERVICES THAT ADT CAN
PROVIDE ME. ADDITIONAL EQUIPMENT AND SERVICES OVER THOSE IDENTIFIED IN THIS CONTRACT ARE AVAILABLE AND MAY BE PURCHASED FROM
ADTAT AN ADDITIONAL COST TO ME.1 HAVE SELECTED AND PURCHASED ONLY THE EQUIPMENT AND SERVICES IDENTIFIED IN THIS CONTRACT. ID) NO
ALARM SYSTEM CAN PROVIDE COMPLETE PROTECTION OR GUARANTEE PREVENTION OF LOSS OR INJURY. FIRES, FLOODS, BURGLARIES, ROBBERIES,
MEDICAL PROBLEMS AND OTHER INCIDENTS ARE UNPREDICTABLE AND CANNOT ALWAYS BE DETECTED OR PREVENTED BY AN ALARM SYSTEM.
HUMAN ERROR IS ALWAYS POSSIBLE, AND THE RESPONSE TIME OF POLICE, FIRE AND MEDICAL EMERGENCY PERSONNEL IS OUTSIDE THE CONTROL
OF ADT. ADT MAY NOT RECEIVE ALARM SIGNALS IF COMMUNICATIONS OR POWER IS INTERRUPTED FOR ANY REASON. (E) ADT RECOMMENDS THAT
I MANUALLY EST THE ALARM SYSTEM MONTHLY AND ANYTIME I CHANGE TELEPHONE SERVICE, BY CALLING 1.800.238.7!722 OR BY LOGGING IN TO
WWW.MYADT.COM. (F) THIS CONTRACT REQUIRES FINAL APPROVAL BY AN ADTAUTHORIZED MANAGER BEFORE ADT MAY PROVIDE ANY EQUIPMENT
OR SERVICES, AND.IF APPROVAL IS DENIED, THEN THIS CONTRACT WILL BE TERMINATED, AND ADTS ONLY OBLIGATION WILL BE TO NOTIFY ME OF
SUCH TERMINATION AND REFUND ANY AMOUNTS I PAID IN ADVANCE.
ADT Rep�esentative N.r
f 7) ^ Rep. License No ' ` �• r Rep.
/rte I' (tI Required) 0r/' r n !: '' '(% ID No
Customer's Approval: Original Signature Required (Must match Customer Nrme in Section 1 above►
1 NOTICE OF CANCELLATION
1, THE CUSTOMER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY
AFTER THE DATE OF THIS TRANSACTION. SEETHE ATTACHED NOTICE OF CANCELLATION -FORM FOR AN EXPLANATION
OF THIS RIGHT. I ACKNOWLEDGE BEING VERBALLY INFORMED OF MY RIGHT TO CANCEL AT THE TIME OF EXECUTION i
OF THIS CONTRACT AND RECEIPT OF THIS NOTICE.
FINANCIAL DISCLOSURE STATEMENT
THERE IS NO FINANCE CHARGE OR COST OF CREDIT (0% APR) ASSOCIATED WITH THIS CONTRACT.
1 Of 6 : ' • • •• - • - 02011 ADT. All rights reserved. (06111)
A. NUMBER OF r'; i ;;. r,
1
TOTAL OF PAYMENTS FOR THE INITIAL TERM IS ,s^
PAYMENTS FOR THE . B. AMOUNT OF EACH PAYMENT IS —f
(A. TIMES B.) (EXCLUSIVE OF ANY APPLICABLE TAXES. FE�
INITIAL TERM IS 24. (TOTAL MONTHLY SERVICE CHARGE FROM BELOW)
AND RATE INCREASES)
LAE CHARGE - PAYMENT IS DUE PURSUANT TO MY SELECTED BILLING
PREPAYMENT- IF I PREPAY THE SEE SECTIONS 2, 7, 15 AND
FREQUENCY, PRIOR TO THE START OF SERVICE. MY FIRST BILUCHARGE WILL
TOTAL OF PAYMENTS PRIOR TO 19 OF THIS CONTRACT FOR
BE SENT/MADE SHORTLY AFTER MY SERVICE BEGINS. ADT MAY IMPOSE A
Twr can nr. TW9 sumer TCOM , annrnauar WCORMaTuou
ONC-TIME LATE CrIArtOE ON EACs PAYMENT THAT IS MORE Tt%N TEN t lo)
I OF THIS CONTRACT, THERE IS NO . ABOUT NONPAYMENT, DEFAULT
DAYS PAST DUE, UP TO THE MAXIMUM AMOUNT PERMITTED BY LAW, BUT IN
PENALTY OR REFUND. AND ACCELERATION.
NO EVENT WILL THIS AMOUNT EXCEED $5.00.
I
1 Of 6 : ' • • •• - • - 02011 ADT. All rights reserved. (06111)
Oct 24 11 02:54p Paul Mahan 8888866905 p•2
' �WII��I��pN19U�C/IINUI
RESIDENTIAL SERVICES CONTRACT FOR USAA MEMBERS
5106 IE13
I CONTRACT CUSTOMER _ IT]JOB ��f LEAD`S
I DATE I ACCOUNT NOSection 2. Services to be Provided (continued)
r 1 it I I
I -
_ NO SOURCE
Momhly S -*e Cherge 10 ImtiaNMnua! Recurring Municipal Fee billed separately Inidat/Arnual Fee
1 (Subject to change based on local bw) t
QS andard Monthly Service, Burglary _ _ _ .__...... __....
ervia includes: Customer Monitoring Center Signal 1 O Customer to obtain and pay for inNallarn ual municipal
Receiving and Nolificadon Service for Burglary, / ; �, alarm use permit. Failure to obtain and provide ADI Mth
Manual Fire and Manual Police Emergency I ! 1 ft municipal a6vm use permh registration number could
r' 1 resWl in no municipal fire/police response to an alarm
I_...._....__._.__._........_.-----•---• ) ('1✓�c !:t•4f,:,% iromthcprdMses
"or aline.
Stannard Monthly Service, FIre(Smoke Detection i
IO Service includes: Customer Monitoring Center Signal Municipal Electrical Permit Fee
Receiving and Notifkation Service for Fite. Manual Fire O Customer to obtain electrical permit
tdanual
`
1 '
and Pobce Emergency I
, f / L
^
O Carbon Monoxide O Flood O Low Temp ' $ Installation Price I $ !
I'^
7""T_
O Medical Alert ' -•.._ .- ' • 'Taxable Amount'•• •- -_• • -
.�Saiewatch Cellguard° ! $/ ; �� -{{{, Non -Taxable Amount
.------- --....._...----.......... --•- - -...:. (_ ! �,it .tial ._.. _ ...._._ ... ....... _.. _._..
--- ..._ .... ._ ., t•
O Secur' rlYl' ink* $ Connection Fee
! Admin Fee
xlended limited Wananry/Quality Service Plan (QSP) I $ Ale
O Guard Response Service $ Sales Tax on Installation*
O Monthly Recurring Municipal Fee
(Subject to change based on local law) I
'
Total Installation Charge,
O Customer to obtain and pay for g
municipal alarm use permit j ; '!:
_._ ..._..._...._.. - ..
OOther Deposit Received
Total Monthly Service Charge $
l� t� a' Balance Due upon Installation,
r
•If applicable sales tax not shown, k will be added to tis fiist irti nice.
Section• • to be installed
Control .s`aut'°� off'
i cY- ♦ NIP
Panel � ;'�'r � �. `a o t.
...
,�,p.•et �,sA���ey •.
�i� ..t
.
30' �' . •' (a�°�d!}� t�cp`O�v"�-
s tt , c` 99�o,C 1�,P4P��
Comments
Package N me: i
^_ 7 ! I I I ! I
InKZs: r
Foyer
Living Room i
_
Family Room 1
Olfice ! ;
Dining Room
Kitchen j
i •�
Laundry Room
Hallway
Master Bedroom ,
Master Barth
.. _. .._.. ... ... _.._...._.. '
Bedroom Z
Bedroom 3 !
Bath 2
Basement ;
,
Garage ,
Price Per Piece
Totals i I j I !
E= Existing Equipment
Estimated Installation Start Dates
L �J
INSTALLER NOTES --..yet k✓ , - - . .... .-`� C. — - �- - - -- - .._
--� �
—.._ _-----..
2 Of 6 02011 ADT. All rights reserved. (06/11)
Oct 24 11 02:54p Paul Mahan 8888866905
I
RESIDENTIAL SERVICES CONTRACT FOR USAA MEMBERS
T T r-•91
CONTRACT
DATE
CUSTOMER
ACCOUNT NO
P.3
Ilililllmlillilihlllp
5106UE13
JOB Ra I i�
NO SOUROF
O Check received for. O Installation: Check M Amount $
O Annual Service Charges Collected: Checks FT� 11111111 Amount
s
I authorizern ADT: OTO withdraw all Service Charges homy bank ace oust O To ch — y • • •• _..—_ •
---..... ... _ .._. _ _.....- _ _ - ••_-- ... � mY cttdiVdebit cud for:
O Annually O Semi•Annualty O Quarterly O Monthly ; 44installation O 3 monthly crediudebit card payments of equal amounts
Choose one: O Checking O Savings O AII/Recurring Service Charges
Name of BanWCredit Union O Annually O Seml-Annually O Quarterly O Monthly
aVISA O MasterCard O Discover O AMEX
ABA Routin Number Bank Account Number Credit/Debit Card Number Ex *ration Date
— 1111M
' M M Y Y�
Recurring Service Charge Amount $ Plus tax I Recurring Service Charge Amount $ Phys tax
Name as it appears on bank account I Cardholder's Name
I
I authorize ADT to debit my bank account fu dice amount of all Recurring Service Charges i H I am using a debit card I authorize ADT to dealt my bank account lot the amount of
indicted above. I may rrm%e this authorization only by notifying ADT and my bank in all Recurring Service Charges indicated above. I may revoke this authorization only by
willing at least 10 business days before the scheduled debit. notifying ADT and my bank in writing at least 10 business days before the scheduled debit
It no oral is filled above, service charges sw.'I be withdrawn monthly. I B no oval is filled above, my credWdebit card will be charged monthly.
I authotb a ADT to withdraw the amounts in this section from my bank account or credit card through an Automated Gearing Hoose ('ACH')• These payments ore for the equlpmem and N
services described in this Contract. this atMo'baoon will remain m effect und) the termination daft of this Contract or urrol I cancel it in writing, whichever occurs first I also agree to
notify, ADT In writing of any changes in my account Information at least 15 coleys prior to the text billing date. If a payment date lalls on a weekend or holday, payrrimm may, be executed on
the next business dry. Because this is an electronic trarsacthoR these funds may be withdrawn from my account each month as early as the tiansacoon date. It she date or amount of the
withdrawal changes, ADT will notily, me at least III days prior to the papnrm being collected Of an ACK vansactton is rejrcled for non•suXicJtm funds (NSF), ADT may attempt to process the
charge again within 30 days, and an ASF charge may apply. the origination of ACH transactions to m7' account must comply with the povlsrons of U.S. law. I am an audharhzed user of this
oedt card or bank account. and I will not dispute the payment with my credit card company or bank, so long as the amount corresponds to the term indicated in this Contract
O To send mea bill; O Annually O Semi-Anmralty O ouanolly O 01her _ DOA Approval H no oval Is Filled ADT will send bill quarterly.
Municipality Municipalitym
Police Name Fire Nae
Municipality Medical Patrol Name
Responder Name 6 Number
I
Cross Street
Job Type CANew Sale O Change Cher O Upgrade O Resale Control Type O HW .RF
r n / 7 .ter., -_1 Permit
Affiliation _�� MemberY J1_� '�1 Number
Burglar Alam: WIS O No Fire! Smoke O Yes JQVo Two-way Voice: C Yes QHc, Cellular Mode I I I I I O Panalld O Standard
Profile m �}� Preferred Monitoring Communication ��,i�—�1 Account Management m
Codes: Ownership I r i•y System Service Services � Method LjQll(J Services I /aril
Guard MarketResale•Fomher
ELW/QSP y Service Group Acis 4Former CS a
MIS password must be issued to all users of the alarm system, inducing all people lisel in Section 7. An optional, secondary password fou service Individuals, housekeepers, tem
etc. is available upon request. A password must be no less than three (3) and no more than five (5) characters in length and may not captain any punctuation or Spaces, offensive
language or non-standard spelling. Customer may change passwords a+d contacts by gong to wvm.MyADT corn or b/ calling ADT tD4hee at 1.800.238.8722.
These ate the Individuals who may be ca;led in the eventot an alarm. Because th eytnol need to meet the authorities T response loran alarm. I sell provide them access to ny premises,
the password and the keypad code. By selecting the 'Yes' designation on the right I am Idendh/ing which of these individuals may be called prior to notilicadon
of the authorities.
Cusionw/EmergencyContact 61 :! ( �•. �� ! .T
�.
;'�r n r;J O
¢
O
• O
Print RrpAast Name v b �/ , i �1, L
Phone
^2, J Home
C
Work
Yes No
�Y' O
O
O
O O
Phone
Home
Cell
Work
Yes No
CustomerlEmegency, Contact 42
O
O
O
O O
Pint FirsVIast Name
Phone
Home
Cell
Work
Yes No
O
O
O
O C
Phone
Home
Cell
Work
Yes No
AltematefEmergencq Only Contact
O
O
O
O O
Print FnrsUlasl Name
Phone
Home
Cell
Work
Yes No
O
O
O
O O
Phone
_ Home
Cell
Work
Yes No
3 of 6
i r ! 1 I r• Rr
-J 02011 ADT. All rights reserved. (06n 1)