520 Liberia Ct; 18-3845; AC CHANGE OUTrCITY OF
DEPARTMENT&
kNFORD
FIRE
Building & Fire Prevention Division
PERMIT APPLICATION
Application No: 1 3 R
Documented Construction Value: $ 4200
Job Address: 520 Liberia Ct. Historic District: Yes No171
Parcel ID: 31-19-31-300-0020-000 Residential Commercial
Type of Work: New Addition Alteration Repair Demo Change of Use Move
Description of Work: AC Change Out
Plan Review Contact Person: Lori
Phone:407-602-3374 Fax:
Name New Tribes Mission
Street: 1000 E. 1 st St
City, State Zip: Sanford, FI 32771
Name
Title: Asst
Email: lori.lockhart@protechac.com
Property Owner Information
Phone:
Resident of property? :
Contractor Information
Pro -Tech AC & Plumbing Service, Inc Phone: 4072911644
Street: 2425 Silver Star Rd
City, State Zip:
Name:
Street:
City, St, Zip: _
Orlando, FI 32804
Bonding Company:
Address:
Fax:
State License No.:
Architect/Engineer Information
Phone:
Fax:
E-mail:
Mortgage Lender:
Address:
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.
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. 1 understand that a separate permit must be secured for electrical work, plumbing, signs, wells, pools,
furnaces, boilers, heaters, tanks, and air conditioners, etc.
FBC 105.3 Shall be inscribed with the date of application and the code in effect as of that date: 6" Edition (2017) Florida Building Code
Revised: January 1, 2018 Permit Application
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 at the time of permit submittal. A copy of the executed contract is required
in order to calculate a plan review charge and will be considered the estimated construction value of the job at the time of submittal.
The actual construction value will be figured based on the current ICC Valuation Table in effect at the time the permit is issued, in
accordance with local ordinance. Should calculated charges figured off the executed contract exceed the actual construction value,
credit will be applied to your permit fees when the permit is issued.
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.
Signature of Owner/Agent Date
Print Owner/Agent's Name
Signature of Notary -State of Florida Date
l
Signature of Contractor/Agent Date
dlonr s T r
Print Contractor/Agent's Name
1 eaua_o— q It
gnat a of Not -State of Florida Date
Owner/Agent is Personally Known to Me or Contractor/Agent is Personally Known to Me or
Produced ID Type of ID Produced ID Type of ID
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building Electrical Mechanical Plumbing Gas Roof
Construction Type: Occupancy Use: Flood Zone:
Total Sq Ft of Bldg: Min. Occupancy Load: # of Stories:
New Construction: Electric - # of Amps Plumbing - # of Fixtures
Fire Sprinkler Permit: Yes No # of Heads Fire Alarm Permit: Yes No
APPROVALS: ZONING: UTILITIES: WASTE WATER:
ENGINEERING: FIRE: BUILDING:
COMMENTS:
Revised: January 1, 2018 Permit Application
o .:-r--. - arar•e .r•!•
Customer's Name: — e-UJ \T {'"t'4opy$
Today's Date:
3._7;i1,
System Description: XR14
Thermostat: i
Pull All Permits/Fees:
b
Included included
Preventative Maintenance: Comfort Club] Included Included i
i
i
CO
Manufacturer, Pro -Tech Rebates, & Pro -Tech cash Discount cannot be combined with Wells Fargo financing and/or any promotions.
Install Date:
Valid until:
Attic Installation:
System Price
Comfort Club Rebate Applied:
Pro -Tech Rebate:
Pic -Tech Cash Discount:
Manufacturer Rebate:
l -
i Thermostat Upgrade
ll - -
p (Air Puri`•itation System
g Zone Systems
r Duct System/Grills
a 'Comfort Club (2nd yr)
d 1Electrical UpgradeseI -
Plumbinl? Additional Items
Approved Upgrades:
Total Due to Pro.Tech:
Power Company Rebate:
Wells Fargo Finance:
a.+Jnt_ and lerrras
Check / Cash/Credit Card Discount: $ [] Financing: $
I have authority to order the wort: outlined above. In the event that payment is not made promptly in accordance with agreed terms, it shall be the seller's option to charge a
service charge not exceeding 1.5% a month, the first service charge becoming due 15 days from the date of installation of our amount due on the job. In the event of collection by
attorney, all attorney costs, court cost and other legal fees shall be borne by the buyer. In the event of nonpayment, purchaser agrees to allow seller on premises to removeequipmentinstalled. This roves LWA xtSAI all be binding upon the heirs, successor, or assigns of the parties hereto. it is understood that the title to all products andequipmentcovetbf"lite contract remains solely in the s tit the entire purchase price has been paid in full and the manner of installation and/or attachment to anyequipmer d/or any portion of the building structure in which the-InstaJIlation is made shall not in any manner jeopardize the setter's title.
Date:
Custoher Signature
w " Date:
Customer
Date.
Pro -Tech Comfort Specialist -
Version 172017 Page 3 Oi 3
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