412 San Lanta Cir; 18-3598; AC CHANGE OUTr
4V16 AUG 2 2 2018
2 PERMIT APPLICATION
Application No: gV B
Documented Construction Value: $ 2 Qa
Job Address: ) Historic District: s No
Parcel ID: Residential Commercial
Type of Work: New Addition Alteration Repair Demo Change of Use Move
Description of Work:
Plan Review Contact Person: f G,>J l `i Title: le, -r
Phone: 4 16 7 1z, , -YO Fax:
Property Owner Information
Name c'i Phone: 40_7 " Z
Street: 7 z .w jcvfZ Resident of property?
City, State Zip: -<.44.- '
Contractor Information
Name di/ /411—, _Z%aJ Phone: 41,) 7 5;19<
Street: /Qo 7 S' i/ / Xv - Fax: ?& 9 4 C 7 7 /
City, State Zip: Jlv i1 /% % % ,Z State License No.:
Name:
Street:
City, St, Zip:
Bonding Company:
Address:
Architect/Engineer Information
Phone:
Fax:
E-mail:
Mortgage Lender: _
Address:
M-ge I &J,",
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. I 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: 61h Edition (2017) Florida Building Code
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
Print Owner/Agent's Name
Date
Signature of Notary -State of Florida Date
Owner/Agent is Personally Known to Me or
Produced ID Type of ID
Signature of Contractor/Agent Date
Commission # GG 060623
Gomm. ExpRes Jan 1¢, 2
BELOW IS FOR OFFICE USE ONLY
Permits Required: Building Electrical Mechanical Plumbing Gas Roof
Construction
Total Sq Ft of Bldg:
Occupancy Use:
Min. Occupancy Load:
Flood Zone:
of Stories:
New Construction: Electric - # of Amps Plumbing - # of Fixtures
Fire Sprinkler Permit: Yes No # of Heads
APPROVALS: ZONING:
ENGINEERING:
COMMENTS:
UTILITIES:
FIRE:
z-Y5
to Me or
Fire Alarm Permit: Yes No
WASTE WATER:
BUILDING:
t = r,Int.INVOICE. 1409
Heating & Air Conditioning
1009 S. Laurel Ave. • Sanford, FL 32771
407-466-9055
Licensed & Insured • CAC 1814661
SEND INVOICE TO: WORK LOCATION
NAME NAME
STREET STREET fir°/' f
DATE SERVICEMAN
CITY CITY 5:
1 ' / STATE ZIP STATE 1 " ZIP
CONTRACT
CHARGE
REPEAT
COD
WARRANTY
CREDIT CARD
j , ; F CONTINUED PM
REASON FOR CALLING Time In Time Out Phone x
Make,,,—
3
Model 7 r r Serial #
s Make Model Serial #
DESCRIPTION OF WORK PERFORMED: INSPECTION GUIDE
QUAN I COST DESCRIPTION PRICE I SERVICE MAN
DIAGNOSTIC
MAT'L CHARGE
FLAT RATE CHARGE
COMPRESSOR
Suction Pressure
Head Pressure
VoltsL WAmps
7,
Super Heat -
Sub Cooling f`J
CONDENSER COIL
Entering Air Temp _"
Leaving Air Temp
REFRIGERANT CHECK
CONDENSER MOTOR
Volts Amps , Ci
HRS
REG
HRS
OT
CHARGE
EVAPORATOR COIL
Entering Air Temp
Leaving Air Temp
EVAPORATOR SECTION
Volts Amps
Pulleys (Adjust Belts)
g
Lubricate
CONDENSATE AREA
Clean Drain Pans
Clean Drain
HEATING
Strip -Heat- Heat -Pump-
Oil Gas
AIR FILTERS
Cleaned [-]Re 'placed
FILTER LISTING
TOTAL INVOICED f 1 _ Quan. Size
F
I HAVE AUTHORITY TO ORDER THE WPp K AS OUTLINED ABOVE. THIS INVOICE IS SUBJECT TO A FINANCE x x
LCHARGEOF1.5% PER MONTH, ANNLYAPERCENTAGE RATE OF 18% WHICH IS ALLOWED BY LAW. I AGREE
TO PAY ALL COSTS AND RLASONAB 1E PTTORNEY'S FEE IF THIS INVOICE IF THIS INVOICE IS PLACED IN THE x x
HANDS OF AN ATTORNEY F,OR C,' L/)EC IION.
1`
x --`- -..
x x
Customer's Signature I c- Date
x x
Driver's License #
x x
2x771
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