1085 ATLANTIC BLVD COMM24-0008 applicationBUILDING PERMIT APPLICATION
City of Atlantic Beach Building Department
800 Seminole Road,Atlantic Beach,FL 32233
Phone:(904)247-5826 Email:Building-Deptf5)coab-us
FOR INTERNAL OFFICE USE ONLY
PERMIT#
ALL information required to process**
Job Address
Legal Description
Valuation of Work (Replacement Cost)
●Class of Work:n New nAddition DAIteration DRepair DMove □D●Use of existing/proposed structure(s):Q Commercial □Residential ●If existing structure,is a fire sprinkler system installed?:GYesQNo●Will tree{s)be removed in association with proposed project?□Yes (Must submit separate Tree Removal Permit)□No
Describe in detail the type of work to be performed:
RE#
Heated/Cooled SF Non-Heated/Cooled SF
□pooI I I Window/Demooor
Florida Product Approval #
Property Owner Information Name
Address
Email
(For multiple products use Product Approval Information Sheet)
Phone
City
Owner or Agent (If Agent,Power of Attorney or Agency Letter Required)
Phone
State Zip
Contractor Information Name of Company
Address City State Zip
Qualifying Agent
Email
State Certification/Registration#
Job Site Contact Number
OR Exempt □Expiration DateWorker's Compensation Insurer
Architect's Name PhoneEmail
Engineer's Name
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 the standards of all the 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.
PhoneEmail
NOTICE:In addition to the requirements of this permit,there may be additional restrictions applicable to this property that may be found inthepublicrecordsofthiscity/county,and there may be additional permits required from other governmental entities such as watermanagementdistricts,state agencies,or federal agencies.
OWNER'S AFFIDAVIT:I certify that all 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 COMMENCEMENTMAY RESULT
IN YOU PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY.A NOTICE OF COMMENCEMENT
MUST BE RECORDED AND POSTED ON THE SITE OF THE IMPROVEMENTBEFORE THE FIRST
INSPECTION.IF YOU INTEND TO OBTAIN FINANCING,CONSULT WITH YOUR LENDER OR AN
NCEMENT.ATTORNEY BEFORE RECORDING YOUR NOTICE OF COM
(Signature of Owner^^gent)
Signed and sworn to (or affirmed)before me this
(Signature of Contractor)
Signed and sworn to (or affirmed)before me this day ofdayof
4(x,fJcXby
OR'[]Produced Identification
Signature of Notary
[I Personally Known OR []Produced Identification
Type of Identificaticm:..
Signature of Notary
(]Personally Known
Type of Identification;
Notary Public Slate of Florida<jjk David A Ward(My Commlssior>HH 321902
(Expires 10/14/2026
<'Notary Public State of Florida▲David A Ward,MniljW^IIII My Commission HH 321902IExpiresl0/14/2026