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1672 Atlantic Beach DR RESO24-0086 Application Building Permit Application Updor8d1019 City of Atlantic Beach Building Department --ALL INFORMATION 800 Seminole Road,Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY /Ph/�o/1ne:/((904) �2r4t7-5826 Email: Building:-Dept0coab.us /l IS REQUIRED. Job Address: r472�y ATI-riI�nI1I� btAq DDiyt Permit Number: m - \JOND Legal Description 4461/2 eke_l'yclagtowtg , &1 REp //. J Valuation of Work(Replacement Cost)$ 2J 5 0 -L74 Heated/Cooled SF MP Non-Heated/Cooled lu n • Classof Work: ❑New OAdditlon XAlteration ORepair []Move []Demo OPool OWindow/Door • Use of existing/proposed structure(s): []Commercial '*esiden4i\al' • If an existing structure,is a fire sprinkler system installed): Oyes IDNo • Will trii,$)be removed in association with proposed proiect?Eyes Imust submit separate Tree Rennova'. Describe in detail the type of work to be performed: -rL,`¢P CA;6rD&I Gq4 6a, Ii k-n cIPLIOtf 45WATIDIIJ 47,11,11' 5AAAklill r ) Florida Product Approval g _ I for multiple products use product approval form Property Owner In rmation. L J Name , 9 Q A Address 2 t RdN, City r L , State Zip Z7- Phone D E-Mail h1G d �9�!/H •ram Owner or Agent(If Agent,Power of Attorney or Agghry Letter Required) Contractor Information Name of Company Qualifying A$$ent / eK� ✓C�s•v/ Address ID2 N - City ff(�/�rd.� L Statet, Zip���� ORice Phone - lob Site Conga Numper 'e StateCertification/Registration g.�" E-Mail IlJ I1U49 J 41 r2 '7 u ✓1' Architect Name&Phone g y Engineer's Name&Phone g Workers Compensation Insurer OR Exempt o Expiration Date Application is hereby made to obtain a permit o do the work and installations as indicated.)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. NOTICE:In addition to the requirements of this permit,there maybe additional restrictions applicable to this property that maybe found In the public records of this county,and there maybe additional permits required from other governmental entities such as water management districts,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 COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPER . IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ITORNE EFORE RECORDING YOUR NOTICE OF COMMENCEMENT. (Signature of Owner or Agent) (Signatu'01 contractor) Signed and sworn to(or affirmed)before me this_day of Signed and sworn to(or affirmed)before me this(rte day of byT (Signature of Notary) (Signature of Notary) I I Personally Known OR I I P ¢anally Known OR I I Produmd Identification mduced Identifcati Type of Identification: Type of Idemificatum +N' "�:: LAOAYUANICHOLS MV ODMMIggIDN M HH 116065 t5' ��' EMPIRES:Fetruaryg,fi26 W24,3 09 PM IMC %64.jpg Building Permit Application Vp.wdaww 1, ] City Of Atlantic Beach Building Department ••AtLWO ATIOH 800 Seminole Road,Atlantic Rrarh, 11 12233 mpaRAV Phone: (904)247-5826 Email: — @_rnah lr, BSO' Job nddre,u _(4.72 ATIeM(1L_ th QWYL Pemgt Number: legal LtessTiptbn VNuatiptra Walt(Replacemem Corti S.-Zl.S - fiR Ilartad/Ceetadas u o_New,"Nalseliciallandi • L1a55 of WedC ON. OAddltimi yAlterNlon ORegaair OM'we Oceans Opea Gaindo./poor • Use of exhsIrg/000Rd eA000. (sl: OCommerclal TsnewmW\I • If an existing Awdure,is a fire wonder system InstaINOR: Uins; 6. Oesctl6e In detM Me type of work to be performed: Iv6AI 2v - S Rtf C v Npl, Jlld r.ota:e, a rl a ver Honda Product Approwl I for multiple padu[ts/u�spe produd approval form Namer rl toe tle ALdfIe Add. 11 city Ste, np orIN. D E-Mail /vr Owner or Agent(if Agent,Powers Attorney orAg platter Reefulnedl cpntraccw In(amatbn y Name Of Company U� 1{'2� pudRyiwh t 14(( / r• Acidness 2 N city 5 t P1, EP-3 CA&OsiO Office Phone lob Sets,Cnistv Nu er State Certifintion/Registration R� EMaI O Y AnIldivt Name&Phone d Engmae/s Name&Phone Y Workers C000eaosadonlnsuferl OR Exemist0 Experaden Dat D Uplintion is hemN made to obtain a permit 0 do the work Rod installations as indinted.I ter"that no work or installation has cornmenced poor to Me issuance da padmis and that all work will be,performed to meet the standards of all the laws nauMdng sonstrucdon in this jurisdiction.I understand Mat a oneste permit must be secured!for ELECTRICAL WORK PLUMPING,SIGNS, WELLS.POOLS,FURNACES,BOILERS,HEATERS.TANIG,ed AIR CONDITIONERS,etc NOTICE:In addition to[herpuimnentsa Mls P,mi%then may be additional000obns seellcaae to this -.p"the may befound m the public rtcondsof this county,and thane mry be addMtwl permits regrired from ober governmentN enties suM az watr management drtdm,sate ageneses,w !Heol whimsies. OWNER'S AFFIDAVIT:I owdh that all the foonong iammation is accurate and the all work will be time in Onmphaore with all aep,ogN.a.regulating cunstmction and zoning. WARNING TO OWNER:YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING,CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECOMNO (OTIC FIOMMENCEMENT. ;sga ureaownw orAsal ola wuwpfcpmraxtN SI arM swornw Ibefose this a 9gllse and sworn to(or aavmh)beLaa me Ni,_data -2a to-P"-Al,mown OR 1 7 PwrxwdN aleem ca P,edwad leemxkmm� '�' 1l Prodwed lMRgkadan rry�al ltlenbfloWo ryP.alewNltawn:_ "y TONIGINDLESPERCBR { MY COMMISSION I HH 0 tI2 s a` EXpMS'.oudgel 6.2021 r nd hf s,llm",9oople imalVulOPltab=wmdinWp FMIcgzOVxdZPTrFBXVJRZdTgCtGghZ?pmi c --1 1It i � l ! ilii s i • fills 11H gi0 Iry 4 ' Fi !9E! 519 � 1 �R9 1 ` , ro �` `Zi`, N D 3 "NEW ADDITION" �i'9[i�$3 fill's ,� . p a 4 `�,P [ CALDERSIDEN 2ATLWDC SEn Da E ,lg ylSipei! �i3 y 1 , ATIANDC BEACH.Fl1NLM3]TSa 11MI! A j ' E'lii'g'•. I erzzc HOV38 aasev U% r . r 30N301S311 ' f: li9�, 3i`i�ales „NOIl100tl MBBM3N. / 3 1 111 � i d 4 \ p \ 1 1 Uhl hl Oi 9 s � eE