417 Aquatic Dr RES24-0233 Application ri- ;,, BUILDING PERMIT APPLICATION FOR INTERNAL OFFICE USE ONLY
,� �'' City of Atlantic Beach Building Department PERMIT# 133
800 Seminole Road, Atlantic Beach, FL 32233
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**ALL information required to process
4!- ',.- v Phone: (904) 247-5826 Email: Building-Dept@coab.us ,
Job Address LI (1- Acte_Ke.. Dr / A414,..1 h'G g& L' , 3 2 Z 3 3 RE# 1l 1 g318 _g211....(
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Legal Description 38 . 4' 14 - 25 - 2q E 41.,c.111. e),, La+ 2Z e—
Valuation of Work(Replacement Cost) .f 31 u!.(., Heated/Cooled SF Ai 4, Non-Heated/Cooled SF
• Class of Work: ❑ New ❑Addition ❑Alteration CgRepair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial EResidential • If existing structure, is a fire sprinkler system installed?:❑Yes❑No
•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:
141:" 'r 4- reps-LC sis41 O✓" CWi*rAG1 64.4%3 OJtr)D0.r 5fareA7f., K4,4- Ace1
42) ‘togySe,
Florida Product Approval# (For multiple products use Product Approval Information Sheet)
Property Owner Information Name 5c,0,214 '.ti(t.., (W d Prype-he')Phone
Address 60 1 it(&t:;., 51-- City A 8 State FL Zip 322 3 3
Email Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information Name of Company €50i ( }- bt.f f 2 i3jA. Phone cicit4 - il(5"--- 3123
Address 5-13 j(- / (( 9(,,d A./. City A i3 State FL Zip 3�2 33
Qualifying Agent &ft,1,j . n 0-6t.t'r State Certification/Registration# CIRC, 1333 11 3
Email U(ZA k p FI C 41.1.,U b Lhi c)tT3 , uir'. Job Site Contact Number OO-I qG 5" • 3(2.3
Worker's Compensation Insurer OR Exempt Expiration Date
Architect's Name Email Phone
Engineer's Name Email Phone
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.
AiO l lilt: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 city/county, and there may be 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 YOU PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT
MUST BE RECORDED AND POSTED ON THE SITE OF THE IMPROVEMENT BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE F COMMENCEMENT.
lif-- --.7— ''.7
w �-�ure o Owner or Agent) ( ign.ture o Contractor)
Signed and sworn to(or affirmed) before me this 1 1 day of Signed and sworn to(or affirmed) before me this)hut day of
ob f , Do at by $t• W I W; N') (V0302._ , 0 by G12- r, r;, i-tt��
Signature of Notary � � k _ Signature of Notary ,
1i ersonally Known OR �Produce�Identification [ J Personally K own OR VI Produced Identification
Type of Identification: Type of Identification:CII- 1)(--- ''')S). �r'N �`1 WO
ZACHARY R.KAHALY
e -Ac Notary Public,State of Florida
Commission#HH 440344
= ia' �`. SHERIDAN SMITH
idAti
My Comm.expires Oct.20,2027 I l� � Notary Public-State of Florida
+,1, /i Commission ar HH 562677
'F..•!‘:"... My Comm.Expires Jun 18,2028 '