815 ATLANTIC BLVD SIGN24-0010 NEW APPLICATION4 ,.41A
BUILDING PERMIT APPLICATION FOR INTERNAL OFFICE USE ONLY
City of Atlantic Beach Building Department jSIGN24-0010JPERMIT#
800 Seminole Road, Atlantic Beach, FL 32233 ALL information required to process
4.31109Phone: (904) 247-5826 Email: Building-DeptPcoab.us
Job Address 815 Atlantic Blvd,Atlantic Beach Fl 32233 RE# 177653-0060
Legal Description 38-2S-29E.33 B DE CASTRO Y FERRER GRANT PT RECD O/R 18981-1751
Valuation of Work(Replacement Cost) 3,000 Heated/Cooled SF 2,100 Non-Heated/Cooled SF
Class of Work: El New Addition X Alteration Repair Move Demo Pool Window/Door
Use of existing/proposed structure(s): X Commercial Residential • 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:
Adding signage for the business
Florida Product Approval# For multiple products use Product Approval Information Sheet)
Property Owner Information Name NORMANDY BOULEVARD LLC Phone 904-993-4901
Address 8650 OLD KINGS RD S STE 12 City Jacksonville State Fl Zip 32217
Email pam.howard®tsgrealty.com Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) At
Contractor Information Name of Company ' S P/37', / ' ( ,(i Z o,r/Phone ' ?o4S-3 &007 6,
Addre_ 4/0/I-Ai`c4n,7-r C 5 c.v i) Cit 411_ State Zip 3 L 2yj
Qualifying Agent J/ zi.ic ,Nt,)4- State Certification/Registration# f C'3C / 2 Si7381
Email bluettd83@gmail.com Job Site Contact Number
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.
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 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 OF COMMENCEMENT.
r• •az,wner or Agent)
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Signature of Contractor)
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Signed and sworn to(or affirmed)be •re me this T• day of Signed and sworn to(or a firmed) :- •r e this day of
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Signature of Notary 4
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Personally l 1'n OR ,4 Pro•uced Identification Personally Known OR ( ] Produce. .-n tion
Yoe of ldentificati.n,:1). G . jyoe of ldpnti.Qc tin
TONI GINDLESPERGER
MY COMMISSION#HH 407122NotaryPublicStatedFlorida1e ''
t' Jason A Smark P EXPIRES October 6,2027
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