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469 ATLANTIC BLVD 5 COMM24-0043 rry -, BUILDING PERMIT APPLICATION FOR INTERNAL OFFICE USE ONLY .:- J 1 City of Atlantic Beach Building Department sOPERMIT# Z4 - oz-3b 800 Seminole Road, Atlantic Beach, FL 32233 **ALL information required to process L—GM m v,t,>/ Phone: (904) 247-5826 Email: Building-Dept@coab.us Job Address (A 9- ,S ti/4,71,.( Ufii°' RE# /7U(o9'D_pvad, Legal Description 10-Ho 2 I - 25- 29 E $A.1-4-..,,- 5 Cc- 3 1-,-1 s .9/d f. 84, ve fa Pyb Valuation of Work(Replacement Cost) a 66• o J Heated/Cooled SF /O!!) Non-Heated/Cooled SF ,ti,/ • Class of Work: ❑ New ❑Addition EAlteration ❑Repair EMove Demo E Pool ❑Window/Door • Use of existing/proposed structure(s): 10 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) 0 No Describe in detail the type of work to be performed: L;.JCi,G''' p..,✓ ;14.el `,drill e7--,-, -4</ /n 1 1-1 t...•cc_LC/y�ety Po \�� ,ss ct_gC_ Florida Product Approval# /01 (For multiple products use Product Approval Information Sheet) Property Owner Information Name . r), l x;e, Phone 67 Pty z , iv Address VG9- 1 /1//A,r A. /�/vl City ,1/�,�/� hAc State , i Zip 722 f j Email-Nei/ 4¢ ,,,,00,„,,, ,,© �, Owner1,C0 or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information Name of Company 7.,0/ /1 r,/,,ic1 '+-, ,jc%,,kiLLC Phone 9cy.,5/8. 9/yz Address vieewyp/p 1,4y City -i, State. i Zip yj 33 Qualifying Agent XL, Fk., 'ei/i c State Certification/Registration# c6C /5"/jdz4/ Email l',/,,... /a d-e..Je_,, f,,pk___,9c'f, co,.., Job Site Contact Number 905,- lie 9/y2- Worker's Compensation Insurer 921ar OR Exempt ,B Expiration Date Architect's Name y/ 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 INSPECTIO . IF OU I , END TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN A Pei! BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. 40521:4"1, (Si: re of Owner or Agent) (Signature of Contractor) Signed and sworn t.'or affirmed) before me this )3t-k? day of Signed and sworn to(or affirmed) before me this 13 day of /vNj(/ , ()DIA by MG a A ,ALA NovISI 6,(Jl', _ •DL by • \\O( Signature of Notary n !g i Signature of Notary [ ] Personally Kno OR [,-46oduced Identification [ ] Personally Kno ,n OR [.ro/ced Identification T se of Identification: ' / , Type oft entification• �1.-Z)1,,:xie ic_AinYA, ..,,,e."4%;:,\ AZR1EL BRADLEY ' se:* AZR1EL BRADLEY Comn#FH 489918 . Commission#HH 49891 o sem. miesioMarch5,2028 Expires#larch 5,2028 . .•........ „ Expires ~..- 010.3,0 li 4 c0Y --i-,.4. - VInlIa UL may- I 9 ' �i j),n,9 J 2w-1 /),,.i/,�.1i., r„,,,,/Ii & 6' , � ' — Ef cbe �II T __ sill , L ___ , '1 6 G { ,) y � �; � / , opo P Ir - 1 le•aaY'^ 12 Yv : t-i �__� __ — TI ; r s 4i Z a a a Nki .i 1 . .__ .. . .. ._ . . ________ _____ 4 J; '(Cp / F x 1 I. . 1 •.,,I. r--1, ..,.„. - , : •,.. .1 , • t- 4 t . ,a 1I 11 T 3 r { _ I 1 I ! ; i 1 I i 'I ! : I ' * I am L._ :__ ons • .‘ --:.-kt. ______, 5' f ,�.< _.. _- ,. T 1 F. I. 1 t I�' _ 1 1 • I' 'I, Ti r 'itir`.. ! Nit .I.- -.. .. Illannillite:::, a_ f • -Al .- . {{ f t ; LL ► IN i j_ y i J I p . „„.., 71 - ' . f 7 • 1 . ' - •..$ i„!..„ ...; r.1, `„ .....t.'"; . i L,_ i + .1" , ' n .. , ., i f� k �P -, ; „ • 1 , ... , -1-.7---.] , . r----—7: 1 .. i t. i -."1`,. —r _.t _ 4 . 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