299 ATLANTIC BLVD UNIT 1- COMM24-00391A1r,,, BUILDING PERMIT APPLICATION FOR INTERNAL OFFICE USE ONLY
r -*civett City of Atlantic Beach Building Departmentv PERMIT#C:Nyvv\?4-a53c
800 Seminole Road, Atlantic Beach, FL 32233 -
ALL information required to process
115)-Phone: (904) 247-5826 Email: Ruilding-Dept@coab.us
Job Address Zqq #9-71,4 A., 71c &,v0• ATC /3C4_ RE#
Legal Description SJR 4-17-4r/-/g7
Valuation of Work(Replacement Cost)' ,dm' Heated/Cooled SF Non-Heated/Cooled SF
Class of Work: New 1=1 Addition tg Alteration Repair EMove Demo Pool Window/Door
Use of existing/proposed structure(s): El Commercial Residential • If existing structure, is a fire sprinkler system installed?:YesaG No
Will tree(s) be removed in association with proposed project? Yes (Must submit separate Tree Removal Permit) ET No
Describe in detail the type of work to be performed:
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S E4 nrar- r gin-He-0v
Florida Product Approval#For multiple products use Product Approval Information Sheet)
Property Owner Information Name $o-r 7#,c / 1 ciia/p pix-iwk--k sine Phone log €j74 aro 6`f
Address 2* #977j wT/( .v/'7 City Arr.-prove r3cN State R_ Zip 322 64.
Email Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)/4090 f
Contractor Information Name of Company J4( /give Sky cedi.s%,2'-cr cy,/ Phone go,_ 606,.4Cj/c
Address 2. vie Jo ST/1F6 T City ST /qc 6--57f,4 State FC Zip 5*20eg
Qualifying Agent kl/Cc//9sy1 /1d2Tu/ State Certification/Registration# C co c'f 7 t
Email JA0673Lv6S/41CaNST e A,z, Covl1 Job Site Contact Number go/ iztZ. 4c/c/
Worker's Compensation Insurer OR Exempt .kt Expiration Date j/23/ZS
Architect's Name JUL/o/wtic °velX31 Email 1S/(rA'IO 2,4;f-yesrsigew7 Phone go`j,5'35,o.70
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
frY f9R 'REC RDING YOUR NOTICE OF COMMENCEMENT.
Signature of Owner or Agent) Sig ure of Contractor)
Signed and sworn to(or affirmed)before me
Jthiiss
2?2 day of ned an sworn to(or : i ed •efore me this -3 y of
k )Cater W2- by N• nc44 u rv1 Lavi+ I I At/
i ( (
d VK O r 1z>r)
Signature of Notary a Signature of Notary_ • '
V] Personally Known OR [ ] Produced Identification Personally Known OR [ ] Produced Ide t fication
Type of Identifica p :*% ASHLEY ANN HOLMES Type of Identification: i
f '`` MY COMMISSION#HH 412715
EXPIRES:OctcYer S.2027 0' ' 'Vit•. TONTCOMMGINDLESPERGERSSIONHHMYI # 407122
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3'1 EXPIRES:October 6,2027
EXHIBIT A
LEGAL DESCRIPTION OF THE ATLANTIC BEACH PLAZA
Those lands described in Official Records 6675, Page 283, Duval County, Florida, being the southerly 15'
of Lot 7, all of Lot 8, and that certain unnumbered lot or strip of land, lying south of Lot 8 between said Lot
8 and Atlantic Boulevard, as recorded in Plat Book 5, Page 69 of said Public Records, together with Lots
1,2,3,4.5 and 6, Atlantic Terrace, as recorded in Plat Book 15, Page 34, of said Public Records, together
with that certain 15 foot alley bounded on the north by the south line of Lot 5 and 6 and on the south bythenorthlineofLots1through4.
51