426 AQUATIC DR RESO24-0121 Application� Grp
BUILDING PERMIT APPLICATION nfff
F4i3;t",rEJ�ltt[C�JrFi+C�"�,iCIPLLI'
".� CIS of Atlantic Beach Building Department
PERMIT #
800"e'rnitiole Road, Atlantic leach, FL 3223 Et anfar ati�rti r�, art to ,r ��s
? ° Phone: {904} 247-5826 -5826 Emailt
fob Address
Legal Description
'aisxatiort of Work (ReplacementCost)•�(� v Heated/Cooled Sf Bort-Fteat i/cooled 5F
• Class of Word; C� Nevi �t}Etion terati�sn ijttepair Move [3Demo Pout []Window/Docrr
# i°se of, ex#st+n 1Prt } isect structure(s),[] Commercial sidential 9 If existingstructure, is a fire sprinkler system Installed. J es rlNb
• Wilt troo(s) be rftmoverl in association with proposes! project? E]Yes (Must submit separate Tree Removal Permit) o
,Describe in detail the type of work to beperfc+"nedt
&Ai4Al i'n Pa- -D CL1 �ci i,owN C-� � e,�- exit tic 1 Z CSP- R� o GLr iv c= -
WfAd er c� U-0K & 6 e � Ref i 4Ce. ex�sfi sc rem
els c�� u� � s s
Florida Pro-iuct Approval# (For multiple products use +
+► Property Owner Information Name, ' Phone qf)�- I_q-7 ' � �-
Address ) 0 `-Rox , � City �®5s� ��j � State ZIP 7
Frrtail Owner or Agent (If Agent, Power of Attorney or Agency Letter Required)
Cesntrarr trtfcsrttlon Irrtef Ci3mpany 1.� Jr�n art t Phone!
Address "jJ i City ::Y�- State ..L zip 3og 3-
Qualifitrig Agent1(.LVL1�- L 2 1 State Certification/Registration#
i
Email[r 2�1`,a� r,� u, tab Site Contact Number 014— rill— 110 1 L
V'Yforker`s Compensation Insurer OR Exempt &I'tpiration Date Z O5'
Architect's dame Email Phone
Engineer's Name a (�I1L1 � AAA&kms Email _ l -)n 011 „iL1 Phmne
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify t a } rk r r'nstatlation 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.
A(OTI F, 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 owner
management districts, state agencies, orfederal 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 LAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE LSE 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
RNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
(Signature ofOwner or Agent) §gnatu a of Contractor)
Signed and sworn to for affirmed) before me this � clay of Signed and sworn to (or affirmed) before rite this �#� day of
"" ' �' by
AA,"-,,Lr lOZ _b
Signature of Notary . Signature of Notary
Personally .�enrx
i�` gy M n rodu d identification �rsonalty Known �P odu d Identification
�Rsrgw ei�
`ype of 6 ; for Iotary-P al Type of Identif c Nntary Public
State of Florida State of Florida
Cyt ' at Comm# HH097095 " r' Comm# HH097095
s�Expires 2/24/2025
-srMc� 1s Expires 2/24/2025