893 Amberjack Lane DEMO25-0003 APPLICATION 1-28-25BUILDING PERMIT APPLICATION E _ �...._.OkllUTe&AL OFFICE USE ONLY
:9< t City of Atlantic Beach Building Department I� PERMIT # _kr,
8€ 0 Seminoie Road, Atlantic Search, FL 32233 111-w'ALL information required process
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Phone. (0)7 5826 Email;ri.0k
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Job Address 893 Amberiack Lane ---_. � RE# 171178-0000
Legal Description 30 -6017 -2S -29E Royal Palms Unit 1 Let 24 Bl_I4 4
Vaivation of Work (Replacement Cost) 250()00 � Heated/Cooled SF 2331 Non-Heated/Cooled SF 610
• Class of Work: 0 New OAddition ElAiteration L—]Repair 01viove r&Demo O Pool ® Window/Door
• Use of existing1proposed structure(s) �._; Commercial fiesident€al ♦ lV existincg structure, is a fine sprinkler system instaNeal%:®Yes E]Nci
• Will tr6eis) be removed in assodation with proposed pro}ect7 ] Yes (Must svbrnit separate Tree Removal Permit) U] No
Oescribe In detali the type of work to be pertormed:
Demolition Ind removal of all existing structures
Florida product Approval # � -- (For mutt: le products use Pr d t A
F *� i €z P i9�j I ----_iforntatign Itf,
PROPERTY OWNER Name Charies Lundgren PhOrie 9049629575
Address 893 Amberiack Lane y _ _ CitY Atlantic. Beach State FL Zip 32233
Ercall oeebreez@hotmaii.to_m__ Owner or Ager t Charles Lundgren
CONTRACTOR Waite of„~
company ��-1�.°S�_ �lf�����r.1......__.._......_ ....._ .....__-____ Phorse
Address �J? t'YLi�c La i City44e&ffee State Zi.p 3 233
Qualifying Agent � � State Certification%Registration#
Email Job Site, Contact Number
Worker'. Compensation insurer OR Exempt E Expiration Hate
Engineer of Record architect of Record
Application is hereby made to obtain a perrriit to do the Mork anti installations as indicated. I certify that no work or installation lovas
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the lays regulating
construction in this jurisdiction. I understand that a separate permit: must lie 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, them may be addit€onal restrictions applicable to this property that moy be found in
the public records of this city/county, arrd there may be cadditionaf permits required from other governmental entities such as sister
monagem- e0lt districts state agendes, or federal agencies.
OWNEWS AFFIDAVIT: I certify that all the foregoing information is accurate arrd that all work will be done in compliance with al applicable
lags regulating construction and zoning.
**WARNINGi 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.
"Ire lieu of signed, sworn and notarized signatures of the properly owner, agent and/or contractor, and under penalties of
perjuryj declare that ave read and examined the fufc-going application and that the facts stated in it are true and correct.”
PAINTORTYPE NAId�EUFCOl�97RA CONTRACTOR � DATE
Charles Lundgren 01/15/2025
Rlhi# Cid fY E l P C1F OWNER OR AGF i MATE