893 Amberjack Lane DEMO25-0003 NEWBUILDING PERMIT APPLICATION � FOR INTERNAL OFFICE USE ONLY
�gs"J City of Atlantic Beach Building Department PERMIT # P,6—.5;,4-D;LJCT
800 Seminole Road, Atlantic Beach, FL 32233 "ALL information required to process
Phone: (904) 247-5826
Job Address 893 Amberiack Lane RE# 171178-0000
Legal Description 30 -6017 -2S -29E Royal Palms Unit 1 Lot 24 BILK 4
Valuation of Work (Replacement Cost) 250000 Heated/Cooled SF 2331 Non-Pleated/Cooled SF 610
• Class of Work: ❑ New ❑Addition ❑Alteration ❑Repair ❑Move NDemo ❑ Pool ❑ Window/Door
• Use of existing/proposed structure(s): ❑ Commercial ❑ Residential • If existing structure, is afire sprinkler system installed?:❑Yes ❑ No
• Will trees) be removed in association with proposed project? []Yes (Must submit separate Tree Removal Permit) M No
Describe in detail the type of work to be performed:
Demolition and removal of all existing structures
Florida Product Approval #
(For multiple products use Product A roval Information Sheet
PROPERTY OWNER Name Charles Lundgren Phone 9049629575
Address 893 Amberjack Lane City Atlantic Beach
State FL Zip 3.2233
Email ceebreez@hotmail.com Owner or Agent Charles Lundgren
CONTRACTOR Name of Company phone
Address
Qualifying Agent
Email
Worker's Compensation Insurer
Engineer of Record
City
State Certification/Registration#
Job Site Contact Number
State Zip
OR Exempt ❑ Expiration Date
Architect of Record
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, 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 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.
"In lieu of signed, sworn and notarized signatures of the property owner, agent and/or contractor, and under penalties of
perjury, I declare that I have read and examined the foregoing application and that the facts stated in it are true and correct."
OUR
OF CONTRACT PRINT OR TYPE NAME OF CONTRACTOR BATE
�- Charles Lundgren 01/15/2025
OF O ORA E PRINT OR TYPE NAME OF OWNER OR AGENT DATE