725 ATLANTIC BLVD 18 DEMO25-0028 Sw 0
-qtr„ BUILDING PERMIT APPLICATION FOR INTERNAL OFFICE USE ONLY
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- City of Atlantic Beach Building Division PERMIT# DFmoz 3 -004?)
6. 800 Seminole Road, Atlantic Beach, FL 32233 **ALL information required to process
rs Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address 725-18 Atlantic Blvd Atlantic Beach FL 32233 RE# 171363-0000
Legal Description 31-1 38-2S-29E 3.95 ROYAL PALMS UNIT 2 A LOTS 1,2,3(EX PT RECD 5294-36,5649-1182,PT IN R/W)BLK 16,B DE CASTa
Valuation of Work(Replacement Cost) $2,100.00 Heated/Cooled SF Non-Heated/Cooled SF
•Class of Work: El New El Addition ❑Alteration ❑Repair ❑Move ❑X Demo ❑Pool El Window/Door
•Use of existing/proposed structure(s): ❑Commercial ❑Residential •If existing structure, is a fire sprinkler system installed?:❑Yes❑No
•Will tree(s)be removed in association with proposed project? El Yes (Must submit separate Tree Removal Permit) El No
Describe in detail the type of work to be performed:
Removal of trash and misc equipment and clean up unit to be ready for new tenant.
•
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Florida Product Approval# (For multiple products use Product Approval Information Sheet)
PROPERTY OWNER Name Atlantic-Penman, LLC Phone 904-588-4538
Address 500 3rd St S City Jax Beach State FL Zip 32250
Email deraz12@gmail.com Owner or Agent Shahab Derazi
CONTRACTOR Name of Company Dimension Construction Phone 904-294-6094
Address 1045 N Liberty St City Jax State FL Zip 32206
Qualifying Agent State Certification/Registration#
Email Job Site Contact Number
Worker's Compensation Insurer OR Exempt ❑ Expiration Date
Engineer of Record 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,or federal agencies.
OWNERS 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 li-. o'signed,s and notarized signatures of the property owner,agent and/or contractor,and under penalties of
pen , de . - I have read and examined the foregoing application and that the facts stated in it are true and correct."
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S N T� MI' PRINT OR TYPE NAME OF CONTRACTOR DATE
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SIGN; ..E 0•0 E• 411r41170.- PRINT OR TYPE NAME OF OWNER OR AGENT DATE
•'riding Pe t Application 07.03.20