1021 ATLANTIC BLVD #975 - FIRE SERVICE �..i;ii;y City of Atlantic Beach APPLICATION NUMBER
c .// Building Department
,0\ (To be assigned by the Building Department.)
2 y:' 4 •) 800 Seminole Road ��� /�/
'`_ ��/ Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 Fax(904) 247-5845
'•,:pr a E-mail: building-dept @coab.us Date routed: /2/4///5--"
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City web-site. http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
/ #q75
Property Address: f D 2 / ,ri a ifri'6. BAId Dement review required Yes No
uildinj `
Applicant: AiA, . „ a .4 ' ,L i I _ laid ning &Zoning
,/ � Tree Administrator
Project: eQ ft)- /n (,J 6 , Public Works
Public Utilities
Public Safet
F. e Service
Review fee $ Dept Signature •
Other Agency Review or Permit Required Review or Receipt
_ of Permit Verified By Date
Florida Dept. of Environmental Protection —
Florida Dept.of Transportation
St.Johns River Water Management District
_Army Corps of Engineers — -
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
_____ — _ _ APPLICATION STATUS
Reviewing Department First Review: Approved. nDenied.
(Circle one.) Comments:
BUILDING cl;NI-erc. Ic.__ 6L
PLANNING & ZONING as ;ev'f'gnant— C- •3014Asn.x_, ` l a- '7 (S
Reviewed by: C '1l, V • -rr0 Date:
TREE ADMIN. Second Review: nApproved as revised. nDenied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
P : SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: nApproved as revised. nDenied.
Comments:
Reviewed by:_ Date:
evised 07/27/10
J BUILDCITY ING OF PERMIT ATLANTIC APPLICATION
I "
800 Seminole Road, Beach,Atlantic Beach FL 32233
O 1 �� Office(904)247-5826 Fax(904)247-5845
Job Address: 975 Atlantic Blvd.,Atlantic Beach,FL 32233 Permit Number:
Legal Description 38-2S-29E 14.040 CASTRO Y FERRER GRAND Parcel# 177602-0040
Floor Area of Sq.l't. Sq.Ft
Valuation of Work$ $33.675 Proposed Work heated/cooled 952 non-heated/cooled 0
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial Residential
If an existing structure,is a fire spnnkler system installed?(Circle one): Yes No N/A
Florida Product Approval# N/A Interior Work Only
For multiple products use product approval form
Describe in detail the type of work to be performed:Interior build out for new tenant.The tenant will be a salon for hair
removal.
Property Owner Information:
Name: Sleek Salon.Inc./Rani Usman Address:975 Atlantic Blvd.
City Atlantic Beach State_FL Zip 32233 Phone(904)294-4484
E-Mail or Fax#(Optional)
Contractor Information:
Company Name: Dimension Construction Qualifying Agent:Ramin Partow
Address: 1045 N.Liberty Street City Jacksonville State FL Zip _32206_
Office Phone(904)249-6094 Job Site/Contact Number_(904)294-6094 Fax#_(904)406-8737
State Certification/Registration# CGC1508799
Architect Name&Phone# AE Studio Architecture (321)615-6171
Engineer's Name&Phone# Same as above
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
Application is hereby made to obtain a permit to do the work and installations as indicated /certtbi 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 laws regulating construction in this jurisdiction. This permit becomes null
and void if work is not commenced within six(6)months,or if construction or work is suspended or abandoned for a period of six(6)months at any time after
work is commenced I understand that separate permits must he secured for Electrical-Work,Plumbing,Signs,Wells,Pools,Furnaces,Boilers,Healers,
Tanks and Air Conditioners,do
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
• TO YOUR PROPERTY.IF YOU INTEND TO OBTAIN FINANCING CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
i hereb•certify that I have read and examined this a lication and know the same to be true and correct. All provisions of laws and ordinances go er tng is
type of work will he complied with whether specified herein or not. The granting of a permit does not presume to give an hority to violate cam the
provisions of any other federal,.sane,or local law regulating construction or the performance of construction.
L /I .�o �-O Signature Signature of Owner gn ature of Contractor
Print Name j).\_4.212,......_4AS `Zj1 Print N: a y)%) 1 .. .._........._ _, OInI
Sworn�,rc,y.�y�,isi�-d subscribed before e ' om h and s ascribe, befo•thisat'i Davof NC.)vc1-tF( .20 l ;. Da . .20
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