2249 W OCEANWALK DR DEMO21-0035 Building Permit Application
City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233
HIGHLIGHTED IN GRAY
vJ='ter IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: Z2.14:61 UC.,Site+J (JJ Permit Number: - E(\ino L - CA35
Legal Description 4z-7 " 2-S 7-9 E OcW,tu.. a./m 3 (,yr—l' E# G5 44,3 - 103 j
Valuation of Work(Replacement Cost)$114 0.0D Heated/Cooled SF 4970 Non-Heated/Cooled
• Class of Work: ❑New ❑Addition )4Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial .Residential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes ❑No
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) ❑No
Describe in detail the type of work to be performed: '06‘,10L-1710,4 CL#c.H vQ� r tJOf-N1 4a if4-L{ p,4$kI..
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Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name TZSD1 A'4 Address Z'L�{q beR4Wy.)44.4- moi` t.•</
City A-71,A141"(L.. IS gA44.1 State r{, Zip 3Z'7 2) Phone gv+, q'l4-.z t
E-Mail r rN (S /1-0MA4 �li.✓IAL,c'U.l`'1
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company k`M.,ciq.,-er. Qualifying Agent ("(IeFIe1-4.4-
Address((7:77c &T-• (649 -'-pk ft_W / City, FZitp v State -f Zip 3124-‘,....
Office Phone Job Site Contact Number
State Certification/Registration# C U4-7E-M ailidit1/,44.LL-{iJr`/rJG/ e 6.A4 rc .�w"►
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer l3/lc" OR Exempt 0 Expiration Date L.-I--
Application
ZApplication 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 county,and
there may be additional permits required from other governmental entities such as water management districts,state agencies,or
federal 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 YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORD G/• IR NOTICE OF COMMENCEMENT.
Si:nature of Owner or Agent) (Signature of Contractor)
Si n d and sworn to(ortaffirmed)before e this 13*-day of Si ned and sworn to(or affirrreld)before mielthis 6r-day of
( , o2-l , • .vk dA �. _1 1,�. , 262 t� "l 1 •.. .
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Miff
(S g ture.of Qlota y (Signature of Notary)
- �irgmia �llletze•
``,,�� u.14�,,, Virginia Wetzel
Personally Known ; �►_COMMISSION#GG23389. [ ersonally Known OR_' ` �a. =COMMISSION#GG233893
[•}-educed Identific� .,•'� %•••,
; E PIKES: July 1, 2022 [ ]Produced Identificatii% _ -
EXPIRES: July 1, 2022
Type of Identification: 'I' • rc Notary Type of Identification: ,;,
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