476 WHITING LN Building Permit Application
City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept(c)coab.us IS REQUIRED_
Job Address:LI 7 C k }_ L h _Permit Number.
Legal Description 0100 S:'^9l'" �,1r!iy ___-- _ REfi /7/453.- G?Ga. ,._....
Valuation of Work(Replacement Cost)$^_9 S 0 Heated/Cooled SF Non-Heated/Cooled _•__�_,,
• Class of Work: `6New DAddition JAlteration DRepair °Move °Demo DPool OWindow/Door
• Use of existing/proposed structure(s): DCommercial Cesrderitial
• If an existing structure,is a fire sprinkler system installed?: DYes $1No
• Will tree(s)be removed in association with proposed project?"lyes(must submit separate Tree Removal Perms) i:No
Describe in detail the type of work to be performed j 1 / 6' /
r Ii I>,.y 6' i1 as -'t,+ . I ah A+a z rev
Florida Product Approval n for multiple products use product approval form
Property Owner Information
Name ro l h IJ s Address 303 6 4.1, $4-
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f-
Cily_ ..
ayl.t/� a 4, State F I zip 3 2z 33 Phone loll S 3 /7-3
E-Mail r ftl•fIvf'cjnn• cf3oGa5r17A,'Lec-Gr''
Owner or kept Of Agent.Power of Attorney or Agency Letter Required)
Contractor Information /
Name of Company �l.t sa cv- ��•tu arwr Qualifying Agent ZrcL_ J ,yi-wt
City S•raiswr+. State I Zip 372-94
Office Phone 104 6S3 63149 Job Site Contact Number 7O11 3IZ 32.5
State Certification/Registration St /CS5I5f E•Mail 0-rec, p'(clir1130,44so>nv;//t,.Gorr)
Architect Name&Phone iY NA
Engineer's Name&Phone 8—�---`A'��� --
Workers Compensation Insurer ft.�f mi. k4 eI OR Exempt 0 Expiration Date g//S/Z L
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 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 wig 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
RECOR>t i G Y•UR NOTI E OF COMMENCEMENT.
c ig .v re o r or Agent) l (Signature of Contractor)
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S: ped and sworn to(or affirmed)before me this9(97/-sday f Signed/ and sworn to(or affirmed)before me this 2-1 ci,:;
2 y_6'x6,4 e -__ �C[•vuo.ry, Zcaz .by•
19)OdAftAll
pnature of Net:_-y; rvgnature of Notary.
Personals•Kn i Notary Public State of Florida Molar)PAN Spy d Fl"a
y r4.- )►)�sonai}y Known OR �� Bntan M Norman
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Jen ter A Motes Ny COrmta.ao HH(JirliE
( )Produced Idea+:, Produced Identification
My Commission ( ) o, Eayraat6:16fl024
Type of ldentzficai HH 183051Type of identification'
Exp.10/20/2025-. — - _ - - -