175 15th ST RES22-0059 revision 3-24-22 Revision Request/Correction to Comments **ALL INFORMATION
Request/.1„.„,_,,, HIGHLIGHTED IN
r• City of Atlantic Beach Building Department
kGRAY IS REQUIRED.
_..)\'' 800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: R ESa.A—oo 5i
Revision to Issued Permit OR Corrections to Comments Date: 3 lay` aa,
Project Address: ` $ f 5 s 4- A i-t Grp,fT c- (c k.
Contractor/Contact Name: ( _,Ln GS1 cos al `l, rt),,,L ,....t-(—
Contact Phone: 904 s--64 t'(v ( t Email: Z-& C VII 3` Cj (v. e ( _ Cvr^
Description of Proposed Revision/Corrections:
N€(kJ e,Ci.rfAlyc aaor Vs wc' ie, Qc P(ac€ 14 civ door
ri EZ-1.0 S l ci 1;n O r! R E .rLcQ c.,_eb c`
1 adios efej1,1st- C' affirm the revision/correction to comments is inclusive of the proposed changes.
(printed name)
• Wiroposed revision/corrections add additional square footage to original submittal?
No ❑ Yes (additional s.f. to be added: )
• Will_proposed revision/corrections add additional increase in building value to original submittal?
Ph-o ❑*Yes (additional increase in building value: $ ) (Contractor must sign if increase in valuation)
*Signature of Contractor/Agent: ��
(Office Use Only)
LI Approved E Denied ❑ Not Applicable to Department Permit Fee Due $
Revision/Plan Review Comments
Department Review Required:
Building
Planning& Zoning Reviewed By
Tree Administrator
Public Works
Public Utilities
Public Safety Date
Fire Services Updated 10/17/18
Building Permit Application
��� updorea to/5,j.,
City of Atlantic Beach Building Department **ALL INFORMATION
� 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826a Email: Building-Dept@coab.us IS REQUIRED.
Job Address: / !5 f fp •5-I—. & l Atitttcn GIN V---339--)6 Permit Number: t \ESZ 2- C}9
Legal Description 1-07 3 Fy< (Q 3 t' L mMNO AL4 Y '
�� 17L8t'v �- c� oU
Valuation of Work(Replacement Cost)$ H°110eO Heated/Cooled SF i...10,46- Non-Heate oo e
• Class of Work: DNew ❑Addition ❑Alteration ictRepair ❑Move gtDemo ❑Poo[ 129Windo /Doo
• Use of existing/proposed structure(s): ❑Commercial ' Residential
• If an existing structure, is a fire sprinkler system installed?: DYes 117JNo
• Will trees)be removed in association with proposed project? DYes(must s_ubmit separate Tree Removal Permit) bQNo
Describe in detail the type of work to be performed: R(,('L hLc, oi. AMS j F-Ra).LA poop...,s ,
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name tK Mf*K. I t t -J_01.1/V '1 Address 115 l.S rtl `51 (2(e/
City AIL • Ac'N State 1=C_ Zip 33.3,3 -) Phone y0L1 Y. n•oq H"ioy4.29ctiN�
E-Mail /11))0 h rl 3vr) J; 5.1- "r or-4-r ( i)n1
Owner or Agent(If Agent, Power of Attoirney or Agency Letter Required)
Contractor Inform.,tio I P,�
Name of ompany (�r I �� t s YJ'— Quali ing Agent(---V\ 6.,.0 S ' \ t i22 ,-- (1",
Address oZ � �� f—' ('� City '-!-
Office Phone 0 ' - l ,lillt Job Site Contact Number • 0 - •
State Certification/Registration# ' Zilin E-Mail _ &-G t, • 4 hn a i • . re.
Architect Name& Phone q
Engineer's Name& Phone q S1;30 b/V'all Aikk- 1/ y()LI 7( s 7
Workers Compensation Insurer OR Exempt Expiration Date
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 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 FINAN•ING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORD)
f i /c YO R 0 ICE OF COMMENCEMENT.
` r
,(')r a' r- of•r ner or Agent)
(Signature of Contractor)
5i ed and sworn to(o affirmed)before me this (t61 day of Signed and sworn to(or affirmed) efore me this ! day1of
tt}2( a;,,ltf, 2t! L,by f1)f;l•S5 �; r� 1-(. i ( t_ / , 2G 1 L by � , /J .(�'�` >�:,, .
(Siik____
lure of Notary) '( gn.tore of o .- )
'i �ip MELISSA JCA$i DAVIS I ? u.
• r a M;.ISSA JOANN DAVIS
IBJ Personal) Kn Notary Public-State of Florida 1 1 ' 4i`ti rotary Public•State of Florida
y Commission N GG 956245
(J.-Personally Known OR r. / Commission 0 GG 956245
I I Produced Ide My Comm.Expires reb 14,2024 [ I Produced Identificatior or My Comm.Exp
ires Feb 14,2024
Type of Identifica n: Bonded through National Notary Asir ! _ Type of Identification' loaded through Nationa Notary ass*