DEMO22-0016 1620 Beach Ave Demo SFD Building Permit Application Updated 1019118
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@coab.us IS REQUIRED./,
Job Address: Ito 20 BES(-} 4vE73'� Permit Number: 2-OV I
Legal Description CM-ZS-24E OCEoN Q^4 U4crJ4b15,(Dp' Lgw7 L r4blK? RE# 1(oti5y7 -0500
Valuation of Work(Replacement Cost)$. IT Oo Heated/Cooled SF _Non-Heated/Cooled
• Class of Work: [--]New ❑Addition ❑Alteration ❑Repair ❑Move ;<Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial 9kesidential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes ANO
• Will trees be removed in association with proposed ro"ect? ❑Yes must submit se arate Tree Removal Permit No
Describe in detail the type of work to be performed:
TEht`z �ov.�tJ � 1t2Er�nQJ� �XISTItJC-� �tdn^E
Florida Product Approval # —for multiple products use product approval form
Property Owner Information
Name &41z J No N Address 1(g?Z B6kd4 p.JE
City g State_�1 Zip Phone 707' 8($"''195`/
E-Mail MJ'TOwsawN ,KAP t^e COM
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company W,II rp-s —a,V,they-S Qualifying Agent A ►"►17`�
Address 95Z nGEA 4 Bl D City Q,'L� State_rr 1 _Zip 32..Z33
Office Phone C1 Qq- ZIAP- 1500 Job Site Contact Number_9 - -155-994ff
State Certification/Registration# elk 12 ,73ILI E-Mail CA ,%rA6T-MET-
Architect Name& Phone#
Engineer's Name& Phone#
Workers Compensation Insurer OR Exempt JfC,_Expiration Date S-11 - Z'3
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 FINANCING, CONSULT WITH YOUR LENDER O AT
TORNEY BEFORE
RECORDING Y?=ICE OF COMMENCEMENT.(Signature of Owner or Agent) ture of Contractor)
Signed and sworn to(or affirmed)before me this day of Signed and sworn to(or affirmed) before me this' day of
by \��5� ,��y —
__(Signature of Notary)V (Sign re o(Notary)
DONNA M DUNGEE
Notary Public, North Carolin ERIN MARIE STEHL
Personally Known OR
0(]Personally Known OR Guilford County _ '9y COMMISSION#GG 26618,
[ ]Produced Identification MY Commission Expires[ Pr ced Identification
Type of Identification:
April 24,2023 a of Identification: j. EXPIRES:October 14,"2021