1915 Sea Oats Dr Interior DEMO22-0018 Building Permit Application Updated 10/9/18
CRY 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: 1115 Sea, CA-T -I)i1X Permit Number: — P A O � 2—V Q '
Legal Description 34-&7- oJ-25-Z96 $EIV4MQfZtn1A >JwiR'll 4oT5 $llc3 RE# l•7202J=)-09 114
Valuation of Work(Replacement Cost)$_ S5,o O c 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 XResidential
• If an existing structure,is a fire sprinkler system installed?: Dyes XNo
• Will trees be removed in association with Proposed ro'ect? ❑Yes must submit separate Tree Removal Permit o
Describe in,detail the type of work to be performed:
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.V E A^,o S keE`T`'v?,ck- Tor_ �►SG-iI NCE 2.
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name &J id,1- Address vi(5 5eA C4 UE
City�, State Zip 3Z233 Phone
E-Mail NiC O1�t5�h�1a►"RJc`�QG�y�n�1k.
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Companyt't1 �5 L`3Ut��E�S Qualifying Agent
Address 9,9?- UC FAP1�I�I1� city,j. State F IL Zip 3ZZ33
Office Phone by--Z - /-S-Oa Job Site Contact Number q0y-75
State Certification/Registration# e-Be-%2573► E-Mail t"1- tIILPse(i,l Cdwe-
T-Architect Name& Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exem pt)!(,,Expi ration Date 9 l7 /Z3
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 OR " ATTORNEY BEFORE
RECORDING YOUNOTICE OF COMMENCEMENT.
4��, d, 1-�O
(Signature of Owner or A t) gnature of Contractor)
S' n and sworn to(or affirmed)before me this day of Signed and sworn to(or affirmed)before me this day of \\
by
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(Signature of Notary) Cigna ure o )
1N aq BARBARA L.TULLIUS ERIN MARIE STEHt
/Personally Known OR y. �` Notary Public-State of Florida [ ]P�X's6nally Known OR ?. My COMMISSION tt GG 266182
[ ]Produced Identificati P' Commission#GG 975342 [qTroduced Identification
OF P` M Comm.ExpiresA r t5,2024 XPIRE&October 14,2022
Type of Identification: y p Type of Identification: