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547 SELVA LAKES CIR RESO22-0063 SCREEN ROOM �L- Building Permit Application Updated 10/9/18 City of Atlantic Beach Building Department **ALL INFORMATION / 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY Phone: (904) 247-5826I Email: Building-Dept@coab.us IS REQUIRED. Job Address: S-7 7 ✓•2(lJ�. L. s 0t rc e Permit Number: IRF Z Z— Legal Description It7 1 �() 5 Q',I .. S RE# /72 o 7>5 -1 5 Valuation of Work(Replacement Cost) Heated/Cooled SF Non-Heated/Cooled • Class of Work: ❑New Addition ❑Alteration ❑Repair ❑ ve ❑Demo ❑Pool ❑Window/Door • Use of existing/proposed structure(s): ❑Commercial esidential • If an existing structure, is a fire sprinkler system installed?: ❑Yes QNo • Will tree(s) be removed in association with proposed protect? ❑Yes(must submit separate Tree Removal Permit) 'IlNo Describe in detail the type of work to be performed: r� x a6, uNroonl / Pie VJ s I 0-10 S- -Ota P-06-E Florida Product Approval# for multiple products use product approval form Property Owner Inf rmation r rf //'� Name (� e (ALI Address 5 r Se-lu0... Lake S'l[� rr7r ft City rr pyl-h(.. Q State Zip Phone 36 g • ' ei - E-Mail Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information 14 0 •0<3 00 Name of CompanyDavid Wesley Patio Rooms Qualifyin gent Address 9951 Atlantic Blvd,Suite 317-5 City State Zip Office Phone Jacksonv lle, FL 3 25 J ite Contact umber State Certification/Registration# S(�C I.II`'(4.$ V4ail LU/2/' ( Q)Ge 5\410-i( ('0(1 Architect Name& Phone# 1 Engineer's Name& Phone# Workers Compensation Insurer OR Exempt Expiration Date 8• 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 % A .` I RNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. / (Signature of Owner or Agent) (Signature o ontractor) ne and sworn to(or affirmed)before e this 7 day of S', -din. sworn to(or affirmed)before e this 7 day of Oa GL w. ignature of Notary) AMY GOODWIN n — \4 Nut(!" /Puhlic State of F lur ida '4914\ vie, AMY GOOi WN rid• n M HH 152236 [ ) Personally Known OR "',•h ( mivk Notary Put!ir.-Sl.rft`of Hui Ida [ ]Personally Known OR � ti . My cumr. t,r,ur•,Jul 31,2025 '����P� Commission N 11li 152'13h [ ]Produced Identification s li,r ;i,N., r el rlutary Assn. [ ]produced Identificati ;; a' My Comm.Expires.lul?1,2025 Type of Identification: -4 '3e"' Type of Identification: .:..<r:- ... .�..., -._.:a.........: �. e.. -. .-. ..r. ..e.......�..w. x..:-.......�......<r...r_ .i. .... �..x.....ar_..s».n. ...�-� I ..ss. .c..�-.F o+c E TREE & VEGETATION AFFIDAVIT ,..,: 1_,,v-,--.-,-;. ,, `f,, City of Atlantic Beach Vit; '`� , ) Department of Community Development � Planning&Zoning Division \ �.. w 800 Seminole Road Atlantic Beach, FL 32233 9t'I91- (P)904 247-5800 (F)904 247-5845 PERMIT# i SECTION I-APPLICANT INFORMATION r Owner(s) E Legal Authorized Agent* NAME OF APPLICANT l ' Of S� % L. (NAME OF COMPANY d),;d Jj ASIS c /0^ I�t6 coal S ADDRESS OF COMPANY A ' • C •• � -E.. O aa33 PHONE19 g • 6866 CELL EMAIL i CONTRACTOR CERTIFICATION NUMBER 3cc, 13 ( ' if-9 S'.1( ATLBCH BUSINESS TAX RECEIPT NUMBER . SECTION II-SITE INFORMATION STREET ADDRESS OF PROPERTY /C i i (fon address has not been assigned to this property,contact the A8 Building Department al (904)247-5826 to request an address. LEGAL DESCRIPTION LOT Lab BLOCK SUBDIVISION L.c2((To,,, t___Glil8LJ ++4 REAL ESTATE NUMBER IzzLOT OR PARCEL SIZE: SQ FT AC RESIDENTIAL COMMERCIAL OTHER(SPECIFY) I affirm that I have reviewed the provisions of Chapter 23, "Protection of Trees and Native Vegetation"of the Municipal Code of Ordinances for the City of Atlantic Beach, FL and/or I have participated in o pre-application meeting with the Administrator of those regulations. Subsequently, I affirm that no regulated trees and no regulated vegetation will be damaged,destroyed and/or removed from the above-described or adjacent properties in conjunction with this project. i/vN . >.c� SIGNATURE OF OWNER SIGNATURE OF OWNER j Signed and sworn before me on this 7 day of / , aim ,by State of 'II County of Identification verified: Oath sworn: r Yes E No -46,,s...,— — i otiixY Pu•., AMY GOODWIN � /Q �� `?: 1�'. . Notary Public•State of Florida -1. igi Commission N HH 1;2136 �rti f i / / Notary Sign. reoMy Comm.Expires Jul 31, 2025 Bonded through National Notary Assn, RE t'7',' slf1.i� My Commission expires: HOMEOWNER SUNROOM ENCLOSURE AFFIDAVIT The purpose of this document is to make you aware of any limitations in the enclosure that is being permitted at your residence. The table below, Sunroom and Screen Enclosure Requirements provides a brief description of the various sunroom category requirements. There may be restrictions on the use of your present home depending on the category of sunroom you are installing. The property owner is hereby notified that should they make changes to the sunroom which could include, but not be limited to,addition of any form of temperature control system or removal of the ( doors/windows separating the sunroom from the host structure, the room may become non-compliant with the re•uirements as mandated by the Florida Building Code, the Florida Model Ene • Code and State Statutes. ----• ER I have read this complete form and un. ''t. . I am receiving a Category___ S . • m-(I-V) Printed Name _ 1 a Address_ _sir1 Ili 0— f___42s- 0itrCI/t Signed iillr 1. , . -( . I Date: J ct l 7 , go...2a Before me this___ day of &FAS 1 in the County of Duval,State of Florida.has personally appeared statements and declarations herein are true and accurate. . a..,Y.,. �ty t� � s�� se Florida rms all lin ., -- 1 � ;? �'- Notary Public-State of Florida =� imi 8 Commission H HH 152236 Notary Public at Large,State of County of �..",, oFF,o?'._--Comm.Expires Jul 31,2025 P Personally Known❑or Produced Ida cation❑ I Bonded through National Notary Assn. ID Type Sunroom and Screen Enclosu Requl' ants Category I II Ill IV I V Habitable Space No No No Yes Yes Foundation Walls<200pff Walls<200pff Walls<200plf can Walls<200plf Walls<200plf can can have 8"W can have 8"W have 8'W x12"D can have have 8"Wx12"D x12"D ftg or 3- x12"D ftg or 3- ftg or 3-1/2"slab if 8"VVx12"D ftg ftg OR have site 1/2"slab if no 112" slab if no no concentrated OR have site specific concentrated concentrated load>7501b OR specific engineering load>750lb OR load>750Ib OR have site specific engineering have site specific have site specific engineering . engineering engineering _ Existing exterior — GFCI outlet Relocate or add additional outlet to exterior if enclosed Exit Lighting Not Required Required Required Required Required Interior Electric Not Required Not Required Required Required Required Outlets Emergency Egress from Egress and Exit Egress and Exit Egress and Egress and Exit Escape exist. structure must meet code must meet code. Exit must meet must meet code. Openings allowed if open to code. atmosphere and has screen door leading away from residence. Misc.Window Host structure Windows must Windows may be Host structure Host structure and Door windows/doors be removable fixed or removable. windows& windows&doors Requirements shall not be Host structure Host structure doors shall not may be removed. removed. windows/doors windows and be removed. Forced entry, air shall not be doors shall not be Forced entry, leakage and water removed. removed. Forced air leakage penetration entry, air leakage and water requirements and water penetration apply- ' penetration requirements requirements 1 apply. Wind Borne Debris Opening Not Required Not Required Required, can be on host structure, if built under existing Protection roof Energy Sheets Not Required Not Required Not Required V 1 Required I Required MAP SHOWING SURVEY OF LOT 60, SELVA LAKES UNIT TWO, AS RECORDED IN PLAT BOOK 43, PAGES 11 , 11A AND 11B OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA. Z5'/g4/Z:)f/ EIe LA,i6 (,44 ,6 / Ab 5-7-e--4:2) 4 a: DocuSign Envelope ID:C126AB7B-BF4B-4A70-9992-20873920EAA2 /LFNJ CRu!5L4p jt ��6+1 0041 c`/7 SEL '0 GgkeS cik_ P i lAx.iC 66-1 3 z7. 3 O.r"`{ t David Wesley Patio Rooms 9951 Atlantic Blvd,Suite 317-5 � � Jacksonville,FL 32225 Vincent Seibold PE 48288 at Nf u t7! poomru i/on/ a o��,o / 1015 Atlantic Blvd.#128 Atlantic Beach,FL.32233 i l7'X;, 64(155 Ewt')ofadt ' a 0 R. 904-568-4112 ``�,OOtiU(fifi,Wind: / Exposure:Bph 1`\ VN7-si/B / � Category:) `,�'�.•�\GENS�.O` i� FBC 7th Edition 2020 — �` S`,fl I *: No 48288 • t J 73 , STATE OF i4'a�` i F /1/rs'GNAL�?G\� AZi, : ...•-1. ..._ ___ I zs3 p _ �'� a� p , 3"comp.panel c, 44 1 ! \ ` � 17t r 4 23 1 4 13' t tEF 1 SODS w414- te.s1 wo t R140 511Y &I4" This item has been electronically signed and sealed by Vincent Seibold PE 48288 on August 29,2022,using a SHA authentication code. —DocuSigned by: Printed copies of this document are not considered signed and sealed and the SHA authentication code must be uta{ cualba verified on any electronic copies \--FFa07E8421C9415 DocuSign Envelope ID:C126AB7B-BF4B-4A70-9992-20873920EAA2 - - -- - - Typical Cage Bracing Details • - • Triangular plate • - : w/8 - #10 sms. : i • 5-3/4" X i" x I/8u Galy. Strop Plate- • - • Cable required • . 2- 5/16o' Anchor bolt (Expansion Bolt) • „ when enclosure • 2+ V.4"x I Yaa Tocr Low' f, S/S Cable extends more than olz 18' from host. Galvanized Detail One pair of cables . Strap for every 300 sq. ft. • . - wall surface area. Ccmelback With 2- - 1/4" x . li/g.'Tf4?GAS ,-•'� " 5/S Cable - NICO Sleeve IV S/S Cable } . _ 1; . • • ooped Cable C.ar-tE l_ 34.4K 9E to i L °a I IIS!rixr6:-?-1 I(-ma co,1G-K B-pFh CK faTri,-JCa . Looped Cable Detail • NOTE: 1.Selr-tapping SMS shall be stainless steel or zinc coated. 2. Members shall be isolated as recommended to prevent corrosion. General Notes and Design Criteria: 1. Pool/Patio Enclosures and Screen/Glass Room Additions are designed to be attached to a permanent structure of adequate capacity. 2. The contractor shall verify that the host structure is in good condition and of sufficient strength to support the proposed addition. 3. The FBC 7th Edition 2020 is the basis for design wind load as per Chapter 20, Table 2002.4. 4. Maximum purlin spadng is T-0" Internal lateral bracing required for spans over 39 feet. 5. Mean roof height shall be less than or equal to 30 feet. The height of the addition shall not exceed the height of the host structure. 6.The exposure is per site location. :7. The pool/patio beam spans are based on open building classification. The typical details shown are indicative of a standard installation. 8 •Fasteners shall have a head and/or be provided with washers not less than 1/2"in dia. For decking •j and siding. MINIMUM POST SIZE AND NO. OF SCREWS • Beam Size Post Size #8. #10 #14 SCREEN/GLASS ROOMS & ENCLOSURES 2 x 5 2 x 4 . 10 8 6 Vin cent Seibold PE 48288 . 2 x 6 2 x.4 10 8 6 1015 Atlantic Blvd. #128 \\,olilII1////i 2 x 7 2 x 5 14 12- 10 Atlantic Beach, FL. 32233 ���`�Co ks�e0%, 2 x 9 2 x 7 - 16 14 Phone: 904-568-4112 a,' 0�'.!Q 2 x 10 2 x 8 •- - 16 * No.48288 MINIMUM SPACING AND EDGE DISTANCES 1 STATE OF : #8 This item has been electronically signed and sealed by ' i 0,� 14 #10 #14 Vincent Seibold PE 48288 using a SHA authentication . 'j A' P 4, Minimum Spacing 5/8" 3/4" 1" code ,,t(4 • oRID---G�?�� • n M Y Printed co les of This document are not considered si ned V- Min. Edge Distance 5/16 3/v 1/2 and sealed and the SHA authentication code must bs //�iO�Alr \\\\\ verified on any electronic copies. �//'//nil 111 t`�\ Get4 i L 1h�r/i 5 DocuSign Envelope ID:Cl26AB7B-BF4B-4A70-9992-20873920EAA2 1x2 perimerter attach to host. 2"x#10 sms or 1/4"x2-1/4 2-2"x#10 smsthru . W tapcons @ 24"oc.for conc. • smb into screw bosses. 2x2 chairrail girt. lx2xl angle w/2- 1/2"x#8 teks ea. leg or internally w/2-2"x#10 sms into screw Bosse Nal .. • . 2x4 smb 1 x2x1 angle w/2- 1/2°x#8 teks ea. leg. . ,' . 1x2 to 2x2 at front wall attach w/2"x#10 sms @ 24"oc. • TYPICAL 1 x 2 TO HOST AT CORNER • TYPICAL CHAIR RAIL TO POST DETAIL 1x2 attach to host w/2"x#10 sms Smb or hollow ost. --�'Ut fa-wood or 1/4"x 2-1/4"quickset p 2x2x2x1/8"angle ea. 76,f-- tapcons @ 24"oc. Min. 1"embed. 1x2 cont.w/1/4" side post w/2-3/4"x 2x2 chairrail girt. x 2-1/4"quickset, #14 sms into post and • -;; or 3"x#10 into - • 1/4"x 2-1/4"quickset band beam for anchor. wood decks.24"oc. t E 2"min.edge gle Add angle for each • for concrete. 4110-- 2"post size. 2-2"x#10 sms thru 1x2into screw bosses. 1-1/4"embed. Use longer anchors for paver decks or 1x2 to 2x2 at front wall attach w/2"x#10 sms @ 24"oc. wood deckss..3"x sms for TYPICAL 1 x 2 TO HOST AT GIRTI . TYPICAL POST BASE DETAIL - . -. r TYPICAL FOUNDATION DETAILS Pile Trpe Footing. Okay to substitute fiberrriesh for steel reinf. - Ribbon Footing Slab on Grade SLAB WITH THICKENED EDGE 2500 psi. conc. t--- ---. --. ,:---. .71‘._ 14 /— ——__..__ _ it ,•Il , IN 6x610/10WM ° 1 - #5, 2 - #4,4 ---- 41-"._,.1 --- or 3.-43 -_or3 - #3 . •- • This item has been e!ecbonlcally signed and sealed by ^. I 12 - rebar cont, Vincent Seibold PE 48288 using a SHAauthenbcafion code I Pnnted copies of 88c document are not considered signed N end sealed and the SHA authentication code must be I l g Notes: verified on any electronic copies r ALO td1-1 D I.Concrete shall be minimum 2500 psi. Cover for rebar to be 3". 2.Fibermesh can be used in lieu of wire mesh. I \�\\I1I l I l l i,///// 3.Slab on grade can be used for roof areas less than 360 sq.ft.or ? . \\\ 1 4T SE'/ for posts with tributary areas less than 75 sq.ft \--, N-►.. ------EN ,0 i 4.Minimum slab thickness to be 3-112". �� SF ' (O 5.Foundation to bear on compacted subgrade with min.Woo psi -- :, No.48288 , bile t type g apacity -0 �t*S' e 6.Pile tpfooting to have 318"rebar 12"long thru posts each way. 7.Embeded aluminum posts to be isolated from posts to prevent STATE OF %i corrosion. 0 �� S 8.Posts supporting carrier beams to have adequate foundation for Vincent Seibold PE 48288 �'% '•;c4ORtOP'-'. � hold down capacity. A minimum of 1 cubic foot of concrete for 1015 Atlantic Blvd.#128 X/ S -—-- G \� each 10 sq.ft.of screen roof. 904-568-411 2'FL.32233 ��//S/O j�AL E?\\\\ GEN1:RAt//l} 5 I A. , DocuSign Envelope ID:C126AB7B-BF4B-4A70-9992-20873920EAA2 1x2 or 2x2 attach to gutter 4"x#10 sms w/ 1-1/4" • . w/2'or 3'x#10 sms 24"oc. neo-washer 12"oc. - 3-1/2"thru bolts 24"oc / 3"x12"pan roof /// mor comp roof. • 3-1/2"x#8 comp roof only. teks pan SIM • roof. 3"x12"pan roof 3-1/2"x#8 • `� teks ea 3" 11.1 . /�or comp roof. x12"pani......- 2-1/4"x3-1/2" roof. ; bolts thru half 1x2 rec - of smb. •.chanw/ \\"„i 2'x2"x1/8" • • 2-1/2"x#8 angle w/ 1/2"x Beaml III teks ea leg #8 teks 12"oc see plan. 'ost see plan. and 4 into for comp Foof. 1x2/2x2 or Super gutter. ' 4-2"x#10 •. . POST/BEAM PATIO/CARPORT. „ sms internal. x1/16' gutter strap.24'oc w/2-3/4"x#14 teks.thru gutter into strap and thru gutter lip into strap. Comp roof4"x#10 sms w/1-1/4" ' SUPER GUTTER AT SOLID AND SCREEN ROOF. f . tneo-washer 12"oc. 3x3 or 4x4 post. 3x3 or 4x4 post � -• <-. 2-1/4"x3-1/2" - 1---- -4-4 or 4-1/2" _111 / thru bolts. r 1 i t.4-2"x#10 sms thru post smb 171' --i _ i_ . 4x2 patio"t 1115117-1 -. "I�1-. w/screw into 4x2 screw bosses. .1 ; . 1 bosses. '-�'� CI see plan. . Alum post base w/ 2x2x1/8"angle POST/BEAM SCREEN/GLASS ROOM. 2-1/4"x1-1/2" w/1/4"x1-1/2" quikset anchors. quickset anchor. This item has been electronically signed and sealed by Vincent Seibold PE 48288 using a SHA For wood decks attach post to band beam authentication code. w/2-3"x#10 sms max 75 sq ft tributary area. Printed copies of this document are not'considered signed POST BASE CONNECTIONS. and sealed and the SHA authentication code must be verified on any electronic copies. r;:: ' • Sealant. . ---,:-:-•-:i' Header, extruded or brake formed with t t' • . 1-1/4"min bearing leg. Rafter. . `1ij�...kit ",: . . 2-2"x#10 sms (Il�, ac each rafter. ��� __ 'oof panel. . 1"x#10 sms 12"oc. .. . \_______ 3-1/2"x#10 teks into bottom and 1 into Fascia. top riser for pan roof or 2-2"x#10 sms thru • boxed pan into fascia and 8"oc.top and ROOF TO FASCIA CONNECTION. bottom for composite roof. -Comp roof. Comp roof. a —- - __ _' • SCREEN/GLASS ROOMS & ENCLOSURES • REVISIONS' \,����ttillliiii�i • 3x2 or g 1 El `\ G�� �SEcce•�, 4x2 edge \�,��,•�;�G NS .O �� beam. •.4 • ,: .„. * : No.48288 ; sms. 10 Vincent Seibold EE.48288 sms. ¢�e; l r 1015 Atlantic Blvd.#128 71 STATE OF %e Screw _ I l 1I --- Post. Atlantic Beach, FL. 32233 i��• Al P �? bosses i i i! Phone: 904-568-4112 ��FSS+• ORIO,�t,-- POST/BEAM SCREEN/GLASS ROOM. • ' I l� f,OL1161 i1 P5 3• • DocuSign Envelope ID:C126AB7B-BF4B-4A70-9992-20873920EAA2 ! . 4" x #10 sms w/ 1-1/4" neoprene washers © 3 - 1/2" x #8 teks ea.roof 3" x 12" 12" oc. 3 - 1/2" x #8 teles each 3", 4", 6" comp. pan for non-insul. roof.: /pan roof roof pan for non-insul / . roof pan roof. RINI MI- 2x3 or 2x4 beam or 2x3 mated with 1x2 2 - 1/4" x 41/2" thru- AI 2 x post or 3x3, attach w/ 2" x #10 . bolts each post -®�- 4x4, 6x6 notched I sms @ 24" oc. ° for beam at edge Corner post 2x2 w/ Beam see drawing./ or center. 1x2 attach w/ 2" x POST / BEAM CONNECTION #10 sms © 24" oc. Cont. extruded header Sub-fascia j 1/4" x 1-1/2" or .032" brake formed req'd when' Cont. ext. header header. I [facia less tap-cons © than 1-1/2"! 3" x 12"pan roof 12"oc. for _ or comp.roof. block wall or 3 pan roof 111. thick or 3" x #101 !for stud wall or 3 ,4', 6 s •1/4" x 1-1/2" ` 2 - #10 sms comp. roof sms into tap-cons 12"oc. each stud. rafters 3 - 1/2" x #8 teks 3 - 1/2" x #8 teks / each roof pan. into each pan or -V Use angle where Alternate: 2 - 2" x#10 sms thru boxed pan into host. 1/2" x #8 teles into req'd to plumb hdr comp @ 12"oc. to fascia 1 Or 1" x 2" rec. channel min. 2 - 2" x #10 sms 1/2"x#8 teles 1 w/ 2 - 1/2" x #8 ea. 8"oc. I le and into post. . thru post SMB into — °� g p screw grooves. lum. flashing. • Sealant under flash. :locking to fit. • Chairrail attach • �lywd/OSB bridge. Composite or pan roof. i to post with 1" . x 2" x 1" x.062" ti 2x2 chairrail angle clip w/1/2" + ___}.--------.. .. - I x #8 teks. SMB or patio post 1 := 1 BEAM BEARING DETAIL �� #10 sms thru ���� comp. into 2x2. 5¢_�_ Comp. roof attach H @ 12.P w/4', 5", or 7" x #10 ��i 2x2 x.044 ext. sms w/ 1-1/4" _o- 4"x#10 sms thru 1 :, neo-washer.© 12" oc. 1 2x2 into rafter tails.1 r < ; ! 1a ,- -- Rafter tail. ` - •• WEDGE ROOF CONNECTION DETAIL 111 ROOF JUMP • Pan roof use III3 - 1/2" x #8 sms. \\011111/0/, Beam see plan. '4/ ‘' F `,l s,0,"'. * i No.48288 '/� This item has been electronically signed and sealed by /��� , 1 Vincent Seibold PE 48288 using a SHA authentication code, Vincent Seibold PE 48288 73 . STATE OF 1015 Atlantic Blvd.#128 % O s ��� Printed copies of this document are not considered signed /-jA� ,'S(oRtgb, '\��� and sealed and the SHA authentication code must be Atlantic Beach, FL. 32233 verified on any electronic copies. 904-568-4112 /"2,' 'ONAL'e \\\\ _� SOI-J"04 -f, 5A. Wesley's Patio Rooms 9951 Atlantic Boulevard, Suite 317-5 Jacksonville, FL 32225 Office Phone: 904-998-0300 Office Fax: 904-998-0030 PRODUCT APPROVAL INFORMATION SHEET LIC#SCC131149576 LIC#CCC1328906 Project Name: fl€ziz Ci? ' i- Permit # Project Address: 5/7 5fGvia Z.41- Cj� Manufacturer Product Description Conversion FL Product # Expiration Date f"72 aAilt 69"1/4 /evoc Zoaa 75(04 t J A/3/Awa 3 F idehav )9( %avz Gass goaP 5'i 7i'z-- Y/.0f,R 5 Authorized Project Agent: David R. Wesley 'Arica j _?0,/ ,�