1777 W PARK TER RESA22-0024 application Building Permit Application Updated 10/9/18
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City of Atlantic Beach Building Department **ALL INFORMATION
,,_ ��/' 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
'�';�� IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us /� /I
Job Address: I !} / PA�k T E2 R A W65( Permit Number: �E S Pet-22,--OU Z'T
Legal Description 3 y- i r t)y -2 j-11g SELLA MA'tgNA Viva S dor 24 `411E# l i:2a2d•- 03 B Z
Valuation of Work(Replacement Cost)$ 3002 000,0J Heated/Cooled SF (liD Non-Heated/Cooled /v14
• Class of Work: ❑New (gAddition ❑Alteration ❑Repairer�❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial L�SResidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes filo
• Will tree(s)be removed in association with proposed
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iisaw 5 ADORESS
Florida Product Approval# SEE S HEtr for multiple products use product approval form
Property Owner Information
Name r144Y F2A4"cf, ()✓E d-cErrE Address /77? PEAK 16"4(t .. Sr
City Art.9^'r,c /3(A( $11 State FL Zip 32.Zi 3 Phone Flo'/. Z 96. c/6//
E-Mail Mwr y FrcnCeS boll tP be/ISovr/, . ner
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) O1,--4-1<
Contractor Information
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Name of Company StabHrn,t C°Asr Cc.,', itutr/6,,t,1 ,n.kualifyingAgent 'f OS, H m X,M4/i/Ci .
Address 5-/3 i//riel/G L4,4d City l 8 State FL Zip 32 3 3
Office Phone 109. 2_01 /Ot f/ Job Site Contact Number got/ 2 c-$ /6? Y
State Certification/Registration# C- C. /2_5139 5 E-Mail ice e. 5 inShIC
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Architect Name&Phone# C g A iv 1Lt,i*/vIS OF s,G N 2 I,v( . 401 3Yr / y/3
Engineer's Name&Phone# SA60 S TRuc,?lil4c. F_n.6 ia..Ek,ti C 90I , 712. . r7 r0
Workers Compensation Insurer wed 6 1 6 A jo1.v7lU/ ., in,.. OR Exempt❑ Expiration Date /0/1/ 2 2
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 AN A P • '°► Y BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
(Signature of Owner or Agent) F'�
(Sign.,ure of Contractor)
ned and sworn to(or affi m:d)before me t,is' y of Si ned and sworn to(or a'irm:• before meA, is , day of
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•''Pvpu TONI GINDLESPERGE ,
o" : MY COMMISSION#GG 3
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[ ]Personally Known OR ti : EXPIRES:October 6,2023 ]Personally Known OR ;.S;,:,.,
..!,,I.. o . � TONI GINDLESPERGER
[ ]Produced Identification '::��Ft° BondedThruNotaryPublicUnderwriters ]produced ldentificatior �� ,a °*; MY COMMISSION#GG 353178
Type of Identification: - Type of Identification: :°:'•,, "r�y .f.= EXPIRES:October 6,2023
e Bonded Thru Notary Public Underwriters