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193 BEACH AVE 3 COMM22-0052 KITCHEN RENO e-""1%-- Building Permit Application Updated 10/9/18 ''i1 City of Atlantic Beach Building Department **ALL INFORMATION / 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY o;=t% IS REQUIRED. Phone: (904) 247-5826 Email: Building-Dept@coab.us !t' a Permit Number: mm ?-7----00S Z Job Address: /93 eg�CA �� Uvc7 3�' ��� 'Q Legal Description/6-2S-2gE 56recoveCbtic' UNnt3 Q/R 55a' - 2o93 RE# 17 os/q- /d o.c Valuation of Work(Replacement Cost)$ 2 S°°° Heated/Cooled SF 76 $ Non-Heated/Cooled • Class of Work: ❑New DAddition *Alteration ❑Repair OMove ODemo ❑Pool ❑Window/Door • Use of existing/proposed structure(s): ❑Commercial $Residential • If an existing structure, is a fire sprinkler system installed?: ❑Yes *No • Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) PNo Describe in detail- the type of work to be performed: / ', 7e / 6 e 4/0 V 4.--6164) Florida Product Approval# for multiple products use product approval form Property Owner Information Name fdittasr7 Nc,.,t(� 9u,.1/ Address /Q3 D€ac 5 Rile C•Ff/ !C'3Cityl iCdc 4 y State 4 Zip 72Z S) Phone 3 2 *- 6.$ 6-©© 2V E-Mail Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information nnt, Name of Company/V t//e.j(I1 tlW?hn Ct4 C7"iNg t r"c tie/at Quali in Agent a,Okt 4P1 l", 'V Address La 3"; f tI!plA rS-rD r City J. X State Zip 3 ' 2Z Z Office Phone 2 5D- q ell Job Site Contact Number 6 35- 1 `/8 State Certification/Registration# C'3C f Zsdl VZ- E-Mail ot.f 56NLt1 (/114./4 c601G4f7-•/rtT Architect Name&Phone# Engineer's Name&Phone# Workers Compensation Insurer OR Exempt& Expiration Date 313• z I 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 LENDS a'? A NEY BEFORE RECOR ING YOUR NpTICEp7".CEMENT. I (Signature of Owner ' (Signature of Contractor) ' Signed and sworn to(or affirmed) before me this da of Signed and sworn to(or affirmed)before me this � day of g y Nov r rr,1,. r , by AJLv1 t y /j") ,(I P'„p1” k r>t,-, 2-v z by VI)U a.wj, -A 1 1 i--).--- L 41' - � � L" "ate_—— — �}---- r i DWAYNE HUGHES II :�D`.•'::k.. A QU _INE F. IACANDONG ,J `'.. - MY COMMISSION#HH 196158 I :P• 1;s^`: Notary Public-State of Florida i. �: Commission M GG 956658 +,�' Q r EXP,i1ES:March 7,202E IS(IPersonally Known OR 4 d p PersonallyKnown OR :;oF ri?,,:' Bonded Thru Not- Public C, ars ' My Comm.Ea fres Mar 5,2024 [ Notary_ Underwriters ( ]Produced Identification Bonded through National Notary Assn. '6Cl Produced Identification 1 - - -- __ Type of Identification: — — — — — —— — — — — Type of Identification: -Ft/ p e-t,i r sil-Z'r 54 E 3 d r F ' r ° s P - IP 1 r o ` ' Z -i r z E 0p / 0 i2- -,...._ r.) 3 ,.... icie 7 c c , (n ,o (b , , o p , o 6( I- ‹4 `— - C C LP (r0 'i iji r 0 (,)i -o 0 rn filI 195 ai" / 57 " ,12" 30" / 31" ,, 1" 24" / 6Z" / 79 " 34;" 26 „ / 84Z3„ " IP 6.T: t S„ / � 7 42,7 57 12„ 30" 15" , „ 31" / 2 Pm 26" / 30" / 1230 W3012BD W3030BD ir- 'ti A2430-R ;,1 FH KVUC600KSS DG3-1!KDFE104KW1 ; _a BF3 I I-1vertical divider r-n_, — w - k. ./7„ y O - 76" 1` N _I_! =w NI. I� %�/ B30BD B30Bp_'-o1„ 17" 14"--/ I I 31" / I