1470 OEAN BLVD DEMO23-0008 --=.*--. 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) 247-5826 Email: Building-Dept@coab.us IS REQUIRED. �
Job Address: 1470 Ocean Blvd Permit Number: l--)C--(Y\0 Z3 -00c .)
Legal Description Lot 5 Block 59 Mandalay RE# 171-855
Valuation of Work(Replacement Cost)$ 5.000 Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration ❑Repair EMove 51Demo ❑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) ❑No
Describe in detail the type of work to be performed:
Home and pool demolition
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name Rick and Becki Saas Address 1470 Ocean Blvd
City Atlantic Beach State Zip 32233 Phone
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company Signature Homes and Development Qualifying Agent Rex Williams
Address 1474 3rd Street S City Jacksonville Beach State zip 32250
Office Phone Job Site Contact Number
State Certification/Registration# CBC048996 E-Mail
Architect Name& Phone#
Engineer's Name& Phone#
Workers Compensation Insurer OR Exempt ❑ Expiration Date
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 PR n 'ERTY. IF YOU INTEND
TO OBTAIN Fl ' NCING, CONSULT WITH YOUR LENDER OR AN A /i • NEY BEFORE
REC it Y'UR NOTICE OF COMMENCEMENT.
(Signature of Owner or Agent) "gnatura-o ctor)
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