945 PLAZA RES23-0078 0E....:'' 'r, 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
'j;19 V IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: 945 Plaza Rd, 32233 Permit Number: \ s zj O U 78
Legal Description_30-6017-2S-29E RE# 171262-0000
Valuation of Work(Replacement Cost)$ 12,000 . Heated/Cooled SF_975 Non-Heated/Cooled_200
• Class of Work: ONew DAddition *Iteration ❑Repair ❑Move ❑Demo ❑Pool ,Window/Door
• Use of existing/proposed structure(s): ❑Commercial ciffiesidential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes IKNo
• 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: ; 1 1*-_-_-_.E-___t-_/_- 1 ' r-L.,c7U r-4 (..it,-... l-
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Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name Mikhail Kushnir Address _13536 Chauny Rd
City Jacksonville State_FL_Zip 32246 Phone_904-597-5668
E-Mail _Mike,Kushnir@yahoo.com
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company Seaco Construction Group Qualifying Agent _Donald Merritt
Address 9750 Arnold Rd City_Jacksonville_State _FL Zip 32246 —
Office Phone _904-337-0303Job Site Contact Number 904-337-0303
State Certifica>on/Registra>on # 11-5-_`7' 3S E-Mail A eALo FL-/2 e (� � c '
Architect Name&Phone# 84/0,;(,
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt 0 Expiration Date
Application is hereby made to obtain a permit to do the work and installations as indicated. I cer>fy 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
construc>on in this jurisdic>on. 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 addi>on 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 FIN CI -G, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING Y OTICE OF COMMENCEMENT.
�_/-
(Signature of Owner or Age (Signature of Contractor)
signed n and swo to(or affirmed)before me this ) day of Signed and sworn to(or affirmed)before me this 1 Z-day of
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[ roduced IdentificationL� •
/Produced Identification
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