598 CLIPPERSHIP LN RESO23-0038 frt9
rs'= Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department **ALL INFORMATION
V 800 Seminole Road, Atlantic Beach, FL 32233HIGHLIGHTED IN GRAY
r IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us Rg Q aJob Address: - 98 VCL/p0te2 (H/P '- # Permit Number: soZ3-b03
Legal Description isbt/a) Riedel j SMS/',.0y RE# / 7®103 — 02367
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Valuation of Work(Replacement Cost)$ �,f��0 Heated/Cooled SF /v //A Non-Heated/Cooled /i;
• Class of Work: ❑New ❑Addition'Alteration ❑Repair ❑Move ❑Demo OPool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial Aesidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes ❑No ,,/I/►
• 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: r4,4/.SGpelt
i/4 At J
Aimy//geL rum P //t/s // y7i1 sJ•,W. 99s-sa .f/-
Florida Product Approval# be) G'-de A./ r/ 4k 1,15/24. for multiple products use product approval form
Property Owner Information
Name G I �-i1v1 '��4Ke i Address K"9 $ C/ i ppe( Ship GANG
City A'E'I • 81/I. State PI Zip 32.733 Phone qac/- 5 63 - 19119
E-Mail 9/enh yeakei h/1AJ/ .COW)
Owner or Agent(If Agent, Power of Att5rney or Agency Letter Required)
Contractor Information
Name of Company SO ti/tUlf.)Z Qualifying Agent
Address 1 DZ- P/tit • City kifs*ii L A(f State j / Zip 7 2 Z�i Z--
Office Phone 94I 386- 57$.7 Job Site Contact Number 5 L!
State Certification/Registration# ----^ E-Mail re.101.d A're10 ' de4//05.014741,4,144.f.O !
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer .all3M-ems OR Exempt D Expiration Date S'''' 21 ' 247-J
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 i a 0;EY BEFORE
RECORDING R NOJIC OF COMMENCEMENT. / 1
44,
(Signature of 0 or Ag *- ZZ II/II D
(Signat re of Contractor) / 00.-
Si ned and sworn to(or affirmed)before me his L •ay of Signed and sworn to(or affirmed)before me this ( day of f F
LA I in 'ct ' ► 2i' Z3 Tod ILroki.. g 34
Yi VI•I
.. 3.c V.
KASEY KING ' O a � 3 -• Q_
'*' 4. '* MYCOMMISSION#HH352750 ' (Signature Notary) (Si nature of Notary) �.
',A,It EXPIRES:January 23,2027 la m iv XI
[ ]Persona y Known •' [ ]Personally Known OR CD g Z
O�W T
()c)_Produced Identification f Produced Identification N w s
Type ��1 Yi Lka ( '\J ( Li Ut,Y^V. T PL Q� o =.
T e of Identification: Type of Identification: d
MAP SHOWING SURVEY OF
LOT 18 , BLOCK 1, SEASPRAY AS RECORDED IN PLAT BOOK 35 , PAGES 64 AND 64A OF
THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY , FLORIDA.
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