330 OCEAN BLVD RERF23-0072 ''+ Building Permit Application Updated 10/9/18
S 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 77
Job Address: .3 0 0Gea4-, n)U ' `r) Permit Number: E_R�/3 — CD- 0-7 Z
Legal Description: 549 j 6-7-6-7.1 a1324Hsi)(4 L ge-A , L0 c2)1 RE# 1iD 1'7 b 00730
oo
Valuation of Work(Replacement Cost)$PI IiT O ' Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration ❑Repair [Wove ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial Residential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes g1No
• 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: 51,1 Al I do f e?o(k,e3-i et-c-1-
Florida Product Approval# 1012 9 for multiple products use product approval form
Property Owner Information
Name 1(-,..)i,e, _r)a4 , or'1'e- Address 330 er—eq Qlv)
City Q'H'la,.-- qt.,I, State fL Zip -7?-7-37 Phone
E-Mail
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company Townsend Roofing&Construction Services, Inc.Qualifying Agent Chris Townsend
Address 1740 Cocoanut Rd.Unit 101 City Jacksonville State FL Zip 32224
Office Phone 904-645-5887 Job Site Contact Number Chris-904-472-4479
State Certification/Registration# CCC1329269 E-Mail chris@townsendroofing.com
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer Zurich-American Insurance Company OR Exempt❑ Expiration Date 120131/2 3
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,BOIL_ERS,HEATERS,TANKS,and AIR CONDITIONERS,etc. NOTICE::In addition to the requirements of this
hermit;there may.be additional restrictions applicable to this property that may be found inthe public records of this county,and
fhere agenciedditional permits required from other governmental entities such as water management districts,state agencies,or
say be
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 ATTORNEY BEFORE
RFrCDI Y®U NOTICE OF COMMENCEMENT. 2,., r,
Sig ature of Owner or Agent) (Signature of Contractor)
2 ri
Signed and sworn to(or affirmed)before me this 3 day of Signed and sworn to(or affirmed)before me this 3 day of
l '?,Q -,,by 30(.1.V\ v rtz Yi Zo- 3 ,by.4 C- - 'ra wAsekatl
f _`
�J(s �� ��.r e .f Nota
""""� MARTIN ARELLANO
.• r r ii
— — itpo Nota Public-State of Florida
t�i'*'s Notary��iir'►�'••. ALEXIOUS HELEN,GAMEL Personally Known OR �. Commission i.HH 286664
ersonally Known OR .,off-* y ''�rflt c` My Commission Expires
�` i Notary Public•State of Florida
Produced Identification [ ]Produced Identification °��.,;;,;;�.�`�
[ l u• .c Commission ri HH 43737 July 07,2026
Type of Identification: ••' 'oFi,• My Comm.Expires Sep 17,2024 Type of Identification:
Bonded through National Notary Assn.