1755 Beach Ave RESO23-0064 Building App/Survey Building Permit Application updot,2�110/9;19
S1 City of Atlantic Beach Building Department **ALL INFORMATION
r i 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
IS REQUIRED.
Phone: (p904) 247-5826 Email: Building-Dept@coab.us y�LC REQUIRED.
Job Address: S� D C�,,11Ch AV i ` Permit Number: r—%—, / `�l�'I`G�'-1n
Legal Description �a�"3 z,Noci`6 Ai),grA1Ci3�tUH I )Nit ND. I RE# 16 �6 /72.4_ 0 0(J
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Valuation of Work(Replacement Cost)$ 23X. 00 Heated/cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial 6dResidential
• If an existing structure, is a fire sprinkler system installed?: Dyes ❑No
• Will trees be removed in association with proposed romect? ❑Yes must submit separate Tree Removal Permit ❑No
Describe in detail the type of work to be performed: ,s(/�G/L/1�/Qtpl10
Florida Product Approval# NU Co cDo&7-W for multiple products use product approval form
Property Owner Information
Name Address . _ Am(114VIK _
City G State Al,_Zip ?7233 Phone — 3 "Z,00
E-Mail
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information _
Name of Company e _Qualifying Agent AIM
Address O Cityfjftj>ft/ - &14. State Zip 377 40
Office Phone & Job Site Co—nit—act Number
State Certification/Registration# NIA E-Mail / GI /� �S'nil} t�Y/� t"(//2 �%� 0
Architect Name&Phone# N y4 —�
Engineer's Name&Phone#
Workers Compensation Insurer Af 8 A-4 OR Exempt❑ Expiration Date o" " Z
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 CO ENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOU PRO ERTY. IF YOU INTEND
TO OBTAIN I N I G, ONSULT WITH YOUR LENDER ATTO EY BEFORE
RECORDIN URE OF COMMENCEMENT
t .
�.
(S n r Owner or Agent) (Signature of Contractor)
2
Signe and sworn to(or affirmed)before me this �Z day of Signed and sworn to(or affirmed)before me this day of
U1,A- 2c�'Z3 by S it inSCY 7 _ 14e 2C23 , by - LY A
nature o Notary)
VANESSA ANGERS
*' MY COMMISSION#HH 244118 [ Personally Known OR
[ ]Personally Known OR =;�� P;= «PrP ••
[v}�roduced Identificati -Ep:.�°; EXPIRES:March 23,2026 [ ]Produced Identification VANESSA ANGERS
Type of Identification: Type of Identification: Ady COMMISSION#HH 244118
EXPIRES:March 23,2026
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CNECIQD BY: FlIE. ra>.rr WTI9Y: �: BOATWRIGHT. LANDSURVEYORS inc. 1500._ ROBERTS DRIVE_ JACKSONVILLE BEACH FLORIDA _ DA,E:,la6a,n-,a., sxm�DF� (90{)2q-6550