439 Irex Rd RESA23-0008 - Revision 7-13-23Revision Request/Correction to Comments
City of Atlantic Beach Building Department
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Ir . rcevision to Issued Permit
Project Address:
Contractor/Contact Name:
Contact Phone:
OR Corrections to Comments
I "\I
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Description of Proposed Revision / Corrections:
Email:
**ALL INFORMATION
HIGHLIGHTED IN
GRAY IS REQUIRED.
PERMIT #:W,et5',' ! y00 2
Date: -711'77)2
� - U m W4t K !!! � I i J 6040, e Cr 0,11C T-6 I M -A"
I Al G1 . QUV✓t ?C�yaLaS I -LS .
I C.a/k1 ( affirm the revision/correction to comments is inclusive of the proposed changes.
(printed ame)
• Wi roposed revision/corrections add additional square footage to original submittal?
o r, , es (additional s.f. to be added: )
• propose vision/corrections add additional increase in building value to original submittal?
NO r ,'Yes (additional increase in building value: $ (contractor must sign if increase in valuation)
*Signature of Contractor/Agent: zS
(Office Use Only)
❑ Approved ❑ Denied ❑ Not Applicable to Department Permit Fee Due $
Revision/Plan Review Comments
Department Review Required:
Building
Planning & Zoning
Tree Administrator
Public Works
Public Utilities
Public Safety
Fire Services
Reviewed By
Date
Updated 10/17/18
Building Permit Application
City of Atlantic Beach Building Department
J 800 Seminole Road, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: '
Legal Description
OF Pr o)x
Updated 10/9/18
"ALL INFORMATION
HIGHLIGHTED IN GRAY
IS REQUIRED.
> Permit Number:
KDYA+-PAuMS REn 1 %) t 12 - DODO
Valuation of Work (Replacement Cost) $_ Heated/Cooled SF Non- Heated/Cooled
• Classof Work: ❑New (Addition ❑Alteration ORepair ❑Move ❑Demo UPool ❑Window/L
• Use of existing/proposed structure(s): ❑Commercial blResidential
• If an existing structure, is a fire sprinkler system installed?: OYes CKNO
Florida Product Approval # for multiple products use product approval form
Property Owner Information
Name /J/!vC 4e "j544 Address 4/39SkEX rtolOW
City i4AW-r1cState FL Zip 7�.273 Phone
E -Mail wti rkkr% 2 cowttagF j -
Owner or Agent (If Agent, Power of Attorney or Agency Letter Required)
Contractor Information I NL
Name of Company LOtJ VG Old 5£RVIG4i (f mlifying Agent CF441G S>'572#4*►'z)
Address City X* State ^, Zip SzoBz
Office Phone _ Q '1,�9 /DOS Job Site Contact Number 90 759 /003
State Certification/Reaistratinn# GBb/2602 914 cne�o "Mn✓n.9.L La-.! _.__fl
Architect Name & Phone # _ Ylikynll? 662= 1-719 1
Engineers Name & Phone # '
Workers Compensation Insurer ADP OR Exempt ❑ Expiration Date 2 • Z$
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 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
_ RECORDING YOUR NOTICE F COMMENCEMENT.
..��y:.
(Signature of Owner or Agent)
VS nature of Contractor)
Ig`ned and sworn to (or affirmed) before me this.day of
Signed and sworn to (or affirmed) before me this 7 day of
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E- 2OV) by cf+A* spyr}y2.1
9-:23
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(Signatu of No ry)
f t] tar)_
(Signature of Notary)
o �
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]Personalty Known OR
"'V'!'!,, MARY N. PONTELLO
Personally Known OR
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Produced Identification
pe of Identification: rt 17 / �GiC t� L'.s L=' 2 G�.� ✓
_ ' ;Notary Public -State of FI•rid4
O Produced Identification - 5 Commission N HH 344910
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Type of Identification: .' My Commission Expires
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