2279 SEMINOLE RD UNIT 6 RES23-0246 Building Permit Application Updated 10/9/18
(J City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@ coab.us IS REQUIRED.
Job Address: 2279 Seminole Road ()n l4 Cc ,Permit Number: R ES 3 - DZ `
Legal Description AG-212 37-2S-29E.24 DEWEES GRANT S/D PT LOT 1 DIV 3 RECD O/R 16851-1a# 168345-0050
Valuation of Work(Replacement Cost)$ 100,000 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 ❑Residential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes ❑No
• 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:
Kitchen renovation,interior renovations U P ,�,c_ 'y\,r s s
Florida Product Approval U for multiple products use product approval form
Property Owner Information
Name Oliver and/or Katherine Oyama , Address 2279 Seminole Road
City Neptune Beach 1-1A14)..(44:
`'tel i. State FL Zip 32233 Phone
E-Mail oliver.ovamaCEamail.corn
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company Quick Construction,LLC Qualifying Agent Mike Quick
Address 436-B Osceola Ave CityJacksonville Beach State FL Zip 32250
Office Phone 904-372-0742 Job Site Contact Number 904-660-8679
State Certification/Registration tt CGC1517983 E-Mail mike@quickconstruction.biz
Architect Name&Phone4*
Engineer's Name&Phone It
Workers Compensation Insurer OR Exempt ❑ Expiration Date
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 A ORNEY BEFORE
RECORDING� �1R NOTICE OF COMMENCEMENT.
(Signat e of Owner or Agent) (Signature of Contractor)
J ••
ned and sworn to(or irmI�jd�)before me this ay of Signed artd sworn to ffir d bef•re me hi . day of
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(Signatur Notary) •ignature of Notary)
[ ]Personally Known OR ersonally Known OR
Li-Produced Identificatjon / [ ]Producecl)�'a-1-1+-a.-
T f ti " a "o • c�Q(t7f1, I.UPS U UM< Type of Idengfi `;fir ., JILL MCDOUGALL
f*: ia;r i• MY COMMISSION#NH 235147
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`_ 1� Notary Public- •
State of Florida -:fFa;f(o7':, EXPIRES:June 14,2026
3 . 49/ Commission#HH 182060
My Comm.Expires Oct 6.2025