1399 VIOLET ST RES24-0049 3s- v,),, BUILDING PERMIT APPLICATION FOR INTERNAL OFFICE USE ONLY
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City of Atlantic Beach Building Department ;�
PERMIT# Iles Zq-- b04ci
800 Seminole Road, Atlantic Beach, FL 32233 information required to process
"'' '' Phone: (904) 247-5826 EEmai(&f.-
l:,,Buuildiing--Dept@coab.us
Job Address 139 I Vic.0 [.GI _'T. RE# / 7,d6/ ''12/�� /kk�(23
Legal Description i 0 - 3 `-( / 7 —oZ S— 29 G .5-- e. H /4/4,44-1 c, &c,/ 5 o�3, 1 F /N/6I 2
Valuation of Work(Replacement Cost) yQ 0 t Heated/Cooled SF 96' Non-Heated/Cooled SF
•Class of Work: ❑ New ❑Addition ❑Alteration I.ii •epair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial Pf esidential • If existing structure, is a fire sprinkler system installed?:❑Yes❑No
• Will tree(s)be removed in association with proposed project? El Yes (Must submit separate Tree Removal PermitONo
Describe in detail
the type of work to be performed:
XefietCt j--(5 "Ire ett. //14eA r• of -r-? i 57 I i'v wl e-lit- gaa roll
14 -Fee- A15\ fry— bio,/.
Florida Product Approval# F P . f 3,2.23 (For multiple products use Product Approval Information Sheet)
Property Owner Information Nape r"� Skil n c / 1' Phone 90 if 19 334(3Y
Address / 7, `� \( G em` c . City /1 . f C State FL Zip 3 2 2_3
EmailQcq fdeQel( y .m 7,(apt— Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)ir
Contractor Inforn�iation Name of Company A5--iv �Pl•�/a ( �aPhone gD f c13 3 3
Address P U 0(0 ? £I(fid 7d City -:11-0-2( State ri_ Zip 322 LI 7
Qualifying Agent Lq r-r Deck. ✓, State Certification/Registration# C 6 C /5 o,-(6 o a
Email c c C(ean g h'tG 11,U/ w
/0 N Job Site Contact Number 9oL( q 3 3H 3 Y
Worker's Compensation I er //WC 119721 r OR Exempt ❑ Expiration Date
Architect's Name W0 i'‘1Email A"D/✓6 Phone u
Engineer's Name tr Email I, Phone 1,
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 city/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 YOU PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT
MUST BE RECORDED AND POSTED ON THE SITE OF THE IMPROVEMENT BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
4iai . ATTO NEY BEF R RECORDING YOUR NOTICE OF COM NC MENT.
0_, - " trill
(Signature of Owner or Agent) igna ure of C� actor) •
Signed and sworn to(or . ed)before me this day of , Simon d and sworn to(or affirmed)'Irm' before met 's Z day of
P_r J , k� A by r+t .I a h 0 h , I•�ij by n.A1 • &_)(A
Signature of Notary _ • EFAIre I Signature of Notary i ��.
[ ] Personally Known OR [ ] Produced Identificatii [ ] Personally Known OR [ ] Produced Idecation
Type of Identification: .. Type of Identification: 6
a°`''•':'•"��:_ TONT GINDLESPERGER _2_:"•�F" ."c••�c,•• TONI GINDLESPERGER
' '•: MY COMMISSION#HH 407122 : 1-est MY COMMISSION#HH 407122
•:. hin pini _
+��`'P EXPIRES:October 6,2027 '-:-%:-.11117-9,--- EXPIRES:October 6,2027
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