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2019 BEACH AVE RES24-0070 Building Permit Application Updated 10/9/18 <.i::,,,..,;,< 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: 2019 BEACH AVE, ATLANTIC BEACH 32233 Permit Number: I-c ._sZ�t — v v / 0 Legal Description 15-93 09-2S-29E N ATLANTIC BEACH UNIT 3 PT LOT 67 RE# 169708-0000 Valuation of Work(Replacement Cost)$S x(-200 b 0 Heated/Cooled SF Non-Heated/Cooled • Class of Work: ❑New DAddition DAlteration DRepair DMove DDemo DPool 6d.Nindow/Door • Use of existing/proposed structure(s): ❑Commercial 'Residential • If an existing structure,is a fire sprinkler system installed?: :Pies ❑No V N/A • Will tree(s)be removed in association with proposed project?DYes(must submit separate Tree Removal Permit) 21No Describe in detail the type of work to be performed: INSTALL 2 MOTORIZED ROLL DOWN HURRICANE SHUTTERS Florida Product Approval# for multiple products use product approval form Property Owner Information Name CARRIE L. LOWTHER Address 2019 BEACH AVE City ATLANTIC BEACH State FL Zip 32233 Phone 814-434-2977 E-Mail Owner or Agent(If Agent,Power of Attorney or Agency Letter Required) Contractor Information Name of Company CUSTOM STORM SHUTTERS DIRECT,INC. Qualifying Agent STEVEN M.LoPRESTI Address 826 HULL ROAD City ORMOND BEACH State FL Zip 32174 Office Phone 9024-8401 Job Site Contact Number State Certification/Registration# CBC1255541 E-Mail rose@cssdus.com Architect Name&Phone# _ _ Engineer's Name&Phone# 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 LENDE• R A , e/N BEFORE RE R©ING YO NQ'TICE OF COMMENCEMENT / . (spat of Owner or Agent) (Signature of Contractor) Signed and sworn to(or affirmed)before me this-4. fday of Signed and sworn to(or affirmed)before me this day of /14,-/C 20.-1/ by C-c >r Lo' .- __ ,by. STEVEN M.LoPRESTI • ry. A : AMNIA` (Signature of Notary) i-vite,64ft (•ignat e of Nota „" WILLIAM POWERS [ ]Personally Known OR :;p•' ; • LUKE GILLIAM Personally Known OR Commission#HH 380251 [.J Produced Identification MY COMMISSION#HH 352746 `?:/ y ]Produced Identification ,�F moo, Expires Jul 29,2027 Type of Identification: `.'re EXPIRES:January 23,2027 a of Identification: ,,•... >�r1Q..