655 SAILFISH DR RES24-0074 'sk
�� : City of Atlantic Beach Building Department PERMIT# RES 24` ba.74
y w- 800 Seminole Road,Atlantic Beach, FL 32233
"ALL Information required to process
1 r,;ar Phone:` (904) 247-5826 Email:6uilding-DeptC'coab.u5
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Job Address S'S S2►t( `S( p �' RE# (7( V WOO
Legal Description o- - - .. . I O 0 n , s AA . .a 0 131 ,
Valuation of Work(Replacement Cost)(W II 12;60 Heated/Cooled SF Non-Heated/Cooled SF
•Class of Work: 0 New ['Addition ❑Alteration rgRepair ❑Move ODemo 0 Pool ❑Window/Door
• Use of existing/proposed structure(s): D Commercial'{Residential • If existing structure, is a fire sprinkler system installed?:DYes D No
•Will tree(s)be removed in association with proposed project? 0 Yes (Must submit separate Tree Removal Permit) 15ijNo
Describe in detail the type of work to be performed:
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Florida Product Approval# FL 1322-3 (For multiple products use Product;_Apgroval Information Sheet)
property Owner Information Name (0(ne t;S . S f eleN Phone .3 ./ --552)Q 7ftf7
Address CvS3 5'a, l :,)Vi 6, -, t`-��`"^ City �T/7�f.c 4.e.2,/, State (( 2-+P 3 2233
ail e)' Sc S n r Agent If Agent,Power of Attorney or Agency Letter Required)
Em t'1:r h ��t ���k �+6 [
Contractor Information Name of Company go i".6.- ,�,I eiM fe'ntAirc ac._ Phone q--S3 4/ 33-t/641"
Address /6 3 CvI(Z( L L'ct.(C • City S v,'n f --0.,3,3 A"..,J4tate 4 1_ zip 3?0 5 7�_
Qualifying Agent R.1,,,,, ,.. ilu-+,f r, lute ti a— State Certification/Registration# , , ,10; dAir
Email 9D 1/6Tf{eal Whir;. (9 L v1�'/s G1,.-, Job Site Contact Number '
Worker's Compensation Insurer - la OR Exempt ix Expiration Date i' I Z.0
Architect's Name Email Phone
Engineer's Name Email Phone
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,•1 U INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
A ' ORE RECORDING YOUR NOTICE OF COMMENCEMENT.
41_eorAge ��(Signature Contractor)
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Signed and"f" n to(or affirmed)before me this 27th day of Signed and sworn to(or affirmed)before a this Z r iay of
March , 2924 by -p rnelis Steyn MUY'C- V , 207. 1 by
VI eT O'
Signature of Notary j { Signature of Notary
PersonallyKnown OR Produced Uficatlon ( ersonally Known OR ( I Produced Identification
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Type of Identification: I.. 1 Type of Identification: ,p`'".'4"rctk KR S1�T #'
Commission I HH 1$3774
Expir s Octobst 9,2025 $
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=o.. . .<� TON!GINCIE�PFRGER
MY COMMISS!0`#HH 407122 +
t' � !::: EXPIRES:Ocl;) er 6,2027
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