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157 Belvedere St CITY OF ATLANTIC BEACH APPLICATION FOR PLUMBING PERMIT JOB LOCATION: v 1::� r OWNER OF PROPERTY: /�z /t/ -----4� --------------------- BUILDING CONTRACTORt - 40-1--------------------------------------- PLUMBIN G CONTRACTOR ZL ------------------- AND ADDRESS: 2 5-- 7� I------------ ay4- /�, 2- - ----------------- TELEPHONE NUMBERt -2- -_ 6 c;2 4�� -------�-2D- �/------- ----------------- - STATE LICENSE NO: TYPE OF BUILDING: SINKS SHOWERS ------------LAVATORY. -------------WATER HEATERS BATH TUBS DISHWASHERS URINALS DISPOSALS CLOSETS WASHING MACHINE FLOOR DRAINS SHOWER PANS OTHER ,_2 TOTAL FIXTURE � IUNT x 03. 50 $15. 00 = $---- --)---- ----------------------------------------- ----------------------- INSTALLATION OF PLUMBING AND FIXTURES MUST BE IN ACCORDANCE WITH THE MOST RECENT EDITION OF THE SOUTHERN STANDARD PLUMBING CODE. CALL A DAY AHEAD TO SCHEDULE INSPECTIONS (904 ) 247-5826 ———————----———————————————------- S DEMOT"MENT OF UiLdi46" [C BEAd clr*(OF ALT T WOROhT, 00 7!7, -7 PERMIT .1 NFORMAT I ON LOCATXON.J, 98 1 15 7 j'ZLVZb9R STRZETT 2 Addros's ev, TIC, 0 M 11, RI ATLAN, EA mit Typ f "�T ---------- tit;L�090 MI, o Wo rk A ERATION ,J?!TI,ON Se C t i on Lot it r Ty0e �466D LE FAMILY To 0 k6pased Use. 8 1 NO WOS D14e I I i t 1, i( 0 Subdivision, to t ii"ted Vairl,ut 0 .60 I r6v. $0 .00 MP -TOta I J-P ee S'4 $25 00 Jno Da APPLjrCAT ON 'FUS TION 25.06 tl, 'p, E STREET WA:Ta IXPA 'T M $0 .00 imp"I A" -0 0 CH I "S 00 R-AbqN 00�k $0 0- ------- 0 F AB 5* $0 00 S,0 .00 1:(1 let PITAL IMP ICA ROVE. S11TER-TW!77 'Ad4 '32205 do $0, UC I LLE :F�jj OVICTI ON Lice C 11 T Yp e, 4 SEC H I MIFACT�FEE,: OrO CON ST,,So**AR0 Trig. Nonce O"m FORMS AND FOOTING$MUST 86� 01900RI E POURING 7 PERMIT VOID SIX MONTHS AFTER DATE OF ISSUE PL AC _PUBLIP ACE BE LbiNG,MATERIAL 'F M' SISH, , 0 AND�DESRIS FROM THIS WORK MUST N'T BE �AND MUST 'CLEARED UP AND HAULEDAWA03Y EITHER CONTRACTOR OR OWNER PLY WITH THE MECHANIC'S �L -AESUL ,IN �4F" j"LURE:I 'A 1, N LAW, AN T THE :PROPERTY: 1�PAYINGTWICE FOR THE SUILAIN IMPR�EMENTIS" T DATION FOR ED ROVED PLAN ANDSU8Jl5CT TO,REVOI, JS'$Ull,r ACCORDI, G S WHICH ARE PART OF THIS PERMI, ROVISI OF AOO 16N OF LAW. ATLANTIC BEACH BUILD T ENT A60 05-4i `777=777X� A(;1- 3 CITY OF .P�� Te4d - 9&V6e4 800 SEMINOLE ROAD ATLANTIC BEACH,FLA)RtDA 32233-5445 TELEPHONE(904)247-5800 FAX(904)247-5805 June 9, 1995 William P. and Cathleen M. Holland 157 Belvedere Street Atlantic Beach, FL 32233 Dear Mr. and Mrs. Holland: Our records indicate that you are the owner of the following property in Atlantic Beach: 157 Belvedere Street a/k/a Lot 595, Saltair RE#170584-0000 Investigation of this property discloses that I have found and determined that you may be in violation of City of Atlantic Beach Ordinance Chapter 22, Section 22-71 (depositing of animal excrement) . We have received a complaint regarding a continuous obnoxious odor emanating from your rear yard. If this is in fact occurring I would hope that upon this notice that you would correct this situation as soon as possible. Sincerely, Karl W. Grunewald Code Enforcement Officer KWG/pah cc: City Manger VIA CERTIFIED MAIL RETURN RECEIPT REQUESTED STATES POSTAL SERVICE tl Officlal Elusin"s PENALTY FOR PRIVATE USE TO AVOID PAYMENT US MAIL OF POSTAGE,$300 L Print your name, addrejs andAT Code here CITY OF ATLANTM BEAN D Boo SEMINOLE ROA -5441 AILANTIC PEACH, FL Off oil I 111 11111 to Illiffill 1111111111 V CITY OF ATLANTIC BEACH MECHANICAL PERMIT APPLICATION Date: Property Address: -7 V- Own er: g am,�- �3 Telephone 3 '_ Contractorocean Emne- i-t-,n Telephone 4: tlp-s4E51 - r�4 Fax Contractor Address: In consideration of permit given for doing the work as described in the above statement, we hereby agree to perform said work in accordance with the attached plans and specifications which are a pan hereof and in accordance with the City of'Atiantic Beach ordinances and standards of Pood practice listed therein. Type of Beating Fuel: If other construction is being done on this building or site,list the building permit number: El ectri c Gas: —LP —Natural _Central Utility D oil El Other—Spec& MECHANICAL EQUIPMENT TO BE INSTALLED NATURE OF WORK ��Heat _Space _Recessed L.,<entral —Floor &-'Residential Air Conditionina: Room t-C-entral :1 Duct System: Material Thickness Z1 Commercial zi RefrioeratioD Maximum capacity ofm ZI New Building 2 Cooling Tower: Capacity gpm ID Existing Building CD Fire Sprinklers:Number of Heads zi Elevator: —- Manlift Escalator (Number) M *"Replacement of Existing Sysicrit 73 Gasoline Pumps —(Number) 0 Tanks (Number) ZJ New Installation ZI LPG Containers (Number) (No systern previously installed) El Unfired Pressure Vessel Q Extension or Add-on to Existing System ZI Boilers U Gas Piping ZI Other-Specify D Other-Specify LIST ALL EQUIPMENT AIR CONDITIONING,REFRIGERATION EQUIPMENT&CONDENSOR'S Approving Number Units Description Model 4 Manufacturer Ton's Agency 61114- eePOY036/110004 , C3 I&L� HEATING—FURNACES,BOILERS,HREPLACES&AIR HANDLER'S Approving Number Units Description Model P Manufacturer BTU's Agency 'a/ -1-0 J:�76 31 L-'13(-,6 .?- f T//f e200 TAUNKS Nominal Capacity Type Liquid Serial Approving Ho,,A,Manv &Dimensions Contained Manufacturer No. Apencv an VAvrn Ql-lfl Seminole Road - Atlantic Beach, Florida 32233-5445 Phone: (904)247-5800- Fax: (904)247-5845 - http://www.ci.atiantic-beach.fl.us CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD 1-7"M ATLANTIC BEACH, FLORIDA 32233 -5826 INSPECTION PHONE LINE 247 Application Number . . . . . 05-00030347 Date 5/16/05 Property Address . . . . . . 157 BELVEDERE ST Tenant nbr, name . . . . . . CONDENSOR/HANDLER Application description . . . MECHANICAL ONLY Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 Owner Contractor ------------------------ ------------------------ BIRCH, ROBERT OCEAN STATE HEAT & AIR 157 BELVEDERE STREET 1476 ATLANTIC BLVD. ATLANTIC BEACH FL 32233 NEPTUNE BEACH FL 32266 (9 04) 24 9-82 5 1 ---------------------------------------------------------------------------- Permit . . . . . . MECHANICAL PERMIT Additional desc . . Permit Fee . . . . 79 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 79 . 00 79 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 79 . 00 79 . 00 . 00 . 00 BUILDING MATERIAL,RUBBISH AND DEBRIS FROM TIES WORK MUST NOT BE PLACED IN PUBLIC SPACE,AND MUST BE CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER. "FAILURE TO COMPLY WITH THE CONSTRUCTION LIEN LAW CAN RESULT IN THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS"ISSUED ACCORDING TO APPROVED PLANS WHICH A _APART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR VIOLATION OF APPLICABLE PROVISIONS OF LAW. 146k BUILDING OFFICIAL in ,23 04 02: 36p P. 1 PROPOSAL 6 OAIC-P-e7��- No. 0elf-"q ew Date ;:I— Sheet No. 11 Proposal Submitted To: Work To Be Performed At: [Name Street Streiet/� ? 0-e-.1yt.,,Pee-e- Az— city State city'5��V-7 Z!�04LCJV tB!:E / ej 2 �jone k,.Date of Plan _a-a(,,l Architect '-We hereby propose to furnish the materials and perform the labor necessary for the completion of co -4 rl-Az"A T. �0-1-v o 61' We, I—In 010 A/e 7e, "no a e..b 'If/V10. -17o'94,Ze-4, _�71 ,v 4r, AT 5L, x;P4 c e- 7e' .4 44�;'4 �P1marer'i`a?XLisUuaranteecV-to be as specified, t t iu drawings and specifications submitted for above work and completed in a substantial workmanlike manner for the sum of with ay be ma 5 follok?:V,97- Dollars $ '25s�' 1'pm IeAl c:; 7/ AVV Any alteration or deviation from above s4-f1cations involving extra costs,will be executed only upon written orders.and will become an Respectfully submitted/Q4'-�z extra charge over and above the estimate.All agreements contingent Upon strikes.accidents or delays beyor d our control. Owner to carry fire,tornado and mhev neuebtiary iii5urance upon above work. Worl�- Per 01t7 kle men s Compensation and Public Liability Insurance On abOVa Work to,be taken Out by i Note—TN5 p3r ��may be withdrawn b if not a(:ce)ted withiu days- ACCEPTANCE OF PROPOSAL T he above prices.specifications and conditions are satisfactory and are hereby accepted.You are authorized tc,do hC VfDrk as specified. PaymenU will he madp as outlined above. Signature Date Signature CITY OF ATLANTIC BEACH CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS 800 Seminole Road 904-247-5800 Atlantic Beach,Florida 32233-5445 Fax 904-247-5845 Date (,0- zcl—c)L-1 PERMIT# Job Address Aig t iff ISSUED BY THE CITY (...(..S - Permitee: Mac. Telephone# e.,14 2-— C.5L49 Perm ittee Address: 1%5 Jaf 610 4 1 wAV I %A )i S ;Lj; Requesting Permission to Construct: y it, C—IRCULOA MAW _WA Y10 Ubmat MAN , AWK 1V Y V Sit Ak. Location: (Reference to Cross-Street) %GLUt h!(AC 0 Amb 14A Q A Applicopf qepf�j es that prior to filing this application he has ascertained the location of all existing utilities, both adrialand underground and the accurate locations are shown on the sketches. otification was mailed to the following Utilities/Municipalities: Jacksonville Electric Authority Yes (V No ( ) Date: &IA2FVA - Bell South Telephone Company Yes (w) No ( ) Dat Ferrell Gas Yes (VI No Dat 11 Comcast Yes (V4 No Date: A'wow 2. Whenever necessary for the construction, repair, improvement, maintenance, safe and efficient operation, alteration or relocation of all, or any portion of said street or easement as determined by the Director of Public Works, any or all of said poles, wires, pipes, cables or other facilities and appurtenances authorized hereunder, shall be immediately removed from said street or easement or reset or relocated hereon as required by the Director of Public Works, and at the expense of the Permittee unless reimbursement is authorized. 3. All work shall meet City of Atlantic BeaqL (�r Fprida epartment of TranEls-portation Standards and be performed under the supgrvision of 1,7a" 11, QJjJJ6&t Witacontractor's Pr9it, Superintendent) located at 19t.6^9 Telephone AE.: 4 6 - W - 4. All materials and equipment shall be subject to inspection tiy the Director of PhI0C IiA orks or his designeE;-. 5. All city property shall be restored to its original condition as far as practical, in keeping with city specifications and the manner satisfactory to the city. 6. A sketch of plans covering details of this installation, as well as, a copy of a recent survey shall be made a part of this permit 7. This permittee shall commence actual construction in good faith with days. If the beginning date is more than 60 days from date of permit approval, then permittee must review the permit with the Director of Public Works to make sure no changes have occurred in the area that would affect the permitted construction. 8. It is understood and agreed that the rights and privileges herein set out are granted only to the extent of the City's right, title and interest in the land to be entered upon and used by the holder, and the Holder will, at all times, assume all risk of and indemnify, defend, and save harmless the City of Atlantic Beach from and against any and all loss, damage, and cost of expenses arising in any manner of the exercise or attempted exercises by the holder of the aforesaid rights and privileges. 9. The Director of Public Works shall be notified twenty-four (24) hours prior to starting work and again immediately upon completion. OWNER Signed: kd,.,:t 4 Date'. f f F_ A unty of Duval, Before ni6 this day o Yt h Meevop 'y State Of Florida, has personally appeared 0 Notary Public at Large,State of Florida,C 1 0 of Duval.1) My commission expires: -7 1 Personally Known: or Produced Identification: ffl:- 1-3 L_ T:;56-7-ol) rp. JENNIFER SCHLUETER MY COMMISSION#DD 121301 EXPIRES:May 27,2W6 Bonded Thru Notary Public Underwriters Cc: CITY OF ATLANTIC BEACH D. Ford L. Higgins BUILDING / ZONING DEPARTMENT 800 Seminole Road D.Thompson Atlantic Beach,Florida 32233 (904)247-5800 (904)247-5845 Fax PLAN REVIEW COMMENTS Permit Application # C4- zasss Property Address: I S7 . i Applicant: 'F36(zC+V Project: This p it application has been: ;�Zroved 0 Reviewed and the following items need attention: Please re-submit your application when these items have been completed. Reviewed By: J-'2'a� Date: MAP SHOWING BOUNDARY SURVEY OF LOT 595, SECTION NO. 1, SALTAIR, AS RECORDED IN PLAT BOOK 10, PAGE 8, OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA. CERTIFIED TO: ROBERT LEE BURCH AND LESLEE A. BURCH GOVERNMENT EMPLOYEES CREDIT UNION OF FLORIDA PONTE VEDRA TITLE, LLC / RICHARD G. HATHAWAY, P.A. COMMONWEALTH LAND AMERICA BELVEDERE STREET (50.0' RIGHT OF WAY) FOUND 1/2- ]RON P PE 50.00- (PLAT) FOUND CROWS FOOT NO IDENTIFICATION 451 260 50.26' (MEA RED) ON TELEPHONE RISER 0.7- 0.2' 6 100.00' (PLAT) 1.2' x F— �i 'C Z Ld 66S UJ < R. 0 X 4 V) 8.5' 12.2' COVERED r WO. in DE K' &F w 5; C5 8.0' < !2, 0 11.4- 0,9: c, o2, :�Y� I K 0: < 10.0' -F- W CL L < la 000), ONE & TWO STORY P, 0 FRAME POSTED # 157 C w 8.0' .30.2' PWOOD DECK LOT 596 z Bosch 0"w"" LOT 595 app""01 10,111lis 1 with applicable . *!!�d g1k other local land o es. hpisio" not constitute for &me of pormb. Compliance T, pigIft&I"Coft wA oll~applicable gft% OW Fodwal pormiliting requirements 0, lobd IWI*Wokm of Me City of Atlantic FOUND 1/2- RON PIPE 0.5,LX—X—X—X—xl prior le the ssuanoe of a IDENTIFICATION UNDER WATER�-; 45-15-22- w 49.85- (MEASURED EN'nFICATI 50.00- (PLAT) -rkaurkma 14op:2 Director LOT 611 NOTES: ACCEPTED BY: LEGEND: R = RADIUS —X— = FENCE L = LENGTH ED = CONCRETE NOTES, 1. BEARINGS ARE BASED ON THE -ASSUMED- BEARING OF --N-45*00'00" W ALONG THE REVISIONS ------- - --------- in i3 04 02: 36p P. 1 PROPOSAL No. "DA -1.1 10? li�))elfkxl eWIDOZO 1(10,4-16 Date e0l Y, �Sheet No. Proposal Submitted To: Work To Be Performed At: �Name 94-,9 Street 457 Streel/S ? City /y, J!!5�C—� State 1"'Cl, City, 75��Y-7 Z!�04c')L "ta",E el -9 63 V 7 �,Dare of Planza—e:p� Architect "We hereby propose to furnish the materials and perform the labor necessary for the completion of C,,.j Z2�- �V// -, ' LAz" A To 14K-0-45 01-7 0--D 7-> 1Fe1,P) p,at-b 14w olo�' Po _(7- A/e 5 5�* 1"AW 10. .671 MA7e� /;g:—,3 I-- ",' ' '7 el?ma;a�riayisouarranteedfto be as specified, nd the above work to be performed in accord;�)Wlt-, tio drawings and specifications submitted for above work and completed in a substantial workmanlike manner for the sum of Dollars $ '2 with ay, b a m V&!e 5 f o I 10?:Vp C70 �2 D Any alteration or deviation from above Z.-f1cations involving extra costs'will be executed only upon writt3n orders.and will become an Respectfully submitted/C" extra charge over and above the estimate.All agreements contingent upon strikes.accidents or delays beyord our control. Owner to carry fire. camadc and otner,net;Ltitidry itisurance upon above wark. Work- Per /Qj .,,eat men,s Compensation and Public Liability Insurance an above WDr taken out by Note-TN5 pr-3t may be withdrawn baif not a(;ce xad withig- days. ACCEPTANCE OF PROPOSAL I he above.prices.specilf-tcations and conditions are satisfactory slid are hereby accepted.You are authorized tc do -.hc viork as t3pecified. Payment will bp mads as outlined above. Signature Date Signature CITY OF ATLANTIC BEACH CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS 800 Seminole Road 904-247-5800 r I g I Atlantic Beach, Florida 32233-5445 Fax 904-247-5845 Date (,0- -Z-=1—n L4 PERMIT# Job Address IS72 aft Lid At" ST ISSUED BY THE CITY Permitee: Telephone# e.,,4 Z 5 L4 9 Permittee Address: MAPJD#t wAV %A N ad3 Requesting Permission to Construct: y it, CuRcULM M1W(.%AAV, to # . -01 126' Y Y ' STU lu&ki Location: (Reference to Cross-Street) IL ire LM!l bf.Aft S*t Midi INA Utz aill R lMAJFpI1c�1.Fi7tA-de'9'q es t at prior to filing this application he has ascertained the location of all existing utilities, ITY F*60&Fia nderground and the accurate locations are shown on the sketches. B jUW� 16�lotificatioh was mailed to the following Utilities/Municipalities: i Jacksonville ElectricAuthority Yes (V No ( ) Date: Bell South Telephone,Company Yes (w) No ( ) Date: B By , Ferr Yes (VI No ( ) Date: Y" 0 __C ............. ate: __c , cast,-- Yes No D om L1111"r Opel WWW-7 2. Whenever necessary for the construction, repair, improvement, maintenance, safe and efficient operation, alteration or relocation of all, or any portion of said street or easement as determined by the Director of Public Works, any or all of said poles, wires, pipes, cables or other facilities and appurtenances authorized hereunder, shall be immediately removed from said street or easement or reset or relocated hereon as required by the Director of Public Works, and at the expense of the Permittee unless reimbursement is authorized. 3. All work shall meet City of Atlantic Beaq� or Forida Department of Tra ortation Standards and be performed under the Suirvision of lk elcontractor's P it A A A AftAIZ )ne#: 1-2 - 1 Superintendent) located at I I W M IN M74c"li`_ - 4 4. All materials and equipment shall be subject to inspection by thf, n4rectrir of Puhfir-Works or his designee. 5. All city property shall be restored to its original condition as far as practical, in keeping with city specifications and the manner satisfactory to the city. 6. A sketch of plans covering details of this installation, as well as, a copy of a recent survey shall be made a part of this permit 7. This permittee shall commence actual construction in good faith with days. If the beginning date is more than 60 days from date of permit approval, then permittee must review the permit with the Director of Public Works to make sure no changes have occurred in the area that would affect the permitted construction. 8. It is understood and agreed that the rights and privileges herein set out are granted only to the extent of the City's right, title and interest in the land to be entered upon and used by the holder, and the Holder will, at all times, assume all risk of and indemnify, defend, and save harmless the City of Atlantic Beach from and against any and all loss, damage, and cost of expenses arising in any manner of the exercise or attempted exercises by the holder of the aforesaid rights and privileges. 9. The Director of Public Works shall be notified twenty-four (24) hours prior to starting work and again immediately upon completion. OWNER Signed: Rd.,,t4. 46-4,,Z Date: eo Before ni6 this day of :th:21n"u'rily of-Duval, State Of Florida, has personally appear AA AA-11- r AJ A.-i Notary Public at Large,State of Florida,Cotof Duval. My commission expires: C; h Personally Known: or Produced Identification: t—L- I-) i�,p 9_6 JENNIFER SCHLUETER sw MY COMMISSION#DD 121301 EXPIRES:May 27,2006 BondedThru Notary Public Underwriters DEPARTMENT OF PUBLIC WORKS 1200 SANDPIPER LANE ATLANTIC BEACH,FLORIDA 32233-4318 TELEPHONE:(904)247-5834 FAX:(904)247-5843 SUNCOM: 852-5834 http://ci.atlantic-beach.fl.us PLAN REVIEW COMMENTS FROM THE PUBLIC WORKS DEPARTMENT Permit Application # DLIL- ZESss- Applicant: 61 PC f4 Address: 577 ep IEL V/a Proj ect: \1 Your application is approved as noted by the Public Works Department. Final application approval must come from the Building Department. u Your permit application has been reviewed by the Public Works Department and the following items need attention: in 5 feet north of existing driveway must be t ence and 1 ter abric) clurinq UunUac-c eUE)iic Works at 247-5834 prior—to struction. 0 Please submit these requirements to the Public Works Department, 1200 Sandpiper Lane, Atlantic Beach, FL 32233 in order that we can approve your application. If you have any questions,please call (904) 247-5834. Reviewed by ick Carper, P.E., Public Works Director %""— Date V?obalcj Signature Contractor Notified DateAVi��l CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FLORIDA 32233 INSPECTION PHONE LINE 247-5826 o OR ft Application Number 04-000285S8 Date 7/02/04 Property Address . . . . . . 157 BELVEDERE ST Tenant nbr, name . . . . . . DRIVEWAY, PORCH, SIDEWALK Application description . . . RIGHT OF WAY PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 Owner Contractor ----------------- ------- ------------------------- BURCH' BOB OWNER 157 BELVEDERE STREET ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233 (904) 642-6349 ---------------------------------------------------------------------------- Permit . . . . . . DRIVEWAY PERMIT Additional desc . . Permit Fee . . . . 35 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 35 . 00 35 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 35 . 00 35 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING S. BUILDING OFFICLA1 CITY OF ATLANTIC BEACH Ocl ROOFING PERMIT APPLICATION Date: Job Address: RfLu i As/zE S.T. , d7zdevr4r- Owner of Property: Lbue 7: L. j2%u jer d Address: jLG2_q ASftLEV M)jlvolL W4 ( 1 11 3.ViTelephone: Contractor: /,A 11"� 'Cl/,_AA,�,S State License Number: '1j ' Contractor's Address: tj� Telephone: 7 Fax: 51) 13 Scope of Work: Deck Slope: —Greater than 2:12 Less than 2:12 Valuation of work. 0o —M%Le�! Product Name(Example: Timberline): Manufacturer(Example: GAF): Of ASTM Designation(s): :2 3 3 Required Inspections: Sheathing and Final Signature of Owner: A,.,� Date: S AS TO OWNER: Sworn to and subscribed before me this day of ou-ioL.C� 120 .0. CAYHERIIINE BERRY Notary's Signature: P .Nokvy Pub4c-Skde of W&I j I -.9*C=n*dan90u0*c5,2= �_�Personally known Coinmbdon 0 DD 366591 Produced identification No 14 FlIvilryla KdNokvvAWL — — — — — — — — — Type of identification produced Signature of Contractor: Date: /0 AS TO CONTRACTOR: Sworn to and subscribed before me this day of Ct_,)rVbe� .20 Dt�� State of Florida,County of Duval Notary's Signature: -- --- - - - ---------- JEANNE M.SHAW F-1 Personally known MY COMMISSION#DD 435986 4-41roduced identification EXPIRES:May 31,2009 '�,t d ,FV,;,�, Bonded Thru Nctary PubHo UndtrwMn Type of identification produced J)rl C4( 800 Seminole Road Atlantic Beach,Florida 32233-5445 Pagel Telephone: (904)247-5800 Fax: (904)247-5845 -http://www.ci.atlantic-beach.fl.us Revised 2/21/03