Beach Ave 1739 CITY OF AtLANTIC BEACH
01- 11,5 1,q Iq I I
800 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233
OFFICE:(904)247-5826 0 FAX NO,:(904)247-5846
BUILDING-DEPT@COAB.US
BUILDING PERMIT APPLICATION DUVAL COUNTY
6 00 !!"', ARW W, DE IROP
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FT-�UN
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Rqb 9,e�illso I A-
Atlantic Beach, FL 32233
p n
MAiptioN7
11 NEW BUILDING 0 DEMOLITION 0 RESIDENTIAL
LOT BLOCK_SUB DIVIS ION 13 ADDITION 11 CONVERTING USE 0 COMMERCIAL
0 ALTE ON
"7 RATI 11 ACCESSORY BLDG. T,FlW7,95ig�-7,777 77
0 REPAIR 0 POOL/SPA 0 YES N/A
Cp Ce,5(0,K T�f- et El MOVE QQTHER 11 NO
��k i 3
RTY,-,OVV-N �q OTOR;ii,,77', 77,7,7, ITECT t
9.NAME: 15.COMPANY NAME: 23.CON�Y NAME:
L 16.NAME\ 24.LICENS!!�AME:
10.ADDRESS: 17.STATE OF Fl-b��LICENSE NO.: 25.STATE OF FLN LICENSE NO,;
P-
18.ADDRESS: 26.ADDRESS:
I I QFFICE PHONE: 12 FA)�NO.: 19.OFFICE PHONE: 20.FARX,��.-. 27,OFFICE PHONE: 28.N�.:
.zq,l-111 bi I a�q- rj.-) 1 1
13.CELL PHONE: 21.CELL PHONE: 29.CELL PHONE:
14.EMAIL ADDRESS: 22.EMAIL ADDRESS: 30.EMAIL ADDRESS:
4"
all
g
31.NAME: 33.NAME: 35.NAME:
32.ADDRESS: 34.ADDRESS: 36.ADDRESS:
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 laws regulating construction in this
jurisdiction. This permit becomes null and void if work is not commenced within six (6) months, or if construction or work is suspended or
abandoned for a period of six (6) months at any time after work is commenced. I understand that separate permits must be secured for
Electrical Work,Plumbing,Signs,Wells,Pools,Furnaces,Boilers,Heaters,Tanks, AIr Conditioners,etc.
OWNEWS 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. I will not occupy or use the referenced building or any part therof,until all inspections are finaled and
prior to obtaining a certificate of occupancy or completion issued by the building official,as required by law.
WARNING TO OWNER:
YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
�g
Signed:WLQ.— a - iaL,,-Date: Signed: Date:
Before me thisAL&-day of Qft W—r—,2007 in the county of Before me this day of ,2007 in the county of
Duval,State of Florida,has personally appeared Duval,State of Florida,has personally appeared
L
herin by himself/herself and affirms that all statements and declarations are herin by himself/herself and affirms that all statements and declarations are
true and accurate. true and accurate.
Notary Public at Large,State of County of']�UV 0,( Notary Public at Large,State of_,County of
0 Personally Known 0 Personally Known
fl�Pfioduced Identificatior 13 Produced Identification
Notary Signature, Notary Signature:
K. CUNNINGHAM
Not"Pwk-SIM of FbrWe
pAy CwwoMm Expku Feb 29.2010
COAB FORM BLDG01:REVISED:11/6/2007 Comffilillillim III DD 52308
M Bmwied By Nobl"=Ann.
CITY OF ATLANTIC BEACH
PERMIT
BUIULDING /ZONING DEPARTMENT APPLICATION#
Z 900 Seminole Road
Atlantic Beach,Florida 32233
(904)247-5800
(904)247-5845 Fax
www.coab.us
APPLICATION TRACKING FORM
RKY41RED DEPT:
v,,) PLANNING
Property Address: z Lgrm
'9
J 'U N UBLIC WORKS
Applicant: 0
( Y) N PUBLIC UTILITIES
Project: I U , FIRE DEPT.
PUBLIC SAFE TY
Cl) APPROVAL
L9
0 0 ,REQUIRED AGENCY: RECEIVED BY: INITIAL: DATE:
z UJ
LU N D.E.P HUFSTETLER
�i=)
y N S.J.R.W.M. CARPER
LU
uJ Of Y N ARMY CORPS of ENG CARPER
Y N HOTELS&RESAURANTS HUFSTETLER
APPLICATION STATUS
CIRCLE ONE: SITE BUILDING DA AP -5�YIEWED BY: INIfl/L: JATE:
I ST REV
PLANNING 2ND REV
BUILDIN
PUBLIC WORKS
PUBLIC UTILITIES
FIRE DEPT.
PUBLIC SAFETY
F] 3RD REV
Retu rn this form to the Building Department once you have entered your comments into the AS400.
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5826
INSPECTION EMAIL REQUEST:
Building-deptgcoqb.us
Application Number . . . . . 07-00001599 Date 12/07/07
Property Address . . . . . . 890 BEGONIA ST
Application type description FENCE PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
--- ------ -------------------- ---------- - ----------- --- --- - ------------------
Application desc
INSTALL 61 FENCE
-- - ----- ---- ------------ - - - - -- - - - -------- - - - ----- -- -- ---- - ---- -- - -- --- ------
Owner Contractor
-------------- --------- - ------- ------ - ---- ------
ARTHUR, WILLIAM OWNER
ATLANTIC BEACH FL 32233
--------------------- -------- --- --------------------------------------------
Permit . . . . . . FENCE PERMIT
Additional desc . .
Permit Fee . . . . 35 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 6/04/08
------------------------- ------------------------------ --- ------------------
Special Notes and Comments
*ALL FENCES OR ENCLOSURES OF LAND SHALL BE SUBSTANTIALLY
CONSTRUCTED.
*SCHEDULE FINAL INSPECTION ONCE FENCE HAS BEEN COMPLETED.
PERMIT AND APPROVED SURVEY MUST BE AVAILABLE FOR FINAL
INSPECTION.
*EMAIL INSPECTION REQUESTS TO BUILDING-DEPT@COAB.US
----------------------- ----------- ---------- ----- ------- ---- ----- -----------
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 CODES.
Public Works Plan Review Comments I eb
Date: JOH09 Initials:
Project Name/Address: glo Application Permit#:
d
Application TraciiingComments �..Ad
Provide impervious surface calculations.
Provide erosion and sediment control plans with installation details and maintenance
schedule.
Provide drainage plans showing site topography(flow arrows, etc.)
Provide construction site management plan, including Right-of-Way Permit if-using k—
Out
right-of-way for construction parking.
Provide a pre-construction topographic survey prepared by a Florida Licensed
Professional Land Surveyor, showing 1' contours.
Section 24-66(b) of the Land Development Regulations requires on-site storage for
increased runoff. Provide Delta volume calculations and on-site retention required rl
per Section 24-66(b). (See attached info. Sheet)
If on-site storage is required, apost construction topographic survey documenting
proper construction will be required.
•Right-of-Way Permit must be obtained for use
•Revocable Encroachment Permit must be obtained.
Pool—Wellpoint(if used)must discharge into vegetated area 10' minimum from 0
street or drainage feature (swale, structure or lagoon).
All concrete driveway aprons must be 5 inches thick,4000 psi, with fibermesh from
the edge of the pavement to the property line. Reinforcing rods or mesh are not 0
allowed in the ROW(Commercial driveways—6"thick).
Any utility cuts in the road must be repaired using COJ Standard Detail.Case X and
must be overlaid 10 feet in each direction.from the center of the cut. Repair must be 0
shown on the plans.
P-Roll off container company must be on City approved list and cannot be placed
on City right-of-way.
0
0
R A
1 'lVf
-Z City of Atlantic Beach APPLICATION NUMBER
GIC f 0 Cro be assigned by the Building Department.)
Building Department
8DO Seminole Road
9 -
Atlantic Beach, Florida 32233-5445 BY-
-5826 - Fax(904) 7�-564
Phone(904)247
Date routed:
E-mail: building-deptQcoab.us
City web-site: http:/ANww.coab.us
APPLICATION REVIEW AND TRACKING FORM
b A A lj*A pep="nt review required Yes No
froperty Address: - P g V r
lanrflng &Kcgq�
Lpplicant:
dublic Works
'roject: A,n e,6 — i
A//y y L ;��Uic IN,itie�s
PMe S_arei�___
Fire Services
_:7�7_77777
W
S
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
Florida Dept.of Environmental Protection
Florida Dept.of Transportation
St.Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other: - I
APPLICATION STATUS
Reviewing Department First Review: [�Approved. []Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: _zw� Date: '1�wo
TREE ADMIN. Second Review: EjApproved as revised. []Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: RAPProved as revised. RDenied.
Comments-
Reviewed by: Date:
Revised 05/14109
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio N
State of K8 County of VjLk\
To whom it may concern:
The undersigned hereby informs you that improvements will be made to certain real property,and in
accordance with Section 713 of the Florida Statutes,the following information Is stated in this NOTICE OF
COMMENCEMENT.
Legal description of property being improved: (B-?A
Address of property being improved: /I k WV
General description of improvements: 1 fi��Wl WnA VPJAP.0 V(a Q&6-
,sA A K -r' ro a v NV D"A,4�6
- .;�a 11�JAA i
Owner 117, WAkalm L -F,-A4 &L
Address RW-, PL_
IA 322Z-�,
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor
Address2)4-10-9 VmLUE, 10,(L C,4f Ix\I I 11p, VL �C4
Phone No.OM4-3S 4- *N�s —Fax No._4W- -3994
Surety(if any)
Address ount of bond$
Phone No. Fax No.
Name and address of any person making a loan for the construction of the improvements.
Name
Address
Phone No. Fax No.
Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other
documents may be served:
Name
Address
Phone No. Fax No.
In addition to himself,owner designates the following person to receive a copy of the Lienor's Notice as provided in
Section 713.06(2)(b),Florida Statutes.(Fill in at Owner's option).
Name
Address
Phone No. Fax No.
Expiration date of Notice of Mer e is one(1)year from the date cording unless a
,Icenment(ffie expiration dat
different date is specilli
ed):.bm �4r zc�
THIS SPACE FOR RECORDER'S USE ONLY
Alp';kNER
Signed: DATE 10MV'l
Beforemethis -t dayof 1,JCAf3bA1 -2)J0t0!7 " ifi the
CoyntyW Duva_,�ta� f A=ars6nal[y ap�eargcl
h rein by
himself/herself and affirms that all statements and declarations herein
are true and accurate ULIE A.BUSSEY
MY COMMISSION#DD 926031
EXPIRES:September 17,2013
All 'p- Bonded Thru Budget Notary Services
. ............ A 4o"flill
N5pry Pu.blic at Large,State 17j—_L- , �county of
INV commission expires: 5s Q 0-1 P kA h,e i- _L� I —
Personally Known f —or
Produced Identification St2
CITY OF ATLANTIC BEACH 09- 1
800 SEMINOLE ROAD,ATLANTIC BEACH,FIL 32233
OFFICE:(904)247-5826 0 FAX NO.:(904)247-5845
BUILD ING-DEPT@COAB.US
BUILDING PERMIT APPLICATION DUVAL COUNTY
:4.VALU�,TlONOFW0RK-;,
QOF
R R
o
1��,'.A,'ILEG�AL"DE I�tTAONC
so z1 6C USE-OF STRUCTURe,.,
777
(Y.;t (4 ko—va-t�; 0 NEW BUILDING El DEMOLITION ARESIDENTIAL
LOT ( BLOCKWSUB DIVISION ADDITION 0 CONVERTING USE 11 COMMERCIAL
F1VIDE
ALTERATION 11 ACCESSORY BLDG. 81 FIRE-SPRINKLER:;-,:�',
REPAIR 11,POOL/SPA 11 YES KN/A
\,u El MOVE OTHER 13 NO
QT-j1ENGINffE-R-
RPHUTE
�9 N�AE le-"comp 23.COMPANY NAME:
elm 16.NAME: (,Vmt� V-4 Ivy. 24.LICENSEE NAME:
L-r
-NkVIL Wty
10.ADDRESS: 17.STATE FLORIDA IC NSE N 25.STATE OF FLORIDA LICENSE NO.:
1,5854-11V60
32Z:Z 18.ADDRESS)26-1 eg V O%d 26.ADDRESS:
11.OFFICE PHONE: 12.FAX NO.: I OFFICE PHQ —
21 FAX NO 7.OFFICE PHONE: 28.FAX NO.:
CM.�tW_? 2
i6- 9d ZqL� --- 1
13.CELL PHONE: 21.CELILP;�NE: 29.CELL PHONE:
14.EMAIL ADDRESS: 22.E I ADDRESS: 30.EMAIL ADDRESS:
0 .0"
FEE SIMPLE,
T
Mdkf64GE'
A
POND NG
6 . '.,',,.,,,,,�COMPA
31.NAME 33.NAME: 35.NAME:
32.ADDRESS: 34.ADDRESS: 36.ADDRESS:
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no worik or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this
jurisdiction. This permit becomes null and void if work is not commenced within six(6)months, or if construction or work is suspended or
abandoned for a period of six(6) months at any time after work is commenced. I understand that separate permits must be secured for
Electrical Work,Plumbing,Signs,Wells,Pools,Furnaces,Boilers,Heaters,Tanks, Air Conditioners,etc.
OWNEWS 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.I will not occupy or use the referenced building or any part therof,until all inspections are finaled and
prior to obtaining a certificate of occupancy or completion issued by the building official,as required by law.
WARNING TO OWNER:
YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
OWNER
dtAGENT!
4WA
gept,Power ofWm6y' Ir
�:(p
Signed-0Akk'C'— W—iL"-ljte7 IV SigneL--�&&jZat1==1 Date:
Before me this daycfi�2c�6�,i-- 2009 in the nty of Bel`65�e this 2bWAdey of 2009 in the county Of
Duval,State ofFlodda,has pers, 11 -.red
W ',I & y DT I'i State of Rorida,has p onally appeared
C' T.y appL
flo rAu r
herin by himself herself and affirms that all statements and declarations are herin by himself/herself and affirms that all statements and declarations are
true and accurate. true and accurate.
Notary Public at Large,State of County of Notary Public at Large,StateorkMeXPA,County Of V A-L--
11 Personally Known -hu It a .1 - '��=n. — T1 .�U� ,.
fly Known
"'S R-S L
'FProduced Identificat' - U Produced Identification- a pit
Notary Signature 4 1 Od K, Notary Signature: aM4,NM
A 1.
�4 — 9
JUUE A.BUSSEY
my cOMMISSION#DD 926031
Z
.
EXPIRES:September 17,2013 #DD 873245
B ded Thru Budget Notary WACO
BLDG01 Permit Application Bldg:REVISED:12118/2&3to,";0 11
ST
T�4
City of Atlantic Beach APPLICATION NUMBER.
Building Department (To be assigned by the Building Department.)
7d 2099
800 Seminole Road
Atlantic Beach, Florida 32233-54 5 z3f
Phone(904)247-5826 - Fax(90 IZ845.-.-
E-mail: building-dept@coab.us Date routed:
City web-site: http://\mww.coab.us r
APPLICATION REVIEW AND TRACKING FORM
6 pepar"rit review required Yes No
Property Address: Sq 11 . .
�oe I ("TIa—nning &2
Applicant: 4113-27S trator
Project: rx/1 417- A 6 ic Works
Y 1�h YJ �;F Tuic Vit_ie—s---%
I ....S—aret—y
Al Fire Services
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
Florida Dept. of Environmental Protection
Florida Dept. of Transportation
St.Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: *Pproved. ODenied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: CO- Date:
T TREE IN.
REE I N* Second Review: [—]Approved as revised. DIDenied.
PUB C WO S Comments:
PUBL I
_rY
PUBLI AFETY Reviewed by: Date:
FIRE SERVICES Third Review: DApproved as revised. DDenied.
Comments:
Reviewed by: Date:
Revised 05114109
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 - Fax(904)247-5845
E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Iroperty Address: review required Yes "No
Fla—nning &?�gp�b
Lpplicant: /1) z ���tor
sroject: 3 an n e,6 < Public Work
-- Yy y L ;;�Ulc�i
MC-S�aety
Fire Services
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
Florida Dept.of Environmental Protection
Florida Dept.of Transportation
St.Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
leviewing Department First Review: EjApproved. E]Denied.
(Circle one.) Comments:
w
PLANNING &ZONING Reviewed by: fil Date:/0--7
TREE ADMIN. Second Review: ElApproved as revised. ElDenied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: RApproved as revised. [:]Denied.
Comments:
Reviewed by: Date:
Revised 05/14109
lid
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NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio N-Q— 'l,-I(Y-A 2-Q- -`�io 0
State of D�� County of.'UL�kV-A-r
To whom it may concern:
The undersigned hereby informs you that improvements will be made to certain real property,and in
accordance with Section 713 of the Florida Statutes,the following Information is stated in this NOTICE OF
COMMENCEMENT.
Legal description of property being improved:
Address of property being improved: 1eR0j&q"DCo/A--!�4. 37
General description of improvements, V(a
14
Owner DL 4A Gi
Address f��IA Pa IiQ "RI iLf A rid P, -
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor
Ad s
dresl
Phone No.
Surety Cif any)
Address Amount of bond$
Phone No. Fax No.
Name and address of any person maldng a loan for the construction of the improvements.
Name
Address
Phone No. Fax No.
Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other
documents may be served:
Name
Address
Phone No. Fax No.
In addition to himself,owner designates the following person to receive a copy of the Lienor's Notice as provided in
Section 713.06(2)(b),Florida Statutes.(Fill in at Owner's option).
Name
Address
Phone No. Fax No.
Expiration date of Notice of mrpericement(Uie expiration date is one(1)year from the date cording unless a
different date is specified):.bQ',TDV-e-k Z-0,-Zn n9
1 0 =44===
THIS SPACE FOR RECORDER'S USE ONLY 4_
Signed: DATE
Before me this 01
day of Q P " ifi the
rid.Rhtspers �f )I d
County Duval, tat of Fl, ap�earjd
9 1;gi tt kA _. /I r!� U r h rein by
himseff/herself and affirms that 611 statements and declarations herein
are true and accurate "'Ity pu,
JULIE A-BUSSEY
MY COMMISSION#DD 926031
EXPIRES:September 17,201:1
0 0 0 0 0
0 v Bonded Thru Budget Notary Senrice,
N ry Public at Large,Sta�e qr1j=L— County of J—V C,I
V. —0 aljjjj�'—o i—
Personally Known f or
Produced Identification M/P.7i'd:12i N r I If,,
CITY OF ATLANTIC BEACH
09
800 SEMINOLE ROAD.ATLANTIC BEACH,FL 32233
OFFICE:(904)247-5826 e FAX NO.:(904)247-5845
BUILDING-DEPT@COAB.US
BUILDING PERMIT APPLICATION DUVAL COUNTY
w
"V-10 6-0
A,*CLAM '%ii-oP'i"!� _T
RK 6,W'CTURV
NEW BUILDING 1:1 DEMOLITION gRESIDENTLAL
LOT t. BLOCK4SUB DIVISION '�;ec_ lAe 171 ADDrnON El CONVERTING USE 0 COMMERCIAL
I,. ALTERATION 11 ACCESSORY BLDG. &FIRESPRINKLER
REPAIR 0,POOL/SPA 1:1 YES WNWIA
wund It �fl 0 Q QAak (Oa_j�' Q'MOVE OTHER 11 No
!-�A !qR1TE-:r-..: NEE
'CONTRAPP EMPI
_gPF!E QR
9.NA a M P ZA Nr
23.COMPANY NAME:
Uj A(aum L_ '�V.
16.NAMEU, (41 24.LICENSEE NAME:
kwv Wt1-<-Ka_wV t-T ftt- - _M16,_k Vaf(
10.ADDRESS: 17.STATE�F FLORIDA LIC NSE NI'J'.' 25.STATE OF FLORIDA LICENSE NO.:
18.ADDRESSY26-1 Vot-!�.Zk L
_ , 1:,<
R_ _&22:�6 28.ADDRESS:
_17 7— FAX NO.:
AX NO 27.OFFICE PHONE:
11.OFFICE PHONE: OFFICE PH 20-FAX No
13.CELL PHONE: 21.CELL PIWE: 29.CELL PHONE:
14.EMAIL ADDRESS: 22._S�AIVADDRESS: 30.EMAIL ADDRESS:
('1'L
V
n't"'n,
_mgg BO tGAGE LENbp
31.NAME: 33.NAME, 35.NAME:
32.ADDRESS: 34.ADDRESS: 36.ADDRESS:
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 laws regulating construction in this
jurisdiction. This permit becomes null and void if work is not commenced within six(6)months, or if construction or work is suspended or
abandoned for a period of six(6) months at any time after work is commenced. I understand that separate permits must be secured for
Electrical Work,Plumbing,Signs,Wells,Pools,Furnaces,Boilers,Heaters,Tanks, Air Conditioners,etr_
OWNEWS 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. I will not occupy or use the referenced building or any part therof,until all inspections are finaled and
prior to obtaining a certificate of occupancy or completion issued by the building official,as required by law.'
WARNING TO OWNER:
YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT
T_�CONTIF
of.AGEN7�:-.
P.y
-t a%,
Signed.— LD ILIDLI_ Sigriv- 4. Date:—0.
Before me this day of t��401)#Ijil 2009 in thger clunty of Before me this 2V411day of v K\bc4--.2009 in the county of
0 0 Ida,ha Pe onally appeared
Duval,State of Fiords,has personally ap eared Duir I,I State f FI n s
L
harin by himself I herself and affirms that all statements and declarations are herin by himself/herself and affirms that all statements and declarations are
true and accurate. true and accurate.
Notary Public at Large,State of EL County of hii if Q Notary Public at Large,State rfix.�' -Dk County of
wn
El Personal[y Known >�Personally Kno
d[dent mt! TlDrl(L �SdVlfl LYIP-09C 11 Produc;ed Identification-
lzProduce Ifi
S101V
Notary Signature A A. 4,0Z
MIRWO FOR C07DE COMPLIANCE
MY(
tTLANIICBEACH #DD 873245
I'M
52
EXNRZS��Sep
3onded Thru r1p RMITS FOR ADDITIONAL
dad
IREMENTSANDCONDITIONS.
B g SSW
fiou
Ftt'E'm't'HFy
BY:
LREVIEWED 117 iQ DATE: /02_02 �Z IC ST N