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Permit 100 Seminole Roadri_:.~~~yy, City of Atlantic Beach f ;~• ~~ Building Department ~ ~ ~ 800 Seminole Road - : :. -~ Atlantic Beach, Florida 32233-5445 Phone (904) 247-5826 Fax (904) 247-5845 ..tit :~%~. E-mail: building-dept@coab.us City web-site: httpJ/www.coab.us APPUCATIUN NUMBER (To be assignedhby the Building Department.) V Date routed: APP'LlCATlOh! REVIEW AND TRACKING FC?RM Property Address: ~~ ~ ~Fi'~1'I I `71 oT J ~ ~~G~ App{icant: ~ lL1 `~? `L ~ !~ Project: ~~ ~ ~ ~ f. D nt review re wired Ye No B' arming ~ Zonin Tree A mtnistrator ublc Works Public Utititie u ~c a e Fire Services Review fee _$ _ , . __ Dept Signature - . . Other Agency Review or Permit Required Review or Receipt of Permit Verified B Date Florida Dept. of Environmental Protection Florida Dept of Transportafion St. Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATIt~N STATUS Reviewing Department First Review: {Approved. ^Denied. (Circle one.) Comments: BUILDIN PLANNING & ZONING Reviewed by: `~ ~ Date: TREE ADMIN. Second Review: QApproved as revised. ^Denied. PUBLIC WQRKS Comments: PURL}C UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: QApproved as revised. ^Denied. Comments: Reviewed by: Date: Revised 65it41i?9 _3rs`a" 1~+,. CITY OF ATLANTIC BEACH ~, ~;:t 800 SEMINOLE ROAD, ATLANTIC BEACH, FL 32233 ~'" ~~ t OFFICE: (904)247-5826 • FAX NO.:(804)247-5845 ~~ BUILDING-0EPT~COAB.US ~~=-~rs,y` BUILDING PERMIT APPLICATION 09 _..~.-. I_ _. _ I W - I--_ __ I_-.__.I nl lvol rnl rnr-rv '~';. :"~: - ; ~~; _ ,_' '2'. VAL"UATIO[~"OF V\IDRK`)i:;w' ~ _ ~..' :, 3::50 FT;'_UNDER ROOF::.'... , _.. ~y s~i ~r ~~C.~ Jr4 ~ ~f G+~'~ ~~+ i M4,~`L'EGAL DESCRIPTION' ',i ~ ',_' ` `' '~'~ ~' "_ ~ .5' CLASS OF.UYO. K:' -, . ', -= ~"' ~ "'? [i,USE OF;~$TRUGTU_RE ~ B ^ NEW BUILDING ^ DEMOLITION ^ RESIDENTIAL LOT LOCK_ SUB DIVISION ^ ADDITION ^ CONVERTING USE ^ COMMERCIAL ~„ .7;iDE$CRIPTJON ORNi0RK:7 ~;- i ` '. < `, ^ ALTERATION ^ ACCESSORY BLDG. 8. FIRESPRWKLER:'_ `- ~J` - y ~~ r/r~l "`~'~~~ ~~`r ~~~~ ^ REPAIR ^ POOL /SPA ^ YES ^ N/A r ' ^ MOVE ^ OTHER ^ NO ,'titil~Jir,;,~i;F!~~ u. +?:PR PERTY OWNER': ;;;,. , ;;,. ;: ;; CONTR AC. OR ~"~,. ,.,, ,. . ~ ,,:;; t t/g ," - -'"ARCHITEC:T :;'7 ENGINEER:", . 9. NNA M E 15. COMPANY NAME: 23. COMPANY NAME: I /~A~ ~* , /~-(.,~ J (fi1(f~1/Ld ,j' 18. NAME: 24. LICENSEE NAME: 10. ADDRESS: 17. STATE OF FLORIDA LICENSE NO.: 25. STATE OF FLORIDA LICENSE NO.: l G ~3 ~,..;~~.s~ ~ ~c 18. ADDRESS: 26. ADDRESS: 11. OFFICE PHONE 12. FAX NO.: 19. OFFICE PHONE: 20. FAX NO.: 27. OFFICE PHONE: 28. FAX NO.: ~~ ~/ 13. CELL PHONE 21. CELL PHONE: 29. CELL PHONE f ~ ,~J .~ 14. EMAIL ADDRESS: ~ /CS crw,c~l ~ ~-~ e.~rev ~i,r. 22. EMAIL ADDRESS: 30. EMAIL ADDRESS: aU z } I '~~i FFrE SIMPLE-TITLE HOLDER ~~.. ~ ~ Hli r i ~ BONDING COMPANY `'' ' ~ I'' - MORTGAGE LENDER: Nh,3s~.lr: ..(IFOT}rEFljHANOWNEft)~ ~,. .: :".t.: '- ; - 31. NAME: 33. NAME: 35. NAME 32. ADDRESS: 34. ADDRESS: 36. ADDRESS: Appligtion 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 pertormed 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. 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. 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 or AGENTS ' CONTRACTOR • " , '' (lf Agent~Power or:Atfomey..'"wAgericy t.et[er Required) ' ~ " (Q<lallfier Only) Signed: Date: Signed: Date: Before me this day of , 2009 in the county of Before me this day of , 2D09 in the county of Duval, State of Florida, has personally appeared Duval, State of Florida, has personally appeared herin by himself / herseff and affirms that all statements and declarations are herin by himself /herself and affirms that all statements and declaratiorts are true and accurate, tnre and accurate. Notary Public at Large, State of ,County of Notary Public at Large, State of ,County of ^ Personally Known ^ Personally Known ^ Produced Identification - ^ Produced Identification - Notary Signature: Notary Signature: BLDGG1 Permit Application Bldg: REVISED: 1Zi8/2008 l ~,i ~,:.L~~;yJ, City of Atlantic Beach ;~• ~~~ Building Department 8D0 Seminole Road '~ s) Atlantic Beach, Florida 32233-5445 v Phone (9D4) 247-5826 Fax (904) 247-5845 `~33:~~` E-maiL• building-dept@coab.us City web=site: hftp:i/www.coab.us APPLIGATION NUMBER (To be assigned by the Building Department.) ~9- ,/310 I Date routed: APPLiCAT10N REV1~W AND TRACMCiNG FORM Property Address: ~~ D ~fi~ / `7i o J~ ~~ Applicant: ~~`71 `L ~ Project: ~~ ~ ~ Ge ~ < 6 D nt review re wired Yes No B' Panning & Zonin Tree A mrnistrator ublic Works Public Utilitie u is a e Fire Servsces _, _ . _ Review fee.$ _ . :. .....Dept Signature..:- ,. Other Agency Review or Permit Required Review or Receipt of Permit Verified B Date 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: []Approved. ^Denied. 4 (Circle one.} Comments: BUILDING /" ~~~ PLANNING & ZONING Reviewed by: .S ~-_ Date: ' ~'V TREE ADMIN. Second Review: QApproved as revised. enied. PUBLIC WC)RKS Comments: ~ ! _ S,~- f ~ ~ /p •~~o{~ PUBLIC UTklkTtES ~ ~~~~ ~ m~ o,-`- t b ~`I~G~~ j1~ PUBLIC SAFETY Y~ ~~ th's 10~.~ fib's ~iy °!, f ~j Reviewed b 5~+~--Date: FIRE SERVICES Third Rev w: QApproved as revised. ^Denied. Cc-tnmen : ,~~, - ~'~9 ay ~~ ~~ ~ reviewed by: Dal®: Revised 05144IQ9 ~,5~ s., ~, ~' ~ 5 - I .~v~ l~ , y \~;~C.r~s~/ CITY OF ATLANTIC BEACH SOD SEMINOLE ROAD, ATLANTIC BEACH, FL 32233 OFFICE: (904)247-5826 ~ FAX NO.:(904)247-5845 BUILD ING-DEPT~COAB.U5 BUILDING PER11AIr oPP~ i~orllnN _ . .. 09- .._.....I _._I_ ._L-__.I_ __.I nr rvnr rnr isirv 1`J06'pDDRESS: " ''' '" °' r 2. VALUA'110N`OFVyORK("-~ °" ~ 3 5.© ,Fi'.UNDER ROOF,:;; ~~ ~~ / ~~~ J ~~ ~/ Ed's ,r ~4, L'EGAh DE5GRIP.TION;" " - ' - ' S(CLASSOFIMO !G ~ -r,i,a:2w.r.tl - i; 6; USE OFSTRUGTURE' j.-'~ ^ NEW BUILDING ^ DEMOLmON ^ RESIDENTIAL LOT_ BLOCK_ SUB DIVISION ^ ADDITIDN ^ CONVERTING USE ^ COMMERCIAL ,.. 7 iIE$CRIPTION OF WORK;' ^ ALTERATION ^ ACCESSORY BLDG i3~ FIRE SPRINKLER ``. ~r/' t tµ~/Y /~ ~ `~~ ~~ ~ ~~ ~~~~ . ^ REPAIR ^ POOL /SPA ^ YES ^ N/A ^ MOVE ^ OTHER ^ NO ;:: ,.. 'I P PERTY OWNER', , .., _ ~. ;:r .; -,,: ., ;, CONTR A.C_ OR:_* , `~ . `: ~ „ .'"ARCHITECT /ENGINEER:. . 9 . N AME 15. COMPANY NAME: 23. COMPANY NAME ] / ~ //~~ //pp ,, ~I /~~'Y „Sj,l'1~~„(~ ,~' 16. NAME: 24. LICENSEE NAME 10. ADDRESS: 17. STATE OF FLORIDA LICENSE NO.: 25. STATE OF FLORIDA LICENSE NO.: IG /3 c,.~N~.s~ / ~~ ~ 18. ADDRESS: 26. ADDRESS: 11. OFFICE PHONE L~ ~ ~/ 12. FAX NO.: 19. OFFICE PHONE: 20. FAX NO.: 27. OFFICE PHONE: 26. FAX NO.: 13. CELL PHONE: 21. CELL PHONE: 29. CELL PHONE f0 ~~~ 14. EjMyAIL ADDRES~S.:,,~ y~ ~ 22. EMAIL ADDRESS: 30. EMAIL ADDRESS: ' ~'~~ EE`SIMP E TITLE HOLDER °°~ ~~"T` a ;~ -~ '~ -.'. (IF OTHEFj THAN OWNFRi - ~ ".' BONDINGCOMPANY~3 ',~' - ~ K:.,, _ ~ MORTGAGE LENDER: - -' :- 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 'rf 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. 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. 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. ~k WARNING TO OWNER: *~-Ik 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 or`AGENT.. ` CONTRACTOR ' . r (It,Agent, Power of A13omey or Agency Letter Required) (QUalHier Only) Signed: Date: Signed: Date: Before me this day of , 2009 in the county of Before me this day of , 2009 in the county of Duval, State of Florida, has personally appeared Duval, State of Florida, has personally appeared herin by himself /herself and afFnns that all statements and declarations are hedn 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, State of ,County of ^ Personally Known ^ Personally Known ^ Produced Identfication - ^ produced Identification - Notary Signature: Notary Signature: BLDG01 Pemit Application Bldg: RE\gSED: 12/i6/2D08 ~~:~; v ~ _ ~1:,~.~ ~~y~ ~,irU~lx~y~ City of Atlantic Beach ~ ~ ~ ~ ~ 2U~9 ~• Building Department 't ~ 800 Seminole Road 1'3~ :_~ ,~ _ ~ Atlantic Beach, Florida 32233-5445 .. Phone (904) 247-5826 -Fax (904) 247-5845 ~J3y~?" E-mail: building-dept@coab.us City web-site: http://www.coab.us APPLICATION NUMBER (To be assignedhby the Building Department.) V Date routed: APPLICATIOhI REVIEW AND TRACKING FORM Property Address: l ~6 ~fi~'I j`~jo J~ ~~G~ Applicant: ~ /,y`~ L Project: ~~~ ~ ~ ~ f.~~! ~ f n !' i`f1 a- L D nt review re aired Yes No B- anning ~ Zonin Tree A mtn-strator ublic Vllorks Public Ufilitie u rc a e Fire Services -- _ _ -:- Review fee _$. ::.. ,. ;, De a Si nature ; _ _ , . - ~ '. -: Other Agency Review or Permit Required Review or Receipt of Permit Veri#ied B Date Florida Oept. of Environmenfai Protection Florida Dept of Transportation St. Johns River Water Management District Army Carps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: ~pproved. ^Denied. (Circle one.) Comments: BU[LDING PLANNING & ZONING Reviewed by: Date: TREE ADMIN. Second Review: [Approved as revised. ^Denied. PUBL WOR Comments: PUBLI U l S PURL! AFETY Reviewed by: Date: FIRE SERVICES Third Review: [Approved as revised. ^Denied. Comments: Reviewed by: Date: 12evised 45H4to8 ~.:~5```~" f2_ CITY OF ATWNTIC BEACH ;`3 800 SEMINOLE ROAD, ATLANTIC BEACH, FL 32233 i OFFICE: (904)247-5828 ~ FAX NO.:(904)247-5845 `J ~ ~ BUILDING-DEPT(c~COAB.U5 ~` ~~w BUILDING PERIIAIT APPLICATION 09- _..v.__.I____ I _ _ ~_~_ __ I ~.._..I rn Ival r-n1 InITv 7 ,1~`JOBgDDRESS: ` 2; VALUA'(IOI~i`DFN/DRKf°;" 3:5~. FT;_UNDER ROOF=" ~~~~ JrL ~ ~~ Es"r ,L.~' 3, ~,4;"LEGAL DESCRIPTION` f" ;` " ~ 5. CLA$S OFWo K -~•~l,'~ -':' ' ~ ~" ? 6. USEOFSTRUCTURE' ~ B ^ NEW BUILDING ^ DEMOLITION ^ RESIDENTIAL LOT LOCK_ 5UB DIVISION ^ ADDITION ^ CONVERTING USE ^ COMMERCIAL ~. 7r!QECCRIFTIQN OF.WORK' ? ^ ALTERATION ^ ACCESSORY BLDG. 8` FIRE SPRINKLER>': ! f.-~f~ ~gi ~~~/Yjl ~ ~~~ ~~"~ ~ ~ ^ REPAIR ^ POOL /SPA ^ YE5 ^ WA r' " " ~+ ""^' ^ MOVE ^ OTHER ^ NO ~~+11'~r;;,4`I,ni ,r'.. ~,'i;PR PERTYOWNER',~„ .: =. .: ...: r .~:::,::,. , . CONTR gCTOR. ~`. ,: ~ ;:,1;; ,~ ,rARCHITEC: N ENGINEER:' . 9. NNAME: 15. COMPANY NAME: 23. COMPANY NAME: /~-~'Y ss~~~~ ,`' 16. NAME: 24. LICENSEE NAME 10. ADDRESS: 17. STATE OF FLORIDA LICENSE NO.: 25. STATE OF FLORIDA LICENSE NO.: l~ ~3 ~~,~~s ~ ~~ 18. ADDRESS: 28. ADDRESS: 11. OFFICE PHONE: 12. FAX NO.: 19. OFFICE PHONE: 20. FAX NO.: 27. OFFICE PHONE: 28. FAX NO.: C~ ~ ~/ 13. CELL PHONE: 21. CELL PHONE: 29. CELL PHONE I D a S'> .~ 14. EMAIL ADDRESS: ~, 22. EMAIL ADDRESS: 30. EMAIL ADDRESS: .~ ~~; FEE'SIM~L,EyTITLE HOLDER _N,, r+H':; SiFO7NEBTFb4NOUVriER; ~~ ,,.,,, ~`"` •.+ `, ' ': BONDING COMPANY ~ '-' w , .N r ,. x r ~ MORTGAGE LENDER. 31. NAME 33. NAME: 35. NAME 32. ADDRESS: 34. ADDRESS: 36. ADDRESS: Appligtion 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 ff 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. 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. 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 wmpletion 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 or"A'GENT`' _ ':`': ';' - . CON'~RACTOR ,- (It.Agecrt; Power oLAttomey'brAgency Letter Required) ._r , (Qilalllier Only) Signed: Date: Signed: Date: Before me this day of , 2009 in the county of Before me this day of , 2009 in the county of Duval, State of Florida, has personally appeared Duval, State of Florida, has personally appeared herin by himself /herself and afFrms 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, State of ,County of ^ Personally Known ^ Personally Known ^ Produced Ident~cation - ^ Produced Identification - Notary Signature: Notary Signature: BLDG01 Permit Application Bldg: REVISED: 12/18!2008 -s ~~1r City of Atlantic Beach ~ ~ ~ ~ ~ 2~D9 ;= `~ f"3 ~ Building Department 800 Seminole Road _- r? Atlantic Beach Florida 32233-5445 ~~+~__--- Phone (904) 247-5826 Fax (904) 247-5845 - _- ~~~ ~?' E-mail: !wilding-dept~Caab.us City web-site: httpJ/www.coab.us APPLICATION NUMBER (fo be assigned by the Building Department.) Date routed: APPLICATION REVIEW AND TRACKING FORM Property Address• / OQ ~fi~J? j e~~ Applicant: ~ l[ )`7? ~ ,~ Project: ~~ ~ ~ G~ f.. nt review wired Yes No nning ~ Zonin Tree A minrstrator ubtic Works Public U#Uitie u ~ e Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt of Permit Verified B Date Florida Dept. of Environmental Protection Florida Dept. of Transportation St. Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurarrts Division of Alcoholic Beverages and Tobacco Other. APPL{CAT{ON STATUS Reviewing Department First Review: Approved. ^Denied. (Circle one.) Commen ~ e ~~ ~ t~y(~ BUILDING PLANNING & 20NING F ~ ~~~~ Reviewed by:,_ Date: ,L-f---- TREE ADMIN. Second Review: []Approved as revised. ^Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: DApproved as revised. ^Denied. Comments: Reviewed by: Date: Revised o5/1dl09 - ~~~`~- CITY OF ATLANTIC BEACH /,~ F .;. - cs 800 SEMINOLE ROAD, ATLANTIC BEACH, FL 32233 * ., ~~ OFFICE: (904)247.5826 • FAX NO.:(904)247-5845 'J BUILDING-DEPT~COAB.US ~ ~ .~~.~~;: BUILDING PERMIT APPLICATION 09- ._ I . ~ . -I_.._.I_.__~.I DUVALCOUNTY ,1'. JOB`ADDRE$S 2. VALUATION,OF W-r~k 3: 50: FF. UNDER ROOF " ~w~y ~'/ ,~ ~~~~ ~c'/ / ~f Fes- L: 4i LEGAL DESCRIPTION: 5 GLASS OFVrlO K `- 6. USE,OF`STRUCTURE: / Ur ¢ ^ NEW BUILDING ^ DEMOLITION ^ RESIDENTIAL LOT4 BLOCK_ SUB DIVIS!OIJ ^ ADDITION ^ CONVERTINGUSE ^ COMMERCIAL ;~~~'i DESCRIPTIQIJ OF WORK ^ ALTERATION ^ ACCESSORY BLDG. 8• FIRE SPRINIQ-ER; ~3 _ G ~~~ ~ ~~ I G L ~ ~~~ ^ REPAIR ^ POOL /SPA ^ YES ^ WA • r ~~' ^ MOVE ^ OTHER ^ NO P PERTY OWNER: CONTR gC,. OR: ARCHITECT ! ENGINEER: 9. NAME 15. COMPANY NAME: 23. COMPANY NAME: A , ~ /Y~~yc.~• / „~(J~~O ,(' / 18. NAME: 24. LICENSEE NAME 10. ADDRESS: 17. STATE OF FLORIDA LICENSE NO.: 25. STATE OF FLORIDA LICENSE NO.: ~~xs ~ ~~ ~ >G i3 c , 18. ADDRESS: 28. ADDRESS: 11. OFFICE PHONE: 12. FAX NO.: 19. OFFICE PHONE: 20. FAX NO.: 27. OFFICE PHONE: 28. FAX NO.: / ~"1 13. CELL PHONE: 21. CELL PHONE: 29. CELL PHONE: ~o ~~~ 14. EMAIL ADDRESS: ~ 22. EMAIL AODRESS: 30. EMAIL ADDRESS: FEE SIMPLE. TITLE HOLDER: ~r~+. ,; v, ~ BONDING COMPANY: ~ " MORTGAGE LENDER: (IF OTHER THAN OWNF.,EZ) ,.... ~ :. 31. NAME: 33. NAME 35. NAME 32. ADDRESS: 34. ADDRESS: 36. ADDRESS: Appliption is hereby made to obtain a permit to do the work and installations as indipted. 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. 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. I will not ocra~py 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. 01NNLR'or AGENT~_ ;; ' CONTRACTOR - (If Agent Pawer of Attorney or Agency Letter Required) (Qualfier Only) Signed: Date: Signed: Date: Before me this day of , 2009 in the county of Before me this day of , 2009 in the county of Duval, State of Florida, has personally appeared Duval, State of Florida, has personally appeared herin by himself /herself and affirms that all statements and decarations are herin by himself /herself and afiirrrts that all statements and declarations are true and accurate. true and accurate. Notary Public at Large, State of ,County of Notary Public at Large, State of ,County of ^ Personally Known ^ Personally Known ^ Produced Identification - ^ Producred Identification - Notary Signature: Notary Signature: BLDG01 Permit Application Bldg: REVISED: 12/18/2008 MA,P SHOWING BOUNDARY SURVEY OF LOT 624, SALTAIR, AS .RECORDED IN PLAT BOOK 10, PAGE OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLO rn7a S EM I N O LE ROAD SALTAIR BOULEVAR D BY PLAT ' 50' RIGHT-OF -WAY 50.00' FOUND 1/2" IRON PIPE FOUND 5/8" REBAR NO IDENTIFICATION 5' CONCRETE SaDEWALK• NO IDENTIFICATION . 0.3' 0.5' 0.4' x o © iw o- . X . ~^O e 11.1' 31.8' ~'~ ~\ 4' WOOD FENCE x FILE coPY °' 1 STORY MASONRY RESIDENCE #100 N W O 1.4'~ X~ ' 11.1' 21.4' ~ S.9' S.6 W COVERED SHOWER n ~ U 4 5 C 5.6' 4 O Q v P • O O 3 x ~ ~ LOT 623 ~ O y ~ O • ° : r-- . ~ Y .0.`~ • a _._ _. _.. BRICK STEPS-~-, - 10.7' FOUND 3/8" REBAR NO IDENTIFICATION LOT 607 FRAME SHED x - .....19.0'~---- x . .. .59:ti _ _ I l 0 © v' D.SJ I FOUND 1/2" iROt` NO IDENTIFIGATION I 1 10.4' 6.4' a ~ ~n <' lHl m m; `u.t o wUUU I-ENCE~ 50.00' i ~~,~.`~ LOT 608 I