Loading...
Permit Folder 230 7th St CITY OF ATLANTIC BEACH s) 800 SEMINOLE ROAD ATLANTIC BEACH FL 32233 INSPECTION PHONE LINE 247-5826 r»4JIt Application Number . . . . . 09-00001073 Date 2/12/10 Property Address . . . . . . 230 7TH ST Application type description FENCE PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 --------------------------------------------- Application desc REPLACE 4FT FENCE --------------------------------------------------- Owner Contractor ------------------------ ------------------------ ARCHBOLD, KEITH PHILLIPS BUILDERS LLC 230 7TH STREET 1250 SELVA MARINA ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233 (904) 24 6-3 677 ------------------------------------------------------------ Permit . . . . . . FENCE PERMIT Additional desc . . Permit Fee . . . . 70 . 00 Plan Check Fee . 00 Issue Date Valuation . . . . 0 Expiration Date . . 8/11/10 ------------------------------------------------------------ Special Notes and Comments *2007 FLORIDA BUILDING CODE W/ 105- 106 SUPPLEMENTS . 2007 FLORIDA BUILDING CODE - RESIDENTIAL. 2005 NATIONAL ELECTRICAL CODE. *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. ------------------------------------------------------------------ Fee summary Charged Paid Credited Due --------------- ---------- ---------- ---------- ---------- Permit Fee Total 70 . 00 70 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 70 . 00 70 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. CITY OF ATLANTIC BEACH i 800 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233 09- %' �'k OFFICE:(904)247-5826•FAX NO,:(904)247-5845 J BUILDING-DEPTQCOAB.US =y9 BUILDING PERMIT APPLICATION DUVAL COUNTY 1:JOB-ADP RESS " „ .,:.,.. " 2.VALUATION OF WORK°, 3.SQ:FT.UNDER ROOF 230 7�'�.�• A.�3. �. 3zz33 4:LEGAL DESCRIRTION;` 5i CLASS OF WORK 6.USE;OF STRUCTURE. x ❑NEW BUILDING ❑DEMOLITION ❑RESIDENTIAL LOT_BLOCK_SUB DIVISION ❑ADDITION ❑CONVERTING USE ❑COMMERCIAL 'fi7::'DESCRIPTIgN OF WORK ❑ALTERATION ❑ACCESSORY BLDG. a.FIRESPRINKLER ��/✓ s ❑REPAIR ❑POOL/SPA ❑YES ❑N/A G ❑MOVE ❑OTHER ❑NO � MINER- CONTRA OR,. ,,. 'ARCHITE AME: PROPERTY OWNER GT!ENG 15.COMPANY NAME: 23.COMPANY NAME: INEER:-. 16.NAME: 24.LICENSEE NAME: 10.ADDRESS: 17.STATE OF FLORIDA LICENSE NO.: 25.STATE OF FLORIDA LICENSE NO.: 277" Sf 9• rl, jWi33 r- 18. 18.ADDRESS: 26.ADDRESS: 72.) D 1tl✓e14e/llld�o Gly. �r Lt3,3 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: 3,f4 --249° 14.EMAIL ADDRESS: 22.EMAIL ADDRESS: 30.EMAIL ADDRESS: FEE SIMPLE TITLE HQLDER �E MORTGAGE LENDER. tiForHERTHnNowNER).. BONDING COMPANY 31.NAME: 33.NAME: 35.NAME: 32.ADDRESS: 34.ADDRESS: 136.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. 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. mow* OWNER or AGENT=` CONTRACTOR:' (If Agenf Power of Attorney or Agency Letter Required)` ;(Q alifier Only)• Signed: Date: Sign . Date: ` Z'? d Before me this day of 2009 in the county of Before a this day of 2009 in the co my of Duval,State of Florida,has personally appeared Du ,State of Florida,has personally appeared h affirms that all statements and declarations i re herin by himself/herself and affirms that all statements and declarationstr re e and acc t true and accurate. N tary Publi rg C r Notary Pubr t e,State of County of t%AVd Person ❑Pe ally own Produced Ident 'o - ❑Pro tificati n- N tary�itwo Notary Sign l 0� JOB +, I" " R CODE COMPLIANCE �,,� A, CITY OF ATLANTIC BEACH BL G01 sllrldr Bt�i ,: �I �r2TI O NJ SEE PERMITS FOR ADDITIONAL REQUIREMENTS AND CONDITIONS. REVIEWED BY: DATE: 27 J'V) � (49.x` F15LO) U $ r . US 44135 f.......V�./{] per(} ` !RrliW� -_1 ...,..._ Vii' xvCONGROC /--,O"T 0-4 W uj c '0000� Cyn 60 7� r O-Av u L9 in i tom€ PEAX PwE, LO NQ Gig 50,0 t t (50.14- FIELD) lgoose, 6 d2,0 o �dR ISS/ a� CITY OF ATLANTIC BEACH ®9_ 800 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233 s7 I I Ia I - �' st OFFICE:(904)247-5826•FAX NO.:(904)247-5845 BUILDING-DEPT@1COAB.US BUILDING PERMIT APPLICATION DUVAL COUNTY .1,JOB'ADDRE$S t, ^ 2:VALU�71Qt OF VJOR(< sE 3;;50_FF:UNDER ROOF1731 2-30 71'r.�• A.�.y'i. 32-2-33 d LEGAL DESCRIPTION "s ' , . firUEOF STRUCTURE ❑NEW BUILDING ❑DEMOLITION ❑RESIDENTIAL LOT_BLOCK_SUB DIVISION ❑ADDITION ❑CONVERTING USE ❑COMMERCIAL ❑ALTERATION ❑ACCESSORY BLDG. ,1MZ:,DESCRIPTION OF:WORK 8:FIRE SPRINY4 ER> _ ❑REPAIR ❑POOL/SPA ❑YES ❑WA /V(� ❑MOVE ❑OTHER ❑NO CONTRACTOR /ENGINEER :PROP.ERTY:OWNER,, 9.NAME: 15.COMPANY NAME 23.COMPANY NAME: �acH,r3�ca p ,WO.S gella&-S 16.NAME 24.LICENSEE NAME Axwto I✓ PJ-tlwj 01 10.ADDRESS: 17.STATE OF FLORIDA LICENSE NO.: 25.STATE OF FLORIDA LICENSE NO.: 2 7?H Sf. ' 1.33G GG /26-7 31f 18.ADDRESS: 26.ADDRESS: '7 2) D JL I✓O Md/l1a/i0 C//d A;:". 2-2,33 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 3g9 Z4,1A 14.EMAIL ADDRESS: 22.EMAIL ADDRESS: 30.EMAIL ADDRESS: ?r�^ , FEE SIMPLE TITLE HOLDER BONDING COMPANY ;, MORTGAGE LENDER (IF OTHER THAN OV MER) .. ,R ... .., .. 7!777- 31. ... .- .. _.. .. 31.NAME: 33.NAME 35.NAME: 32.ADDRESS: 34.ADDRESS: 35.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. 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: 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 � x (If,Agerif Power of Attorney or Agency L'ette�Required)' (0 rvalfier Only) a Signed: Date: Signe . Date: s? / Before me this day of 2009 in the county of Before a this y o 2009 in the co my of -y Duval,State of Florida,has personally appeared Du ,State of FI a, to nall WY herin by himself/herself and affirms that all statements and declarations are herin by himself!herself and affirms that all statements and declarations tre true and accurate. true and accurate. Notary Public at Large,State of ,County of Notary Pub&ul,-' JL- BLDG01 ate of County of r�rtyco ❑Personally Known ❑Pers a ❑Produced Identfication- ❑Pro Notary Signature: f ILE lair T- Notary SigPermit Application Bldg:REVfSED:12/18/2008 / PYA (49.x= Fln.D) U s r RW t,q• OM 50,001 !' tU 41-33 FOUWO I/r Roar a t ,' !RON POC Le No CAP Mr, LZ 40 W w 11-1A 44FTC 'tC > . OWICUM Cra +� 'a' Cy� o,t• r-aU4 xA ff �tiE.t E3i'tg`t 1" ti nrc►tttt MauMH LD No tW 50.00' �.,�`' Uj M CAP City of Atlantic Beach Planning and Zoning Department tp Y!�(2,0 IThis approval verifies compliance with applicable / zoning, subdivision and other local land development regulations, but does not constitute approval for the issuance of permits. Compliance with Florida Building Code and all other applicabit- local, State and Federal permitting requirement must be verified by signature of the City ofAtlaoc Beach Building Off ial prior to a issuance of a Building Permit. _ Approved By: Il'I Comm ity Develo men Date: �C}) I t y �, :ii -. '� { ,. ,.,... .. ....,.... .. .. ,. ,....V Cit of Atlantic Beach .APPLICATION NUMBER Building Department � (To be assigned b the Buildin Department.) 800 Seminole Road I / J Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 • Fax(904)247-5845 E-mail: building-dept@coab.us Date routed: b-7 To c9 City web-site: http://www.coab.us 11 1 APPLICATION REVIEW AND'TRACKING FORM Property Address: _� l cam'' Dglaaftment review required Yes No Applicant: P ping &Zonin re . trator Project: "Public Work 41 �ic Utilities Public afety Fire Services Review fee $ F Dept S16n.ature' 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. ❑Denied. (Circle one.) Comments: BUILDING .n PLANNING &ZONING Reviewed by: If Date: v TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. Comments: Reviewed by: gate: Revised 05/14/09 CITY OF ATLANTIC BEACH 44 1¢ 800 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233 0 _ 9 I I h I I OFFICE:(904)247-5826•FAX NO.:(904)247-5645 BUILDING-DEPT@COAB.US BUILDING PERMIT APPLICATION DUVAL COUNTY 1,1 JOB'AODRESS :, 2.:VALU�4T7QN OF WDRfC �, ? 3%?50 FT_UNDER ROOF ,230 71'�.�• il.�.�i. 321-33 40,.,4 LEGAL DESIMRTION 6:USE.OFSTRUCTURE , . a ❑NEW BUILDING ❑DEMOLITION ❑RESIDENTIAL LOT_BLOCK_SUB DIVISION ❑ADDITION ❑CONVERTING USE ❑COMMERCIAL s7„DESCRIPTION OF:WORK ❑ALTERATION ❑ACCESSORY BLDG. 8:FIRE SPRINKLER;°r„ ❑REPAIR ❑POOL/SPA ❑YES ❑N/A /►/C�� ❑MOVE ❑OTHER ❑NO , !Fres ..:i PROPERTY OWNER „ ',.; °_ ;, `CONTRACTOR �";, t +",,�;. ARCHITECT.!ENGINEER. 9.NAME: 15.COMPANY NAME: 23.COMPANY NAME: 18.NAME: 24.LICENSEE NAME &L pk(14•1 Q1 10.ADDRESS: 17.STATE OF FLORIDA LICENSE NO.: 25.STATE OF FLORIDA LICENSE NO.: 2�-7TN ,S j. j?. rl, 18.ADDRESS: d4WA e//g, 26.ADDRESS: 72) d 1tl✓a14 y ► Lz3,3 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 3g9 --?"m4 14.EMAIL ADDRESS: 22.EMAIL ADDRESS: 30.EMAIL ADDRESS: ern., FEE SIMPLE TITLE HOLDER t BONDING COMPANY MORTGAGE LENDER .- PF OTHER THAN ONRJER) .t.•,.....,, ..: �', t . ..._.. - 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. 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. O WN�R or AGEN'Is _ ` CONTRACTOk Y 9 cy r eq ) (O alifier Onl ;.a, -, ., (If,Agenf,Power ofAttome orA en 'Letttte R uired y) Signed: Date: Signe . Date: Before me this day of 2009 in the county of Before a this day of 2009 in the co my of Duval,State of Florida,has personally appeared Du ,State of Florida,has personally appeared herin by himself/herself and affirms that all statements and declarations are herin by himself/herself and affirms that all statements and declarationsr�e true and accurate. true and accurate. l/ Notary Public at Large,State of ,County of Notary Pubaure" h- BLDG01 tate of County of VC' ❑Personally Known ❑Pers a ❑Produced Identification- ❑Pro Notary Signature: Notary SigPermit Application Bldg:REVISED:12/18/2008 City of Atlantic Beach APPLICATION NUMBER BuildingDepartment p (To be assigned b the Buildin Department.) 800 Seminole Road I �� Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 • Fax(904)247-5845 E-mail: building-dept@coab.us Date routed: Z7 City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: _rQ� -7 1' '' D ent review required Ye No Applicant: P ping &tonin trator Project: "41JPublic Wor c Utilities Public afety Fire Services Reviewfee $' Dept Signature , 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: APP (CATION STATUS Reviewing Department First Review: Approved. ❑Denied. (Circle one.) Comments: BUILDIN PLANNING &ZONING071 Reviewed by: Date: 17 � TREE ADMIN. Second Review: ❑Approved as revised. Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05/14/09 Vis'-Vj:r City of Atlantic Beech ri� APPLICATION NUMBER Building Department g (To be assigned by the Buildinq Department.) w 800 Seminole Road Atlantic Beach, Florida 32233-544511CIg / Phone (904)247-5826 • Fax(904)247-584 co)I E-mail: building-dept@coab.us Date routed: 27 City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 1' c, D ent review required Yes No Applicant: P ning &Zonin re trator Project: f'- Public Work is Utilities Public afety Fire Services Review fee $ ` Dept Signature . 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: ®Approved. ❑Denied. (Circle one.) Comments: 1 e,� a s ► er�cC BUILDING PLANNING &ZONING Reviewed by: 'J Date: 7[2,7(01, (0 TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05/14/09 x J,Jr City of Atlantic BeachJUL20�� APPLICATION NUMBER r �,;•. J °•�5� building Department (To be assigned b the Buildin Department.) 800 Seminole Road _ M Atlantic Beach, Florida 32233-5445 B U _ Phone(904)247-5826 • Fax(904)247-5845 E-mail: building-dept@coab.us Date routed: 27 City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM D ent review Property Address: � � � required Yes No Applicant: f-�I �� �,©S P ping &Zonin re . trator Project: ublic Work is Utilities Public afety Fire Services Review flee $,, ..- Dept Slgnature 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: Approved. ❑Denied. (Circle one.) Comments: BUILDING PLANNING &ZONING �Q Reviewed by: Date: TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. PUBLI WOR S Comments: PUBLI U I PUBL SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05/14/09 yMA CITY OF ATLANTIC BEACH ___... .... _ /' �.,,�;_ 800 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233 ®�+/y� I I f I • +irk OFFICE(904)247-5826•FAXNO.:(904)247-5645 BUILDING-D EPTGCOAB.US O� BUILDING PERMIT APPLICATION DUVAL COUNTY ,,I�,1;JQ6'ADDRESS '. t�"• ,,, .,, _ { 2'VALU�TIQ{�;OF WO(i�:E„�; i •,; ? 3,SO_FT_UN.DER,ROOF- 230 71 .3• 01- 3zz33 , EGAL DESCRIPTION „,-r77jf,,777- 0,1'dLAsS.OKUORK ❑NEW BUILDING ❑DEMOLITION ❑RESIDENTIAL LOT_BLOCK_SUB DIVISION ❑ADDITION ❑CONVERTING USE ❑COMMERCIAL ,c5,77-,DESCRIPTION OF WOR iE a t ` 1 ❑ALTERATION ❑ACCESSORY BLDG. S:FIRE SPRINKLER'_`u, _ ❑REPAIR ❑POOL/SPA ❑YES ❑N/A ❑MOVE ❑OTHER ❑NO ,.5+r,xPROPERTY OWNER •, ?`GONTRgCTOR 9.NAME: 15.COMPANY NAME 23.COMPANY NAME: 16.NAME: 24.LICENSEE NAME A.16-WAN, nklw1 v1 10.ADDRESS: 17.STATE OF FLORIDA LICENSE NO.: 25.STATE OF FLORIDA LICENSE NO.: 2 -37N S1 �. r'I. 3 Z1r33 13c /2-j i 7 16.ADDRESS: 26.ADDRESS: 720 oft/✓e�+ A:*I. Lz33 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 3¢9 -2gj4 14.EMAIL ADDRESS: 22.EMAIL ADDRESS: 30.EMAIL ADDRESS: tkf a ^jt^' FEESIMPLE,TITLE HOLDER "f NG COM rt r ,� .. '' �,'" ''"v -MORTGAGE LENDER 4pPoTHFUtTHANotnmiElxpr _ BODINPANY 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. 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 A_`GENT' s CONTRACTOk (If Agent,Power of'Attome arA Venc Letter Re uired Y g Y 9 (Q alder OnIY) + a Signed: Date: Sign . Date: ` 2'? / Before me this day of 2009 in the county of Before a 4this day,of ,2009 in the comy of Duval,State of Florida,has personally appeared Du ,State of Florida,has personally appeared herin by himself/herself and affirms that all statements and declarations are herin by himself/herself and affirms that all statements and declarationsra e true and accurate. true and accurate. Notary Public at Large,State of County of Notary Pub&ure* L te of County of Vd ❑Personally Known ❑Pers a❑Produced Identfication- ❑ProNotary Signature: Notary SigI BLDG01 Permit Application Bldg:REVISED:12/18/2006