Permit 705 Redfin Drive aity of Atlantic Beach (� m��"' APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road } S O
r� Atlantic Beach, Florida 32233-5445 '+ /
Phone(904)247-5826 • Fax(904)247-5845 9
E-mail: building-dept@coab.us OT I �/�r LIDate routed: z J
City web-site: http://www.coab.us S
%
APPLICATION REVIEW AND TRACKING FORM
De Edministrator t review required Yes No
Property Address: anon'
Applicant: ubls
ublic Utilities
Project: Public Safety
/.4cE ry�J t,r Fire Services
( Review or Receipt Date
Other Agency Review or Permit Required of Permit Verified B
Florida Dept.of Environmental Protection
Florida Dept.of Transportation
St.Johns River Water Management District
(}Q��C t Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: FlApproved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING
TREE ADMIN. Reviewed by: Date:
PUBLIC WORKS Second Review: FlApproved as revised. ❑Denied.
Comments:
PUBLIC UTILITIES
PUBLIC SAFETY
FIRE SERVICES Reviewed by: Date:
Third Review: RApproved as revised. ❑Denied.
Comments:
Reviewed by: Date:
,s t e1e; CITY OF ATLANTIC BEACH 09- I I I I I
800 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233
OFFICE:(904)247-5826 0 FAX NO.:(904)247-5845
BUILDING-DEPTGCOAB.US
BUILDING PERMIT APPLICATION DUVAL COUNTY
�,1..JOB
�ADDRESS: 2.VALUATION OF WORK
] 3:S0:FT.UNDER ROOF
`05M �liV` - � - 3.USE USE OF STRUCTURE:
4.LEGAL DESCRIPTION: 5.CLASS WORK
❑NEW BUILDING ❑DEMOLITION ZBESIDENTIAL
L0*t'%-BLOCK_SUB DIVISION ❑ADDITION ❑CONVERTING USE ❑COMMERCIAL
7.DESCRIPTION OF WORK ❑ALTERATION ❑ACCESSORY BLDG. 8.FIRE SPRINKLER:
❑REPAIR ❑POOL/SPA ❑YES ❑N/A
iktKc ❑MOVE OTHER NO
CONTRAC OR ARCHITECT/ NGINEER:'
PROPERTY OWNER: 23.COMPANY NAME:
9.NAME: 15.COMPANY NAME:
J6q,lp: � 1
16.NAME: 24.LICENSEE NAME:
10.ADDRESS: 17.STATE OF FLORIDA LICENSE NO.: 25.STATE OF FLORIDA LICENSE NO.:
7 15 V b _)f ( �be1 c 18.ADDRESS: 26.ADDRESS:
1 .OFFICE PHONE: 12.FAX NO.: 19.OFFICE PHONE: 20.FAX NO.: 27.OFFICE PHONE: 28.FAX NO.:
'7 •0�1
13.CELL PHONE: b-7_ 1 21.CELL PHONE: 29.CELL PHONE:
3
14.EMAIL ADDRESS: 22.EMAIL ADDRESS: 30.EMAIL ADDRESS:
FEESIMPLE TITLE HOLDER: BONDING COMPANY: MORTGAGE LENDER:
(IF OTHER THAN OWNER) ..'
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.
�HNr 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
1 (If Agent,Power of mey or Agency Letter Required) (Qualfier Only)
Att
Signed:
Date:,, ` y'1 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 declarations are herin by himself/herself and affirms that all statements and declarations are
true and accurate. true and accurate.
Notary Public t 'S to of ,County of-'T� l Notary Public at Large,State of ,County of
L'I Pe ally ❑Personally Known
roduced Identifi ❑Produced Identification-
Notary Si t Notary Signature:
BLDG01 Permit Application Bldg:REVISED:12/18/2008
Page 1 of 1
SO.
TV el
>t?O
80:w
sm
WAS
_ WAS
_ Ww
mm
140'
640
74s ras
Caprnn,(Cl2DDSCnrof Jackw"WW,F1 rig 0 801
/�-, -jam .lig �'� w�"lC b NoT )LNoGv i✓fiO4J Frin
/VIf65 .rivarg Tae,#y
#w s fir, /xte. fD viaikf�y
7olr tt iT qv- met bqc-r- uP
httn://maDs5.coi.net/outDut/DuvalMaDs itdizism6367232601298... 3/20/2009