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Permit 1317 Fleet Landing BoulevardCITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5826 Application Number 10-00000722 Date 6/08/10 Property Address 1317 FLEET LANDING BLVD Application type description RESIDENTIAL OTHER Property Zoning TO BE UPDATED Application valuation 2450 -------------------------------------------------------------------------- Application desc remove wall stucco and sheetrock repair ---------------------------------------------------------------------------- Owner Contractor ------------------------ -------------------- PRESTIGE BUILDERS & ---- REMODELERS 848 AILY CHURCH LANE SEVIERVILLE TN 37876 (904) 662-1528 --------------- ------------- ------------------------------------------------ Permit BUILDING PERMIT Additional desc . Permit Fee 65.00 Plan Check Fee 32.50 Issue Date Valuation 2450 Expiration Date 12/05/10 ------------- ------------------------ ------------- -------------------------- Special Notes and Comments *2007 FLORIDA BUILDING CODE W/'05-'06 SUPPLEMENTS. 2007 FLORIDA BUILDING CODE - RESIDENTIAL. 2005 NATIONAL ELECTRICAL CODE. *REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING DEPARTMENT IMMEDIATELY. ----------------- ------------- --------------------------------------- Fee summary Charged ---------- --- ------- Paid Credited ------- ---------- --- Due ------- ----------------- Permit Fee Total 65.00 65.00 .00 .00 Plan Check Total 32.50 32.50 .00 .00 Grand Total 97.50 97.50 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. May 11 10 12.3f)p LUII.DING PERMIT APPLICATION CITY OF ATLANTIC BEACH SflO Seminole Road, Atlantic Beach, FI.32233 rI ~1t1 Qffice (9(}4} 247-5826 Fax (444) 247-5845 ~ ~ ~ ~ ~ L'1 Job Address: ~~ ~'I F~LE.E'T L-C~ N D I ~ U Permit N ,~ J U N 112 010 _ Legal Description Parcel # Valuation of Work S ~4,,,,,~~ Proposed Work heatedtcaauled non-heate~Tca ,_,_, Class of Work (circle one): New Addition A e~sh'1u. Repair Move Demolrtiau pooUspa window/door Uae of e>QStialgjp struMn~s~ {{circle one):. Commercial Resi.denlial~` }# as existing s~hro~~is a fire spramhter system n~alkd?' (Circle one . o /A Florida Product~~gx+oval # For multiple p acts use p ex~:ppruv orm p_ ~ Describe in detail the Type of work tia be performed: i~.~C ~,.~~_~.Et 12"T 1 "T 1 D hl W 1~ zi L N b E~'!,~ E 1= ~l=aR. ~u~~ t~iy ~ 5I'CTi N.U RboM ; ~EPAir2 sTuc.co A~Nt~ 5 N ~.~CC2~-1~.~ Property Oevaer Information• Name: ~ C:... Addz~ess:~,~ ~ r- F 1~ ~T ! ;Pr N .~} i I~l C3 t~ L y b City State ~ Zip ,;~~ Phone E-Mail or Fax # (C?ptional) Contractor I~ormatioa. Company Name: p Cam' .~1i is ~~ t l ~F j~S ___ Qvaiifying Agent: -~i.t`~T A ~ --~ ~ ~ !~ C C' .fZ lj 12 `~ Address:~.q M .~.R ~s ~ f2.E T ~ '~ City ~t ~ 4~ tp N E AtfN State- l= L _ Zip 7 Office Phone Job Site) Number ~}~_- b .t~~_15.~ ~ Fax # `~.io5 4 Sri f'j • °7 ? 1() State CertificationlRegisttaLion # ~ ~ ~ G 5 i Architect Name 8c Fine # tV ~ ht ~ Engineer's Name & Phone # )y b N C. Fee Simple Title Holder Namte aztd Address lV f ` A Bonding Company Name and Address N t3 N E Mortgage Lender Name and Addaress i~t D Application is het eby Horde to o~xritt a permit tri do the wont mid itutaltetiorta cis wed I rxrt¢y that rro work ~ ~ has commenced prior to issuance a pwrarit rttrd thm ell work wilt be armed to the atatadmds of adl taws Ttgrrl~irrg cortsinrction itt ttris,ryr7sd~ort 7Yris permit hecwnes 1 anal voidwork u not ~ within aixmartths, or if o«t~ttcttox or wonE is or abaeu~ed for a ~~d of afar (6} months at cmy time work is conu+rtrrced. I xnderartm+d that arp~aAe permits mrrat be secured far 81e+c~r't~~, A''aibr, Path, ~I'trnaoes, ~otler8, llta, Tanlra ctrl dtr Cow etc WA1tNxNG TO OWNER: YOUR FAILURE fi0 RECORD A NOTICE OF CONIlVlENCElV9~NT MAY RESULT IN YOUR. PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING CONSULT Wl~'Yi YOITR LENDER OR AI~T ATTOA;NEY BEFORE RECORDING YO'[3R NOTICE OF CON'IlVIENCEMENT. 1 hereby certify that I tmvie read avad esemuied~thra appticatinn atrf 'bar tyre med carr~ect ~ltl provzsians v~'laies a~ widinances g this type of work wilt be evrmptied with whether ~ fte_d tzereut ra- r~dt. drs~ermit does riot pr+eswne to gyve axthorztp to violate aryc~ tJ4e provisions of grey other fidrraL state, or toccl regulating caR~n i`~ r of carrstrycfion Signature of Uvvner .~4~ - `~_ S.Eht?~ ~~~,' -~; Print 2+ta~ae SWOT12 to 8nd subSGrlbed I~fOre rzte '°~°u~~• `' ` • • • ' c, t Ibis ~ Day of /'yI ~_.~T,~ ,' , 20 ! O °°s,,,FR CO .~ rr- n ttrrrinit~~ Et-ZRBETH fESKE Notary 'ryL N~uy Pubic -State of Florida M11 Cotr-m._Expires Apr 5, 2013 ~. Commission #i DD 867829 Bonded Through National Notary Assn. of Contracxo ~ .- ~ ~~ ~-9~-{. i ~~ and subscrcbed before me ay of ~ 20 ~ b ~~a~1~cc..r ti liana. e~~ a~ Revisec101.26.1 U -r.a,~Jr , City of Atlantic Beach .:'' ''~ ~ i3uilding Department ' ""x ~' st r ~ ~ 800 Seminole Road t;~ ,' , -_- ~ Atlantic Beach, Florida 32233-5445 _ Phone (904) 247-5826 ~ Fax (904) 247-5845 "'--JS3 ~'~ E-mail: building-dept@coab.us City web-site: http://www.coab.us APPLICATION NUMBER (To be assigned by the Building Department.) //~ - // 7 Z Z-- Date routed: _ _S1/_L! Property Address: ~ / 7 `~~~/~~i~ri~~ Applicant: i CY~~ Project: ,g-LL -- ~-TC G D~~f~f~/~i oGi~ .~~ f7fii2 ent review required Ye No Building g & Zoning Tree Administrator Public Works Public Utilities Public Safety Fire Services Review fee $ '~ Dept Signafiure. Other Agency Review or Permit Required Review or Receipt of Permit Verified By 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: APPL,I:CATION STATUS Reviewing Department (Circle one.) BUILDIN PLANNING & ZONING First Review: Comments: [Approved. Reviewed by: ^Denied. Date: G `- 7~~D 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 CITE OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5826 Application Number 10-00000722 Date 6/24/10 Property Address 1317 FLEET LANDING BLVD Application type description RESIDENTIAL OTHER Property Zoning TO BE UPDATED Application valuation ------------------ 2450 ------------------ Application desc ------------------------------- --------- remove wall stucco and sheet ------------------------------------ rock repair ------------------------------- --------- Owner ------------------------ Contractor ------------------------ PRESTIGE BUILDERS & REMODELERS 848 AILY CHURCH LANE SEVIERVILLE TN 37876 --------------- (904) 662-1528 --------------------- Permit ELECTRICAL ------------------------------- PERMIT --------- Additional desc . Permit Fee 90.00 Plan Check Fee .00 Issue Date Valuation 0 Expiration Date 12/21/10 Special Notes and Comments *2007 FLORIDA BUILDING CODE W/ '05-'06 SUPPLEMENTS. 2007 FLORIDA BUILDING CODE - RESIDENTIAL. 2005 NATIONAL ELECTRICAL CODE. *REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING DEPARTMENT IMMEDIATELY. Charged Fee summary Paid--- -Credited- ----Due --- --- ------ Permit Fee Total 90.00 --- 90.00 .00 .00 00 Plan Check Total .00 .00 .00 00 . .00 90.00 Grand Total 90.00 . CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5826 Application Number 10-00000722 Date 6/24/10 Property Address 1317 FLEET LANDING BLVD Application type description RESIDENTIAL OTHER Property Zoning TO BE UPDATED Application valuation 2450 ---------------------------------------------------------------------------- Application desc remove wall stucco and sheetrock repair ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ PRESTIGE BUILDERS & REMODELERS 848 AILY CHURCH LANE SEVIERVILLE TN 37876 (904) 662-1528 ---------------------------------------------------------------------------- Permit ELECTRICAL PERMIT Additional desc . Permit Fee 90.00 Plan Check Fee .00 Issue Date Valuation 0 Expiration Date 12/21/10 ---------------------------------------------------------------------------- Special Notes and Comments *2007 FLORIDA BUILDING CODE W/'05-'06 SUPPLEMENTS. 2007 FLORIDA BUILDING CODE - RESIDENTIAL. 2005 NATIONAL ELECTRICAL CODE. *REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING DEPARTMENT IMMEDIATELY. ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total Plan Check Total Grand Total 90.00 90.00 .00 .00 .00 .00 .00 .00 90.00 90.00 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. Jun 24 10 01:20p BARKOSKIE ELECTRIC (904)249-8017 p.1 ELECT~CAL P.EXtMi'T APPLICATIOI~T C,~TY OF ATX.AN,CIC BI3A-CS 800 Seminole Rd, Atla~atie Beacb, FL 32233 Ph (904) 247-5826 Fax (904} 247-5845 Jos AnnRFSS: ,~~ l 7~L~r" L.,9~ ~ ~ ~/~ 1~~-~.~ PE~n~cr # ~ D- 7 Z 2 NEW SERVICE DOverhesd ^ Underground Q Underground up Pole OResidential (Ma~itn) Servitce ^ 0-100 amps 0141-I SOamps ^ 151-200amps ^ amps # of Meters O Commercial (Maio) Service ^ ©-I00 amps 23101-150amps ^ 151 240a~m~ps ^ amps O CT Service amp Conductor Type Size ^Multi-Fam1p (Nairn; Service DO-100 amps 0101-1i4amps ^ 151-200amps D amps # of Unit Meters DTemporarq Pole ^ amps SERVICE UPGRADE D amps Q CT Service amps NEW FEEDER (ADDTTIOI~IS, ACCESSORY STRIIC7'I3RES, ETC.) ^ 104 amps ^ 150amps ©240amps o amps ^ CT Service amps ADDI'TIO~IS, RE1V.[OD~~~REPAIRS, $UILD-UUTS, ACCESSORY STRTJC:T'URES, ETC. OTSER ELLCFRICAL PROJECTS OSwimmingPool ^ Sigo. OSmakeTk~ectflrs Qty ^Traasformers KVA ^MOtols FIRE A-LtARM SYSTEM {Requires 3 sets of plans & Fire Alarm Checklist) Qty volts/amps VALUE OF WORSE OutletslSwitches: 0-30sutps 31-100amps 101-200amps Appliances: 0-30amps 31-100amgs 101-200amps AlC Circuits: 0-60amps 61-I44amps Heat Circuits: # circuits (a kw Number of Lighting Outlets, Including Fitxttues: REPAIRS US ORepIau;e BuruttDamaged Meter Can QSafety Insp~tion ^Pane1 Cfmage ^OH to UG .~7ther:~LZ,aef--t-~- pu ~~-5 ~ ~ (,~R~-~-- 'TZ.~--wt ~ / ~. Permit braamars void if work does cot oommeaac within is six month period m wozic is saspaaded o: abandoned for sbr moatLs. I hereby certify Shat I have tzedthis applimtim and k4ow the same to be true sad oorrzet A!1 prtsvisioas of Iaws and oa~anees governing this work vviiF be complied with whettrer sperifsed a cot. The permit dog not give authority m viohwe toe provisions of azry o[firer sisme or coca! [aw rtgalarion consbvciion or the puforrnaace of caosbuctioa. _ . Properly Owners Name YZ. ~~~ fir" ~ -'~`S ~'! Phone Number •Z ~~ ! ~`7 D d Electtica] Company 1~ A'~-~Lc'~$ 4~ 1 E ~t_..~G~f ~ p~.ee Phone ~7' ~o ~ 73% Fax2i~8~~ Ca Address: ..'~~ ~ 'YL- ~~ , City "Jf ~ State~G Zip'~~'-~ License HnIaer (Piriut): S`lute CertificationlRegistration~G/Sao Z3 S ; Notarized Si~matrue of License .8'older „~,,....,, =...-:.-;~.~.~<~~ -~`Y-'°-~`="~`'" Sworaz and s~~~cnbed before me this ~L day of ~~rL~t~1' 24~~ ~"~~ NcNBNPUtfrc~tataniFbrKla tp~ i ~ Ti11am+ Attest tarn •`^~•,W(, ~,'"F s; ~ ~,,c~;~w„noea„4s SignatureofNo Public r t~,f <_~.: •s~ , a(;.,F•..c" CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5826 Application Number 10-00000838 Date 7/07/10 Property Address 1317 FLEET LANDING BLVD Application type description RESIDENTIAL ALTERATION Property Zoning TO BE UPDATED Application valuation 0 ------------------------------------------------------------------------ Application desc renovate bath and shower --------------------------------------------------------------------------- Owner Contractor ------------------- ---- ------------------------ - PRESTIGE BUILDERS & REMODELERS 848 AILY CHURCH LANE SEVIERVILLE TN 37876 - (904) 662-1528 ------------------------ ------------- -------------------------------------- Permit BUILDING PERMIT Additional desc . Permit Fee 65.00 Plan Check Fee 32.50 Issue Date Valuation 2400 Expiration Date 1/03/11 --------- - ------------------------ ------------- - ---------------------------- Special Notes and Comments *2007 FLORIDA BUILDING CODE W/'05-'06 SUPPLEMENTS. 2007 FLORIDA BUILDING CODE - RESIDENTIAL. 2005 NATIONAL ELECTRICAL CODE. *REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING DEPARTMENT IMMEDIATELY. ------------------- ------------- -------------------------------------- Fee summary Charged ------ -- ------ Paid Credited -------- ---------- --- Due ------- ----------------- ---- Permit Fee Total 65.00 65.00 .00 .00 Plan Check Total 32.50 32.50 .00 .00 Grand Total 97.50 97.50 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. 06/30/2010 08:53 8659087710 PRESTIGE BUILDERS rr~Ut n~ ~uncnn+r~ ~zvIIT A.~,P~.ieATrox Cr~r of AT~A~r~rc BF~.ce[ t3ffiae +('Q04) 247-58,26 ~x ~) 247-S84S a~b aaa,~s: I :~J--i ~~~ t~th t mot; ('~LV Ib ~ x~-~: , b - r~ .~ ~'' _ ~ ~scrt~hon~ v~~.otW~ s a ~oQ. `~F~a Gae~ ai"'Wosk (ait+ele one): I~'erw Addition A~atiaa , ~f ava .Uemolitio~ ~oaU'spa wiud~~a+l~r Uee of ou~ed ~tclur>e(ts d+r~3e ones; C.aimm~ia3 Rrsideuttial F!' as eta ~ ~ a flr+e• igod? {C~r3e +o~ . o fA klctric~aPtodrnct vale Fear mak~le p~ a~ p : Mtn a~pprorx Descn'be in detail tlz~ ~ of wo~elk ~a be ~Cfonaed: ~El~~ -~"~ _ 1~'i•'~/ .51-41?5~~' Proge>r~~ar~atioa: Comgsnplr3emu: ~' ~`Tt(~ ~'3ttt 1~L~`3 Q>~IiS...~t.ITTR --~0~ ~ ~ A A • _ .~ _~ Uffitx Pie ~ Tob Simi` C N~mube~c ~, j~t•~ - fs (~~ • 15~.$ P~ 1t $ ta5 ~ ~ • 7? 1,() ~e~ sim~e ~e ~r~ I±iaaoe aqd t~ ~ $aomditt7~ p Name sued Address i•t D N ~ _ _ Mortgage Leod~r Name and Addi~ss -- -__1+t Q N E. ~ - . a as ~a eQ a la ab Pik want mod tA~lggoaea at I ~Y friar na Irarrt a lws caenoswaced,priao• to >~' b 1md91' QYs sA~lodmds a f ~r ~ti ~adro~g ~sswatrati 6t tAdr~~i~ 4T<1t+rp~wfr bsc~oa~es and void !f ~vmr~E is ad coo~oa~sd'~FdFo~ aia~ ar gFCw~d+~Kars ov~ w fa as abawdoroc~ifor a ofs~ix~J o+o°~ia~ -u~y~ g ~ i ~ ~I dial n~m-aee,Qerr.i5pr ,~ bs e~er-ed far ~ l~uppaffi ~i~e ~~. ~, oTLe# Wt~,ItN](NG TU tI'4(~1ER; 'YQUR FAILI T4 RLCUR~ A N'tJ'FICE OF COEATCE~T l~l'~C RESIIET Il~ Y1JUIi PAY:4YQ 7'V~+CE FOR ]~'R.tJV~.MEI'd'rS T4 YQUR P~l.4PERTY. ~' ~QII IN'T~NB TO OHTAYN FlATAN£~i'G GONSUL'~ RiI1~ Y4i3R LENDER OR AN ,A~'T'TE?ANLY BEFORE ItF.C+O~RDING Y'Q~IR NGITIG''E OF • Cfl11~1VIENCE~NT. ~~~~~ie:ea~iso;r~ thcr~by~ tlxrt,fl;Raas t~esae~inoo~Mb ica6aYZa>Aat~e ,a»dc~rcet cv~scffmr ~ ranossg~~ g+,~e of sr1r~ be 'MafR w~e~isr ~~d /~e+gile a~' ~iE ~j~r dvtr leas 6d S-5'e rart/r to violate or ~, sTA . `, .~' ,praY-saona sa(mgr a~-ear~ +~5. ar~aaat e~d~aeg'rnroAli~ l6e s~e:enogYwo, .' .~-.~ Signature of Qwrscc ~-~ ~ : TENh~S~.af Co NaT?~~tY -..' y~y ~/ `~ ,,~4 ~ 1 Gr/~ gillktNBme __- _.~_! '~L.`_=-v.-_-^~.-~'.s ~~~,~,~~up~r ~41,I,:ILrJS1~. nr~~~..~. _... •-L.r•~ ..~ Sworn,~~?i ~d seobscrib be~ure tote %,~J~ C to aiui subscribed before me /// • ~- ,~;~ ~. w~ . this..GL~13aYa£ ., 24 U ~~~tatrireel Da3'vf 2Q It?~ ~..:.~.~`-.~ ~^ c bfOT~81'g-I7Lt G bjp , • ELIIA6ETH TESKE iP~~"V °`"~t': Natary PuD~IC • srn~ o, aria. g,EVIEWED FOR CODE COMPL~~I~+° Flo ~,~~_ ~commy o li oo es~~ a CITY OF ATLANTIC BEACH '~~`: `,~~'~ ao~dee Through Notional Notary Rsca SEE PERMITS FOR ADDITIC)NAL REQUIRE..M~~Eyy~~NTS AND CONDITIONS. REVIEWED BY: _.L.l'__,~_._ DATE: 6--s'a7~ V v' ii's k `~ ~.i.~ ' ,~ ^...~ 4eea s'~~~r,. City of A$iar~tic i3each ~ ~, ;~ . _ ..:;.~ ~aaildirog ®epartsv><ent "y~~;-`~._> 800 Seminole Road ,s i!, r~ \, ~. ,• .,, • :. r Atlantic Beach, Florida 32233-5445 ~ :a-°' Phone {904) 247-5826 Fax (904) 247-5$45 .ryJft ~r E-mail: building-dept@coab,us City web-site: hftp://www.coab.us APPLICATION NUMBER (fo be assigned by the Buildizng Department.) /~ + ~ ~e~ Date routed: ,APP~~~A~~®N ~::~~01 ~V~l ,A~l~ 1'~~~~I~l~ F~~OVI 'r®perty Address: ~~ ~ 7 / C ~ ~~n ~~C ~ iYh q i -pg~llcec>tt: r i project: ~ V 9~1 ~. ~ ~ ®e artrnent revievr required Ye No Building anning ~ Zoning Tree Administrator Public Works Public Utilities Public Safety Fire Services .-.~,.s.~.-c•.-,~-a ,~a~r'.-+~r~ ~a c~~:s^^r' h r _ "°,~' y .~..x-.*^~ "~' Y .: - o-~^'r,~s'"rT Review fee=~~`~ .~~-~.3m.,~. ° ~_. ' ~~ °Dept; S,Ignature5= ~._ ~~ f;, Other Agency Review or Permit Required Review or Receipt of Permit Verified i3y pate Florida Dept. of Environmental Protection Florida beet. of Transportation St. Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: ~ Reviewing Department (Circle one.) BUILDI PLANNING & ZONING TREE ADMIN. PUBLIC WORKS PUBLIC UTILITIES PUBLIC SAFETY FIRE SERVICES APPLICATION STATUS First Review: ^Denied. Comments: Reviewed by: Second Review: ^Approved as revised. ^Den Comments: Reviewed by: Third Review: ^Approved as revised. ^Denied. Comments: Reviewed by: Date: G ~.3C7°lC~ Date: Date: Revised 05114/D9 May 11 10 12x3©p p_ ~ BUII.DING PERMIT .APPLICATION CITY OF ATLANTIC $EACH 8a0 Seminote Road, Atlantic Beach, FI, 32233 Office (944} 247-5826 Faze (444) 247-5845 Jab Address: 1.aJ ~'1 Fl~~FT L_~ N ~ I I~ L- ~ LV (b Permit Number: Le~gsl bescription S C~,r ti E Parcel # k'(oar o esq. '-t~~ q. t Vslnatiog of Work ~ ~ ADO. Proposed Work heateidlcooled non-}~eated/cooled______ Class of Work (circle one): New Addition Alteration ~ Move Demolition pooUspa wiadowldoar Use of erisiaia pro stracture(s circle one): Commercial Residential '' If an ezistiag ~a >ts a fire sp r sya~n i~1s~lEed? (Cir~cte ose . o !A Florida Product Approval # For muttipie p acts ase p ac# appravu orm Describe in detail the type of work to be performed: ~~r~...~~.._~~T~_I-tQS~~_ Pro_,perty Owner Information: V City A~L.~iriTtC 1~C:..~ State ~Zig ~3 Phone E-Mail or Fax # (C~ional) Contractor Irnformartioar Company Agent: ~.~ftT" i~ ~ --~D ~ ~ G C-!ZQ ~ ~ !v E ~at~ State_ ~ L Zip ~ Office Phone Jab Sitel G Numher F~' ~!.{` ~~ ~ -1 ~£~ F~ # ~ E ~f~ $ • X71® State Certificl;rdonlRegisfi~tion # ~ C .5 (o Architect Name & Fhone # Pi d !~! E Engineer's Name 8c Phone # _~(Q N E. I?ee Simple Title Holder Name and Address ~~ A - Bonding ~p~y Name and Address N D N E. Mortgage Leader Name ani Address i•t D ~~ Application is hereby made to obtain a permit to do the work and installations as urdicated I ~jY that no work ar instaUativn has commenced prior to issuance a permit and dwt all work will be 6a meet the standards of aQ law: r~Ggulatiiag co»atruction lit tlda jsa~sdicdion. This permit becmrar and void ~wou~k is nor: commenced within siz (6~ or tf coristrt~ction or work is d or abandoned fora of six S~ months at arty time ~ Tmeks and # Catt~Giewas, cafe that aeparaoe .permits must be secured jot ki?eofi~cat tl~~, Plumbirt~, Slgns, We[Is, Pants, lees, Botleri, He~f~s, WAI2NYNG TO OWNER: YOUR FAILURE TO RECORI? A AtC?TICE OF CflNIlVIENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR Il13PRO~EMENTS Tfl YOUR PROPERTY. IF Y~4U INTEND TO OBTAIN FINANCING CONSULT WTI'H YQUR LENDER UR AN ATTORNEY BEFQRE RECORDING YO'[TR. NOTICE OF CQNZMEl~TCENIENT. `~~~titturt,tt~t, f hereby certijy that I have read road ezarrrined~~ris apprticatinn and tilde amd correct Allprovisiwrs Flaws and ordinances govaer this type of warrE will be complied with whether a~ec~' e_d herein or 'does not presume tv gave axfhmit}~ to violate or ~ the provrsrons ajany other jederal, sta#e, or focal regulniing ~+tfre ' ~conatnurtion. Signature of Owner (.c "` .~-Q~~ ~ TEN N E~+~' ~ =of Con~racto NC}TP~~Y a' - Print Name ._~.~'-T..~II-~-- ~ . Y/S /~ -..__.W_ ~-.-vn-''.:; A U lrlt.l ~'rint Nalane _<_~ Ci~...__ ....~~.D)..._....._~e~ ~.T?..~~...____ Sworn and stabscri before ixte ~'~.,;~J~R ~~~,•' ~ to and subscribed before me t6is,~Dayof 20 U ~~ttttrtierir>~ _~ Day of 20 ~(} Notary Pu 'c - Notary lie •. ice..:.i~~~ `~1Pµy p~e`'~,'' ELIZABETH TESKE Revised Q1.26,1a ,':°~ . ~ : Notary Public -State of Florida " My Comm. Expires Apr 5, 2013 ., P:= Commission N DO 867829 ~~"f ""~'~` 8nnded Through National Notary Assn. ... ....n,~.,r~..,...•~.,~o...~•..-...