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CITY OF ATLANTIC BEACH
PERMIT APPLICATION REMODEL, ADDITIONS OR ALTERATIONS
DEMOLITIONS
owner(s) :_9dA,
Address : S:2 3 19,,q- Phone:
Lot # Block or Unit # Subdivision:
Contractor: -/-ht)/1,t4 3 P14/(- )1,4 L,)
State License CQ_C C-3S-6 3�S_
Address : Pcymou7-,.1j- J -
—Phone No:-793 105:5-
Describe work to be done:, /eFPL4CF
9(Es
Present use of building: kES-jj_)e---,(F
Valuation of Proposed Construction: '2?0 0
Proposed use: kFS1 IDEL,C e
Is this an addition? zLIO If yes , what are the dimensions of
the added space.,_ -ft . X "u-1 ft . Will the added area
be heated and cooled? New electrical (or increase)?
New Plumbing fixtures? New fireplace? --&-0 New Heat/AC?
SUBMIT THREE COMPLETE SETS OF PLANS, INCLUDING SITE PLAN, SURVEY,
ENERGY CODE FORMS, NOTICE OF COHMHENCEHFNT, AND OWNER/CONTRACTOR
AFFIDAVIT, IF OWNER S CONTRACTOR
___u
Signature OWNER:Z: &W_�Lovl
Signature CONTRACTOR:
Date: 10-1,P-9(.
License Supplied:
Liability Insurance:
Worker's Compensation Insurance: