Permits 475 Beach Ave 105,18
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06
OF 41A
CITY OF ATLANTIC BEACH
PERMIT APPLICATION REMODEL, ADDITIONS OR ALTERATIONS
DEMOLITIONS
Owner(s) :
Address : 217-5- BEAC " +VE —Phone:
Lot # Block or Unit # Subdivision:
Contractor
State License #
Address : Phone No:
Describe work to be done:
Present use of building: /J//14
Valuation of Proposed Construction:
Proposed use
Is this an additionV �If yes , -what 7are 7Zhe
the added space: ft. X — ft . Will the added area
be heated and cooled? New electrical (or increase)?
New plumbing fixtures?_ New fireplace?_New Heat/AC?
SUBMIT THREE COMPLETE SETS OF PLANS, INCLUDING SITE PLAN, SURVEY,
ENERGY ' CODE FORMS.- NOTICE OF COMMENCEMENT, AND OWNER/CONTRACTOR
AFFIDAVIT, IF OWNER IS CONTRACTOR.
Signature -
OWNER:2)–, /&J&42 X1 Date: -712
Signature CONTRACT Date
0
License Supplied:
Liability Insurance:
Worker's Compensation Insurance: