Permit 871 Beach Avenue CITY OF
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WOO of Suliding Official
RE(IUEST FOR INSPECTION //rf f
Permit No•
A M oistrict No.
Date p.m.
Time Locality
Received _,.,..--.•.,
Job Address contractor MECHANICAL
MECHANICAL
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Name CONCRETE �ughwirin9t O Fire
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Certificate of Oce p
inspector Date
000490
DEPARTMENT OF BUILDING
CITY OF ATLANTIC BEACH
----- PERMIT INFORMATION ------ -------- LOCATION INFORMATION ---------
Permit Number: 496 Address: 871 OCEAN BOULEVARD
Permit Type: ELECTRICAL ATLANTIC BEACH, FLORIDA 32233
Class of Work: NEW ------ LEGAL DESCRIPTION ----------
Constr. Type: N/A Lot: Block: Section:
Proposed Use: SINGLE FAMILY Plat Book: Page: O
Dwellings: O Code: O Subdivision: A
Estimated Value: 90. 00 ---------- OWNER INFORMATION ----------
Improv. Cost: 90. 00 Name: FRED CARLSON (BUILDER)
Total Fees: 90. 00 Address: 871 OCEAN BOULEVARD
Amount Faid: 90. 00 ATLANTIC BEACH, FLORIDA 32233
Date Paid s Phone: ( )
Work Desc. : 00AMPS, IPH, 3W, 230VOLT= COURTESY PERMIT/VACANT FOR ONE YEAR
---- CORTRACTOR(S) -------- ---- APPLICATION FEES -----
PERMIT ' $0. 00
WATER IMPACT FEE 90. 00
SEWER IMPACT FEE $0. 00
WATER =METER $0.00
RADON GAS-H. R. S. *10. 00
RADON GAS - 5% $0. 00
WATER TAP 90. 00
SEWER_ TAP *10. 00
HYDRAULIC SHARE 90. 00
RE-INSPECT FEE 90. 00
ENGINEERING $0. 00
OTHER 99. 00
NOTES:
NOTICE —ALL CONCRETE FORMS AND FOOTINGS MUST BE INSPECTED BEFORE POURING
PERMIT VOID SIX MONTHS AFTER DATE OF ISSUE
BUILDING MATERIAL, RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC SPACE,AND MUST BE
CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER.
"FAILURE TO COMPLY WITH THE MECHANICS' LIEN LAW CAN RESULT IN
THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS."
ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR
VIOLATION OF APPLICABLE PROVISIONS OF LAW.
ATLANTI BUILDING DEPARTMENT
B JOB COPY
Xw
000496
I DEPARTMENT OF BUILDING
CITY OF ATLANTIC BEACH
PERMIT INFORMATION __ _._.___ _ _.__ __. _ LOCATION.. INFORMATION ----- -- - --
Permit
W__- _ ._Permit Number ; 496 Address: 87.1 OCEAN BOULEVARD
Permit Type: ELECTRICAL ATLANTIC BEACH, FLORIDA 322;:33
Class of Work: NEW _ __,_M.._._ LEGAL DESCRIPTION
Constr. Type: NAA Luk. : Black: Section:
Proposed Use: SINGLE FAMILY Plat Book: Paye: 0
Dwellings: O Cade. O Subdivision: A
{ Estimated Value; x+0. 00 __ _ _._ OWNER INFORMATION
Improv. Cost: $0. 00 Name: FRED CARLSON (BUILDER)
Total Fees; $0. 00 Address: 871 OCEAN BOULEVARD
Amount Psad; $0. 00 ATLANTIC BEACH, FLORIDA 32233
Dat+ P c cc#
Phone: C 1
Work Desc. : ' 20OAMPS,,IPH, 3W, 23OVOLT; COURTESY PERMIT/VACANT FOR ONE YEAR
CONTRACTOR(S) APPLICATION FEES -_ .... -_
PERMIT0, OC?
WATER IMPACT FEE x$0. 00
NEWER IMPACT FEE _ . 00
WATER METER _.t $0. 00
RADON GAS-H. R, S sb. 00
RADON GAS -- 5% $0. 00
WATER TAP $0. 00
SEWER- TAP _ . $0. 00
HYDRAULIC SHARE $0. 00
RE-INSPECT FEE $0. 00
ENGINEERING *0. 00
OTHER 3Rt3. 00
NOTES:
i
NOTICE—ALL CONCRETE FORMS AND FOOTINGS MUST BE INSPECTED BEFORE POURING
PERMIT VOID SIX MONTHS AFTER DATE OF ISSUE
i
BUILDING MATERIAL, RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC SPACE,AND MUST BE
CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER.
"FAILURE TO COMPLY WITH THE MECHANICS' LIEN LAW CAN RESULT IN
THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS."
ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR
VIOLATION OF APPLICABLE PROVISIONS OF LAW.
ATLANTIC BUILDING DEPARTMENT
r
By CONTRACTOR COPY