Permit Shed 745 Cavalla Rd 2010 DO
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BUY-LDING PERmn APPLICATION
CITY OF ATLANTIC 13EACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904)247-5826 Fax(904)247-5845
Job Address: A(S az L C" Q-0 ad Permit Number:
Legal Description Parcel#
Floor Area of Sq.Ft. /0?1/0 Sq.Ft
Valuation of Work S-SCILl-00 _ProposedWork heated/cooled.4(� non-heated/cooled .4"leillo
Class of Work(circle one): (�� Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed struFtureQ) ��iicle one): Commercial 4j_s�yid
[f an existing structure,is a fire sprinkler system installed? (Circle one): esX0 N/A
Florida Product Approval#
For multiple products use product approval Torm
Describe in detail the type of work to be performed:—6 U idliAIA '4
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Property Owner Information: 2,
game: jeh,
lodt' (—Address: CqVq11C' f'00.e-t
City Qeuc�-)-% State_LQip 3z?-33 Phone �2
E-Mail or Fax#(Optional)
Contractor Information:
Company Name: Qualif��g Agent:
Address: city State zip
Dffice Phone fob Site/Contact Number Fax#
State CertificationfRegistration 9
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
3onding Company Name and Address
qortgage Lender Name and Address
by ad b 'n �d w o k antd in,�a *f�n, as ind* or installation has commencedprior to the
'ica�'0 is re m e'o 0 'a' "permi't 0 the " ' "a" ,,'c
'PP . a d h k will be e rmed to m Z, 'an� r ak.aw thisjurisdiction. This permit becomes null
f f sixj6�months at any time after
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WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUi NOTICE OF
COMMENCEMENT.
'iereby ceryfy that I have read and examined this application and know the same to be true and correct. Allprovisions of laws and ordinances governing this
j work will be coTplied with whether speciffed herein or not. The granting of a permit does not presume to give authority to violate or cancel the
ofany otherfederal,state, or local taw regulating construction or the pei�'brmance ofconstruction.
gnature of Owner Signature of Contractor
int Name Print Name
voin to and subscribed before me Sworn to and subscribed before me
is —Day of LIns Day of . 20
'To le
,Ear�T N taiv Publ'
ublic
Revised0l.26.10
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CITY OF ATLANTIC BEACH PRODUCT APPROVAL SPECIFICATION SHEET (short form)
As required by Florida Statute 553.842 and Florida Administrative Code 913-72,please provide the information and approval
numbers on the building components listed to be utilized on the construction project for which you are applying. We
recommend you contact your local product supplier should you not know the product approval number for any of
the applicable listed products. Statewide approved products are listed online @ www.floridabuilding.org
Category/Subcategory Manufacturer Product Description FL Approval#(s)
EXTERIOR DOORS
a. Swinging
b. Sliding
c. Sectional/Roll Up
d. Other
WINDOWS /V76Z,
a. Single/Dbuble Hung
b. Horizontal Slider
c. Casement
d. Fixed
e. Mullion
f. Skylights
g.Other
PANEL WALL
a. Siding
b. Soffits
c. Storefronts
d. Glass Block
e. Other 14a lr�e Aa"dee Cor, rd
ROOFING PRODUCTS
a. Asphalt Shingles
b. Non-Structural Metal
c. Roofing Tiles
d. Single Ply Roof
e. Other
STRUCTURAL COMPONENTS
a. Wood Connectors
b. Wood Anchors
c. Truss Plates
d. Insulation Forms
e. Lintels
f. Others CLU-
NEW EXTERIOR ENVELOPE
I understand that,at the time of inspection,the following information must be available to the inspector on the jobsite:
1. A copy of the product approval.
2. The list of performance characteristics which the product was tested and certified to comply with.
3. A copy of the applicable manufacturers'installation requirements.
Further,I understand a product may have to be removed if approval cannot be demonstrated during inspection.
e
Applicant Sig6ature Date
H:/Product approval spec sheet short form.xlsx
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