Permit 28 Jackson Road *
CITY OF ATLANTIC BEACH
PERMIT APPLICATION REMODEL, ADDITIONS OR ALTERATIONS
DEMOLITIONS
Owner(s) : L,_ ti:, -Q (1-
Address: 7,34t ks„ Phone: 2L tip=
Lot # Block or Unit # Subdivision:
Contractor: / l E= - 7 1, r' -pl
Address : / % 1 C .1-i,2 . 1 ( ),f, 0 Phone No: 4: I - Y.? ‘
Describe work to be done: ;_!.t- - efi«:t - e �� /94 „
�'lel r ?� ciA . w ,/ 5;-ik f a t 54 ? — j i � . S c - 1 : p -
' 4 ! ( 6 -I 7 (.4k—
Present use of building:
Valuation of Proposed Construction: L I L I- 2
Proposed use:
Is this an addition? h ° If yes, what are the dimensions of
the added space: ft. X ft. Will the added area
be heated and cooled? New electrical (or increase)?
New plumbing fixtures? 6d1 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;9 Date:
9 -4 -93
Si CONTRACTOR: r- / '�E'i Date: "' / �:''