Permit 1958 Sevilla (row no permit required) City of Atlantic Beach '4c)�;TVUTI APPLICATION NUMBER
Building Department (To be assigned by the Building De rtment.)
800 Seminole Road DEC 1=0 2010
Atlantic Beach, Florida 32233-5445 7
Phon (904)247-5826 - Fax(904)247
E-mail: building-dept@coab.us Date routed: Z2-
City web-site: http://vmw.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: Department review required Yes No
Building
Applicant: 2v-,,eru-,� Planning &Zoning
TrSe_AdmiQ�istrator
ublic
Project: -k��VEWW 1_6�'
�c7u_blic Utilitie`s��
___T�
f�f 4--f 66C Alb -Pub ic afety—
Fire Services
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
Florida Dept. of Environmental Protection
Florida Dept. of Transportation
St. Johns River Water Management District \V
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: pproved. F�Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: Date:
TREE ADMIN. Second Review: F
]Approved as revised. RDenied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: FlApproved as revised. MDenied.
Comments:
Reviewed by: Date:
Revised 05/14/09
BUILDING PERMIT A ATION
CIT
6 U) 1�6
CITY LAN�Tlc�BEACH
8'o
00 inolee Road, Atlantic Beach, FL 32233 --Tpv je5
Office (904) 247-5826 Fax (904) 247-5845
Job Address: Sz�\�, Permit Number:
Legal Description Parcel#
Valuation of Work$ 0 fl'7-.
;i i ion poollspa window/door
Class of Work(circle one): New d t;' Alteration Repair olit
Move
c e ,Xle"identi
Use of existing/pro osed structure(s _one� Commercial' s
spr, system � _ y
If an existing structure,is a fire ni installed? (Circle one'--_-� es o N/A
Florida Product Approval #
For multiple products use product approval form
Describe in detail the type of work to be erformed: I I )L 14 x 5�1 SE C�-_ O-A�A'
La<\
PropeM Owner Information:
?Name: CL Address: k-\1AV,
city
JNa ija State TA- Zip
R� -32Z33Phone _!i
E-Mail or Fax#(Optional
Contractor Information:
Company Name: lk*16 CCyy1C_,rP,� Qualifyin Agent�:
Address: 51 _0UAte,1 a(�P_,eA city &,48-o State Y-10- Zip
OfficePhone Job Site/Contact Number 460-57(,77 Jax
State Certification/Registration
Architect Name&Phone#
Engineer's Name&Phone 4
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the
issuance of a permit and that all work will be pe)�formed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null
and void if work is not commenced within six(6)months, or if construction or work is suspended or abandonedfor a period of sixj6ul months at any time after
work is commenced. I understand that separate permits must be secured for Electricat Work,Plumbing,Signs, Wells,Pools, urnaces,Boilers,Heaters,
Tanks and Air Conditioners,eta
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 FINANCING5 CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
I here certify that I have read and examined this applica ion and know the same to be true and correct. All provisions of laws and ordinances governing this
1�work will be complied with wkethearlsfecifi'ed h rein or notA The granting of a permit does not presume to give authority to violate or cancel the
" w
st't, oc aw
provisions of any otherfederal, r local la regul constr ion or the pe�formance of construction.
Signature of Contractor :�3u�-4
Signature of Owner
-7
Print Name ................................................
Print Name
.... ...................................
..................... ....... .........
Sw and s s me Sworn t and subscribed befoilp me
th*s Day 2014 i T)ay of C-f0_144 P e o )
k-86-ei- _M_!9KZf__J
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Notary Public Y COMMIP, ary Public
PIRES: 4,
onded ThTu y
0��.o tNotaryPublic State of Florida
0
0
Albert Moreno
y Comm's."on Me 4778J
:,J MY Commission DD674778
Expr /1 01 1
'01 Expires 05/15/2011
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1958 W SEVILL
im Gross Area Heated Area
Base Area 2681 2681
Fin Screened Porch 294 0
Finished Garage 120 0
Finished Garage 288 0
Finished upper story 1288 288
Finished Garage 120 0
Finished Open Porch 173 0
Total 3964 2969
A BLVD Atlantic Beach FL 32233
S9;N4oWlNG 90LJVDARY SLRVEY 45e
i V. AS RECORDRD
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