Permit Bldg Foundation Repair 1258 Beach Ave CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
J
; ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5826
Application Number 10- 00001460 Date 12/14/10
Property Address 1258 BEACH AVE
Application type description RESIDENTIAL OTHER
Property Zoning TO BE UPDATED
Application valuation . . . 16165
Application desc
raise bldg replace foundation
Owner Contractor
DUSH HYGEMA HOUSE MOVERS, INC
1258 BEACH AVENUE PO BOX 2655
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32203
(904) 764 -9509
Permit BUILDING PERMIT
Additional desc .
Permit Fee . . 135.00 Plan Check Fee . . 67.50
Issue Date . . . Valuation . . . . 16165
Expiration Date . 6/12/11
Special Notes and Comments
NEED NOC
*2007 FLORIDA BUILDING CODE w /2009 REVISIONS
NATIONALELECTRIC CODE
*REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING
DEPARTMENT IMMEDIATELY.
Other Fees STATE DCA SURCHARGE 2.03
STATE DBPR SURCHARGE 2.03
Fee summary Charged Paid Credited Due
Permit Fee Total 135.00 135.00 .00 .00
Plan Check Total 67.50 67.50 .00 .00
Other Fee Total 4.06 4.06 .00 .00
Grand Total 206.56 206.56 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
City of Atlantic Beach APPLICATION NUMBER
S .;; Building Department (To be assigned by the Building Department.)
, ' } 800 Seminole Road
t i � Atlantic Beach, Florida 32233 -5445
Phone (904) 247 -5826 Fax (904) 247 -5845 j P.V/O
".»01t >- E -mail: building- dept @coab.us Date routed:
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: / � 1S C / /I ✓ � De artment review required Yes o
uilding
Applicant: / � - tt £ `Thovfz 'din & Zoning
Tree Administrator
Project: pq7: / e Public Works
/ Public Utilities
/,c�
l0 /1 �,„ 11 Public Safety
Fire Services
ij�]�'d "�Itll Ii a j�'n� '�. j �� " a + I
ept S.� tur Ill* 2 m � � t . ,C41:11,6
Review or Receipt k
Other Agency Review or Permit Required of Permit Verified By Date * / •
Florida Dept. of Environmental Protection 4/ A
Florida Dept. of Transportation /
St. Johns River Water Management District / N
Army Corps of Engineers „ r
Division of Hotels and Restaurants �/
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: proved. ['Denied.
(Circle one.) Comments:
BUILDING
PLANNING & ZONING Reviewed by: / Date:
TREE ADMIN. Second Review: ['Approved as revised. ❑ enied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ['Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247 -5826 Fax (904) 247 -5845
Job Address: f217 eerc 1 /4Vc / 4 i44 ii, Oita Permit Number: /L - / e
Legal Description Parcel #
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work $ ` ) 1 LS , rya Proposed Work heated/cooled ei9a- non - heated /cooled
Class of Work (circle one): New Additio Alteration
x� Repair Move Demolition pool/spa window /door
Use of existing/proposed structure(s) (circle one): Commercial Residential
If an existing structure, is a fire sprinkler system installed? (Circle one): Yes No N /A
Florida Product Approval #
For multiple products use product approval form
Describe in detail the type of work to be performed: 111 ;5 G 1 .80 fgY10 ,f1Q pi A cQ i drlAers
•
Property Owner Information: (7\\
Name: if r . vvf Address: 125' �CG 1 At.
City MEM ( Staten_ Zip J Phone 3i -0 ,
E -Mail or Fax # (Optional) Ic r- &i /Mt 7 M , 1x D — , y qF
Contractor Information: /�
Company Name: \ Rty,,,{\ 0 bIXSE, pjl�S D ( Qualifying Agent: (c (A b® p in A03- S tim
Address: :5 - b4 C a,\% 141 City 4'\j On 1{363 ti State P L J Zip '3
Office Phone 9t)‘t — ) (0 -qS Job Site/ Contact Number Gib4 -5 09 —(l if Fax # 9b`t -a4V 659
State Certification/Registration # LJ C d .c DI
s:¢a1n irw..• ::,...,...s .wn: ssnwnra�aa.�.
Architect Name & Phone # i y ems „,, .
Engineer's Name & Phone # ' "i, - a.)qj O N c 1-\o1. C ru �. r
Fee Simple Title Holder Name and Address 2 g-C\ 1., _ , FILE COPY!
Bonding Company Name and Address ;t
Mortgage Lender Name and Address 'ei -,;�; ; „
: t .,71 * ., P I
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 certify that no work or installation has conunenced prior to the
issuance of a permit and that all work will be performed 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 abandoned for a period of six (6) months at arty time after
work is conunenced. 1 understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, Furnaces, Boilers, Heaters,
Tanks and Air Conditioners, etc.
WARNING TO OWNER: OURY4. ' TO RECORD A NOTICE OF
COMMENCEMENT MAY RESUL YOUR YING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU I ND TO 1 I TAIN FINANCING CONSULT WITH
YOUR LENDER OR AN ATTO ' 11 : Y BEFO . RECORDING YOUR NOTICE OF
II I ■■ E] CE l i NT.
z
1 hereby that 1 have read and examined this application n z0'Srt c rze to true and correct. All provisions of laws and ordinances governing this
type of work will be complied with whether specified herein : �. 4licg ntir •o' a permit does not presume to give authority to violate or ancel the
provisions of any other feder. state, or local law regulating dwzOu2Cfrp ie pp- 1 - mance of construction.
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Signature of Owner - `' .1 k\,(9i/di4 P Q Q Q i e nature of Contractor __ _, ilk
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Print Name
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ec I, � V� 1 O ' t Name (- i...&V W m DJ 0 i
r4 E~ ° � l _
Sworn to and subscribed before me `^, W ern to and subscribed before le
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this i Day of c - w `(,-..'2 , 20' ®W r �I • " ., ' ,� , c o ;, -;,� .
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Notary Public ;5 U c4 [z CD . ■ ary i expires 0512W2014
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