Permit 800 Jasmine Street CITY OF ATLANTIC BEACH, FLORIDA
UTILITY PAYMENT PLAN AGREEMENT
PROPERTY DESCRIPTION:
OWNER: Tara M. Wilson
800 Jasmine Street
Atlantic Beach, Florida 32233
RE# 170927 2030
LEGAL DESCRIPTION 18-34 38-2S-29E Sec H Atlantic Beach S 40 FT Lot
3,N 20 FT Lot 4 BLK 146
TOTAL AMOUNT OF AGREEMENT: $4,138.11
This document shall serve as an extended payment agreement between you and the City of
Atlantic Beach, Florida for the above listed total amount and for which said amount will be filed
as a lien with the Court of the Circuit Court for Duval County, Florida until the entire balance is
paid.
CHARGES: Sewer Impact Fee $1,250.00
Contractor 2,050.00
TOTAL CHARGES: $3,300.00
Less 10% Down Payment 330.00
Payment of lien filing fee 19.50
TOTAL DOWN PAYMENT: $349.50
TOTAL AMOUNT FINANCED $2,970.00
TOTAL AMOUNT OF LIEN $4,138.11
TERMS: Number of Monthly Payments 120
Due Date: Due monthly with your utility bill
Billing Included on utility bill
Late Charges 10%
Failure to pay all charges will result in the water services being cut-off.
Payment Amount $34.48 per month
Total Interest over term of loan $1,168.11
LIEN: A lien in the amount of the TOTAL AGREEMENT above shall be executed and
recorded against the above referenced property. The owner hereby agrees to pay all
recording fees and costs involved with the execution of the lien. Upon payment being
made in full, the lien shall be released of record.
Please indicate your acceptance of the provisions of this agreement by signing in the place
indicated. Your signature signifies your agreement to indemnify and hold harmless the City of
Atlantic Beach, Fl., from any and all damages resulting from your failure to timely make the
above payments, including reasonable attorneys fees and court costs.
The City of Atlantic Beach looks forward to cooperating with you under this agreement.
PROPER OW
y: Date:
Ta a . Wilson
City of Atlantic Beach
B : Date:
Jim nson, City Manager
Prepared by and return to:
Maureen King, City Clerk
City of Atlantic Beach
800 Seminole Road
Atlantic Beach, FL 32233
REAL PROPERTY LIEN
The parties have agreed that this LIEN be filed against the real property owned by Tara
M. Wilson, and shall be recorded in the official public records of Duval County, Florida.
This LIEN is for financed costs associated with the conversion of a private septic system
to public sewer system and including sewer impact fees on the following real property located in
Duval County, Florida, more particularly described as follows:
RE#: 170927 2030
LEGAL DESCRIPTION: 18-34 38-2S-29E Sec H Atlantic Beach S 40 FT Lot
3, N 20 FT Lot 4 BLK 146
OWNER NAME &
PROPERTY ADDRESS: Tara M. Wilson
800 Jasmine Street
Atlantic Beach, Florida 32233
This LIEN is to secure payment from Larry D. Wagoner to the City of Atlantic Beach in
the amount of$4,138.11, pursuant to Utility Payment PI ree nt tached.
--Witness (Sign N e) 0 ara s
Witness (Print Name) ' CITY OF ATLANTIC BEACH
Witness (Sign Na e) By ala—"AL-ay�
Maureen King
Witness (Print N e) Certified Municipal Clerk
Page 1 of 2 Wilson Lien
STATE OF FLORIDA
COUNTY OF DUVAL
Sworn to and subscribed before me this b'191� day of2001, by --1-140 A
�IC..S 0a who are personally known tome or produced jc=n 4 A)4Qs"?/3- 77-708-D
as identification, and who did/did not take an oath.
Notary hblic, State ofor' at Large
My Commission expires:
Eco
MAUREEN KING
ory PUCIio-StateofFlorida
mmission E=;res Mar 31,2002
ommission #CC720781
Page 2 of 2 Wilson lien
Building Department 904-247-5805 p• 1
PROPERTY OWNER NAME:
SERVICE LOCATION Q
ADDRESS: 0 SA�1N� r
T--�LA tJV C
PROPERTY OWNER PHONE NUMBER: �� /N
PROPERTY TENANT NAME:
SERVICE NOW: ON CITY WATER ON WELL Q
CONVERT FROM ON-SITE SEPTIC SYSTEM TO CITY SEWER:
OPTION A: Customer to hire own contractor and pays cosh
OPTION B: Customer pays costs and hires contractor with City's assistance.
_OPTION C: ustow"to hire own contractor and finance cost through the
City of Beach.
OPTION D: Turnkey Support City assists with entire conversion.
CUSTOMER SELECT OPTION PRE D:
U Option A Cl Option B Optio C
OWNER'S SIGNATU
Please return to:
TO BE COMPLETED BY CITY:
JREAL ESTATE NUMBER:
LEGAL DESCRIPTION:
PRICE QUOTE:
CITY OF
r� rtic �eac� - ��vaida
800 SEMINOLE ROAD
ATLANTIC BEACH, FLORIDA 32233-5445
TELEPHONE (904)247-5800
FAX(904)247-5805
on.*. SUNCOM 852-5800
Date 2/1/01
Tara Wilson
800 Jasmine Street
_ Atlantic Beach FL 32233
RE: Sewer Connection for 800 Jasmine Street
Dear Property Owner:
The costs to connect your building to the City sewer and/or water system are as
follows:
Sewer Tap - Labor and Materials to tap into
sewer main $
Water Tap - Labor and Materials to tap into
water main $
Water Meter - Cost of Meter $
Cross Connection Inspection - Inspection by
Public Works to ensure backflow
prevention $
Sewer Impact Fees - Funds future expansion
of the sewer plant $ 1,250.00
Water Impact Fee - Funds future expansion
of the water plant $
Capital Improvement- Funds for improvements,
expansion or replacement to
water system $
TOTAL COSTS $ 1,250.00
If you have any questions concerning these charges please call the building
department at 247-5826.
Sincerely,
Don C. Ford, C.B.O.
Building Official
Feb-01-01 08: 24 Harry McNally 904-247-5872 P.01
BuildinG Department 804-24*/-!aUUZ>
PRICE QUVA""' TE
APPLICATION FOR WATER ANDIOR SEWER TAP
APPLICANT MANIC
.MA;LING ADDRESS--
PH'ONL NUMBER—:;Z
a a44
SEG'/ICE RECUEsazc) C2
SERVICE LO CATION ?oe
CA-r-:--, sr,r TCPUeL,C ,,AJORK-1�z 9�7
DAT; RETURNED TO 1220.'LDING CEPARTMENT--, ......
PUBLIC WORKS OEPARTMENT
PRICE QUOTE RESPONSE
MATER
SEVVERt Y,,A
PRICE CUOTE PREPARED BY.
Stgraturc, - T,t:e
CATE NOT'll"IF-C 0VMER_._
CITY OF .ATLANTIC BEACH
APPLICATION FOR PLL7.MBXNG PERMIT
JOB LOCATION: ?f C c) c
OWNER OF PROPERTY: La r cfJA/ i I .5 u f1 TELEPHONE NO. z
PLUABING CONTRACTOR yj q �l�t A 17 - �lun A .Ln c .
CONTRACTOR' S ADDRESS : 1766 ISIG +' �.f _TV G c/� u'a
STATE LICENSE NUMBER: C [Z( 02 I V/ � TELEPHONE: 7
HOW MANY OF THE FOLLOWING FIXTURES
RE—PIPED OR NEW
SINKS SHOWERS
LAVATORY WATER HEATERS
BATH TUBS DISHWASHERS
URINALS DISPOSALS
CLOSETS WASHING MACHINE
FLOOR DRAINS SHOWER PANS
l SEWER WATER
RE--PIPE (LIST FIXTURES BEING REPIPED)
OTHER
TOTAL FIXTURES: x $3 . 50 + $15 . 00
MINIMUM PERMIT FEE — $25 . 00
SIGNATURE OF OWNER:
SIGNATURE OF CONTRACTOR.
------------------------------------------------------- -- ----
INSTALLATION OF PLUMBING AND FIXTURES MUST BE IN ACCORDANCE WITH
THE MOST RECENT EDITION OF THE SOUTHERN STANDARD PLUMBING CODE.
CALL A DAY AHEAD TO SCHEDULE INSPECTIONS — ( 904) 247-55266
CITY OF ATLANTIC BEACH
DEPARTMENT OF BUILDING
800 Seminole Road-Atlantic Beach, FL 32233- Tel: 247-5826- Fax: 247-5877
PLUMBING PERMIT
PERMIT INFORMATION LOCATION'INFORMATION
Permit Number: 21435 Address: 800 JASMINE STREET
Permit Type: PLUMBING ATLANTIC BEACH, FL 32233
Class of Work: ALTERATION Township: Range: Book:
Proposed Use: SINGLE FAMILY Lot(s): Block: Section:
Square Feet: Subdivision: SECTION H
Est.Value: Parcel Number:
Improv. Cost: OWNER INFORMATION
Date Issued: 2/09/2001 Name: WILSON, TARA
Total Fees: 25.00 Address: 800 JASMINE STREET
Amount Paid: 25.00 ATLANTIC BEACH, FL 32233
Date Paid: 2109/2001 Phone: (904)241-5962
Work Desc: CONNECT TO CITY EWER/IMPACT FEES PAID THROUGH CITY AGREEMENT
CON to S z � t. .,3v N FEES
JAX PLUMBING & SEPTIC TANK PERMIT 25.00
nsCt4on'�R�: 1!i
FINAL
NOTICE- INSPECTIONS MUST BE REQUESTED AT LEAST 24 HOURS PRIOR TO INSPECTION
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 CONSTRUCTION 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.
$M.N 14
Date: ?./12/8181 Receipt: OW7399
ATLANTIC BEACH BUILDING DEPT. PECKS 18�
I
. CITY OF ATZANr C
BEACH
APPLICATION FOR BUILDING PERMIT
Owner / Address J` zip Phone �
Architect
Address zip Phone
Cantractor� r -�,e_Address i-���-7��t ���� d—� zip 333 Phone
i@6�014�
I Copy an FileCortr 3s LicenseNumer r piration Date '
or2B1V Section # 4Zoning
vision
Streets'M Between r and side �.tf
Valuation $ Type of Construction FRA m%:
Purpose of Building-5 - �,�,r, /
-� s Number of Units I Fireplaces
Utility Service: Water ,/ Sewer .Scoe- c-.
Ifthe City if providing water or sewer service, do we need to maketaps?
Dimensions: Building 3-ti_,A- 3 5y Lot Size Footings /0"XI -c rr
Sz. Piers Sz.: Sills Greatest Span Sills
Sz. Ceiling Joists 7?usscS Distance on Centers ,ill rr Greatest Span 3� `
Sz. Floor Joistsi rCvs G� Distance on Centers Z,�� Greatest Span 3 `
Sz. Rafters J R v.5 SS Distance on Centers �? Greatest Span 3;�r
Method of Heating LE -rx:ic P�P. Solid-Filled Ground , rc,�,,j Roof Fi 6 C 0 e i-Ass
Flood Zone If located within a FLOOD HAZARD complete page 2
SUBMIT: Two complete sets of plans, including a detailed site Plan.
Florida Energy Efficiency Code Sheets
Recent Survey
Inspections Required:
1. When steel is in place and ready to pour footings.
2. When steel is in place and ready to pour columns/lintel.
3. When steel is in place and ready to pour beam.
4. When framing, mechanical, plumbing, electrical, fireplace, is completed and ready
to cover up.
5. Final inspection.. SETBACKS
NO INSPECTION WILL BE MADE IF BUILDING CARD IS NOT POSTED ON JOB.
In case of rejection, reinspection MUST be called for after Rear Lot Line
corrections are made.
In consideration of permit given for doing the H..
work as described in the above statement, we w w
hereby agree, to perform said work in accordance '
with the attached plans and specifications,
which are a part hereof, and in accordance rt i�z 6 rt o
with the building regulations of Atlantic Beach. <--I
Signature Owner
Signature Contractor, �
kront Lot Lane
I
DEPARTMENT OF BUILDING i 7
�� /[
I
CITY OF ATLANTIC BEACH,FLORIDA PERMIT NO. i 4
PERMIT TO BUILD
THIS PERMIT MUST BE POSTED ON JOB
139#00
TL
i Date May 27 19 S6 fa 3 ! '13
39 IC"
Valuation$ 44,002.00 Fee$ 139.04 77211 •(11.It"AC
7i"C3 1 A WO/9
This permit not valid until above fee has been paid to City Treasurer,and is Omni
{ subject to revocation for violation of applicable provisions of law.
This is to certify that David Baker RGO014690
91 Red Cloud Trail, St. Augustine, FL 32086
has permission to build single family home
Classification residential Zone RS2
OwA by David Baker
Lot 40' of 3 & 20' of 4 Block 146 S/D Beet. H
j House No. 800 Jasmine St.
According to approved plans which are part of this permit
NOTICE—ALL CONCRETE FORMS
AND FOOTINGS MUST BE IN-
SPECTED BEFORE POURING.
PERMIT VOID SIX MONTHS
-n AFTER DATE OF ISSUE
/—� 4�----10 O Building material,rubbish and debris
zq from this work must not be placed
in public space, and must be cleared
= up and hauled away by either con-
tr ct or owner..
Building Official.
FOR OFFICE PERMIT DATE CONTRACTOR
USE ONLY NUMBER
PLUMBING
ELECTRICAL
SEWER
WATER
�r �3
A dress `�`-�
'�� a:C7 @ $ 3a Co Per sq ft = $ 1A $O 170
t,,,,,•
square Footage @ $ per sq ft = $
Garage/ShedDS per sq ft = $ 3—aa-00
Carport orch @ $ per sq ft = --
Deck
Deck @ $ per sq ft = $
Patio TOTAL VALUATION; $
y( . oc� $ y9 00
Tota a uatian lst $ �5 ooy
�S• C7 L7 $ �S, C7 c'�
aq , 00 A . O C� er thousand or
Reminder nder Valuation (3 'Sop
portion thereof
-------------
Total Building Fee
-------------------- ' $
ADDITIONAL PERMITS and/or FEES REQUIRED ; -} ',a Filing Fee
i Fireplaces @ 15.00 $ u
Mech ni.cal BL'TI�)ING'PEi�IIT FEES X3`1 00
Plumbing
--------------------
Electric/New --------------------
---------
Electric/Tem} ✓/ BUILDING PERMIT
Septic Tank WATER METER URGE
Well SEWER IMPACT FEE $
swiinning Pool WATER IMPACT FEE
Sign MISCEU ANEOUS $
Water Connection ✓ $
Sewer Connection $
Water Meter ✓
Elevation Certificate
GRAND TOTAL DUE $ L�601-A •0 C)
---------------------------------------------------------------------------------------------
CALCULATIONS and/or NOTES
SQO
—;� STATE OF FLORIDA
DEPARTMIEINT OF HEALTH AND REHABILITATIVE SERVICES
-:;a: - � ONSITE SE1.'�AGE DISPOSAL SYSTEl�'i CONSTRUCTION AND INSTALLATiOfJ PERMIT
Authority: Chapter 381, FS
Chapter 1 OD-6, FAC
Applicant Norman Chapman Permit umber 51979
;_ Jasmine, S `tL ��y # 3 ?1 ,2U'c
---------------PART I - SYSTEM CONSTRUCTION SPECIFICATIONS AND CONSTRUCTION APPROVAL---------------
Treatment Tank Minimum Draintrench OR Minimum Absomtior,
Size Bed Size
Septic tank or Grease
aerobic unit 9'0C gallons interceptor galions Square Fee; 37' Square Feet
Septic tank or
aerobic unit gallons Dosina Lana; aaiions Square Feet Square Feet
Graywater
tank aaiions Square Feet Square Feet
Laundry
waste tank galions Square Feet Square Feet
Other Requirements:
(a) installation must be in accord with requirements of chapter 10D-6, FAC.
(b) A system construction permit is valid for a period of one calendar year from date of issue.
(c) Final installation inspection and approval is required before the system is covered.
(d) invert of stub-out for house to be 16" above exisiting grade benchmark,
Invert of stub-out for to be benchmark
Invert of stub-out for to be benchmark.
Invert of stub-out for to be benchmark-
(e)
enchmark(e) Fill quality and quantity: Public water recuired. Permitted for 3 BF. single family.
Scrape off organic topsoil and baekfi 1i to grade. In area 30 X 58. vrovide 4" of clear.
sand and 12" cf rock. Cover with 9-12" ofsand and sod over mound within 7 days of
install = .ion
(f) Other.
System design and specifications by: �T qiva Title RRS
Construction authorized by: V1�N � rv �^r Date
Duval County Public Health Unit
Note: Completed copies of this form will be provided to the applicant, installer and the building department.
AUDIT CONTROL NO. 13079.,
CITY OF ATLANTIC BEACH, FLORIDA
N FOR ELECTRICAL PERMIT
Aop•�ar PLICATION ��-
a
TO THE CHIEF ELECTRICAL INSPECTOR: DATE:
IMPORTANT NOTICE:
IN CONSIDERATION OF PERMIT GIVEN FOR DOING THE WORK AS DESCRIBED IN THE FOLLOWING, WE
HEREBY AGREE TO PERFORM SAID WORK IN ACCORDANCE WITH THE ATTACHED PLANS AND SPECIFICATIONS,
WHICH ARE A PART HEREOF, AND IN ACCORDANCE WITH THE ELECTRICAL TIONS, CODES AND CITY OF
ATLANTIC BEACH ORDINANCES.
Dewpill AW:4 i']' Vit," ' ' ��Jou
a
ELECTRICAL FIRM: MASTER ELErTRI&AN SIGN RE
0;�
NAME ADDRESS: � RFD BOX
BLDG.SIZE BETWEEN:
RES.1 APT.( 1 COMM.( 1 PUBLIC l 1 INDUS.( ) NEW 10 OLD l ) REW.( )
ADDITION( ) TRAILER ( ) TEMP.1 i, SIGNS ( ) SO. FT.
SERVICE: NEW t 1 INCREASE ( ) REPAIR( ) FEE
CONDUCTOR SIZE AMPS COPPER I A U
SVnTCjHORBREAKE AMPS PH p VOLT RACEWAY
EXIST.SERV SIZE AMPS PH 1, W VOLT RACEWAY
FEEDERS NO. /fL� SIZE NO. 1---- SIZE J ,NO. SIZE
LIGHTING OUTLETS CONCEALED OPEN TOTAL
RECEPTACLES CONCEALED OPEN TOTAL
0.30 AMPS. 31.100 AMPS.
SWITCHES
INCANDESCENT
FLUORESCENT.&M.V.
FIXED 0.100 4mrs 1. 1 OVER
BELL TRAN$F.
APPLIANCES
AIR H.P.RATING H.P.RATING
CONDITIONING COMP.MO. OR OTHER MOTORS AMPS, CEIL HEAT: KW-HEAT
Q1 OVER
MOTORS H.P. VOLTAGE PHS NO. I B-P. VOLTAGE PHS
•` »rt v e 'a ��;} �"'� s 7 ",ay�'xFm.z. w,y . ',r✓a
P`t a>
MISCELLANEOUS
�..rrin��esuzoc.. lunEn 4M V AVPA$AA V
DEPARTMENT OF BUILDING Ct
CITY OF ATLANTIC BEACH,FLORIDA PERMIT NO. y
I
PERMIT TO BUILD 55.r�f �r
THIS PERMIT MUST BE POSTED ON JOB 5•60CR
92U 14 6/17/8
Date June 27 19 86 77P9 af3oc
! G/ 7/9
Valuation$ Fee$ SS-SO 1,900
This permit not valid until above fee has been paid to City Treasurer,and is
subject to revocation for violation of applicable provisions of law.
This is to certify that Duckworth Plumbing RP0437336
I
has permission toinstall plumbing
Classification residential Zone
Owned by David Baker
Lot 401 of 3 & 201 of 4 Block 146 S/D Sect. H
House No. $00 Jasmine St.
According to approved plans which are part of this permit
NOTICE—ALL CONCRETE FORMS
AND FOOTINGS MUST BE IN-
SPECTED BEFORE POURING.
PERMIT VOID SIX MONTHS
„ AFTER DATE OF ISSUE
--► �---- 0 O Building material,rubbish and debris
� A from this work must not be placed
in public space, and must be cleared
up and hauled away by either con-
tra for or owner..
;,r<, .,� t c •_
�—Building Official.
FOR OFFICE PERMIT DATE CONTRACTOR
USE ONLY NUMBER
PLUMBING
ELECTRICAL
SEWER
WATER
*4W
Of
AWOO• -Aviv Standard
utl Southern
pvx d� sof Section 1p9 of she carnQltiu"ce With
the
t a
�� t to the requirem�tce this stru�tur��olla�i't�.
issued �ursuan e time of issu ar the f
This Gerttf�cate certif ging that at ldin5 constructs°'t ar use 4"m``No
Code regulating bu
ng I,
�wildiordinaltices DiStYi``
Va�aLts
Nttt°°� nddcesS= � J.
C1as$1hlA�j°" 'CYP°
Uxality
er°49u'1d1nB `�J'" vie �'"l�-
C.ro
'got nddx
s
��ptld«+6
CITY OF ATLANTIC BEACH
APPLICATION FOR PLUMBING PERMIT
JOB LOCATION
PLUMBING CONTRACTOk
LICENSE NUMBERS e� '
OWNER
BUILDING CONTRACTOR
TYPE OF BUILDING
SINKS SHOWERS
, LAVATORY WATER HEATERS
BATH TUBS DISHWASHERS
URINALS DISPOSALS
CLOSETS WASHING MACHINE
FLOOR DRAINS OTHER
TOTAL FIXTURE COUNT
INSTALLATION OF PLUMBING AND FIXTURES MUST BE IN ACCORDANCE WITH
THE MOST RECENT EDITION OF THE SOUTHERN STANDARD PLUMBING CODE.
INSPECTION LOG
JOB ADDRESS F) ti� .rte
CONTRACTOR e2�
OWNER L.n �_) _ c � --
BUILDING PERMIT `]� a�� ELECTRICAL PERMIT y �
PLUMBING PERMIT _j a'S TEMPORARY POLE PERMIT
MECHANICAL PERMIT v1 MISCELLANEOUS PERMIT
FLOOD ZONE DATE SURVEY FILED
Called-In Approved J .F .A.
Temp Pole
Footing
Slab
Framing
Plumbing (R)
Electrical (R)
Mechanical
Fireplace
Top out
Other
Electrical (F)
FINAL INSPECTION
Certificate of Occupancy Issued
COMMENTS : D om,
CITY OF
- �� rmOCEAN BOULEVARD
mr P.O.BOX xs
----
ATLANTIC BEACH,FLORIDA uxuxo
TELEPHONE(Vn«)u4*xm6
August 11, 1986
Pre-Service Section
Jacksonville Electric Authority
233 West Duval Street
Jacksonville, Florida 32202
The following final inspections have been made and are
satisfactory:
Permit #4893 - 805 Camelia Street
Permit #4894 - 807 Camelia Street
Permits issued to Early Electric Company
Permit #4927 - 800 Jasmine Street
Permit issued to Dennis Electric Company.
Sincerely,
/ .
PpEent
Rene, Angers
Community Devel Director
oc:building file
`
i
1 DEPARTMENT OF BUILDING 7726 72 6
'
` CITY OF ATLANTIC BEACH,FLORIDA PERMIT NO. v
PERMIT TO BUILD 119,no r
THIS PERMIT MUST BE POSTED ON JOB 3s'a•n 11CK
0
6165 1 A 7/117/83
Date ��7�8� 1.6_ E 172 1,1101!:AC
Valuation$ Fee$ b 165 1 A 7/17/
101313
This permit not valid until above fee has been paid to City Treasurer,and is
subject to revocation for violation of applicable provisions of law.
I
This is to certify that GRENIER SERVICES INC
has permission toYaQ install hest & air
i
Classification residential Zone
Owned by David Baker
j Lot 40' of 3 & 20' of 4 Block 146 S/DBect. H
House No. 800 Jasmine St.
According to approved plans which are part of this permit
NOTICE—ALL CONCRETE FORMS
AND FOOTINGS MUST BE IN-
SPECTED BEFORE POURING.
PERMIT VOID SIX MONTHS
„ AFTER DATE OF ISSUE
---► �---► O Building material, rubbish and debris
zq from this work must not be placed
in public space, and must be cleared
up and hauled away by either con-
tract, , or owner..
it,r'))
Building Official.
FOR OFFICE PERMIT DATE CONTRACTOR
USE ONLY NUMBER
PLUMBING
IELECTRICAL
SEWER
WATER
BUILDING AND ZONING INSPECTION DIVISION
CITY OF ATLANTIC BEACH
ATLANTIC BEACH, FLORIDA 32233
APPLICATION FOR MECHANICAL PERMIT CALL-IN NUMBER
IMPORTANT — Applicant to complete all items in sections I, Il, III, and IV.
LOCATIONStreet Address:
OF Intersecting Streets: Between L And
BUILDING
Sub-division
Ii. IDENTIFICATION — To be completed by all applicants ,
In consideration of permit given for doing the work as described in the above statement we hereby agree to perform said work in accordance
with the attack9d plans and specifications which are a part hereof and in accordance with the City of Jacksonville ordinances and standards
of good-practice listed therein.
Name of Mocha nicaly" Contractors
Contractor (Print) J ex �Z vi't E`T rrL Master G t__'O IPX
Name of
Property Owner d ?///D
Siguatera'of Owner !""" ` Signature of
or Au$Irormod Agent ldo ` Architect or Engineer
111. GENERAL INFORMATION
A', Type of heating fuel: B.
,,�
/ IS OTHER CONSTRUCTION BEING DONE ON
8 Beetric THIS BUILDING OR SITE? +�
❑ Gas-❑ LP ❑ Natural ❑ Central Utility
IF YES, GIVE NUMBER OF CONSTRUCTION
❑ OR a PERMIT
M/Otber— Specify 1 R y*
IV. M CM4M" L9UIPMONT TO U INSTALLED NATURE Of WORK
(PmvW*complete list of components on back of this forml J'Residential or O Commercial
Heat ❑ Space ❑ Recessed Ei"tonfral O Boor M-_'New Building
fY'*'/Ur Conditioning: ❑ Room 0Centrel ❑ Existing Building
ao'-Cect System: Materia SW440.15 Thicker ElE� Replacement of.existing system
f
Maximum capacity V-'a .m.
�ZLs3 New Installation(No system previously Installed) i
e.
❑ Refrigeration
❑ Extension or add-on to existing system
`❑ Cooling.tower: Capacity. 9-p^ El Other— Specify
❑ fine sprinklers: Number of heap
Q Elevator ❑ Monlift ❑ Eeala or (number)
THIS SPACE POR OPPICE USE ONLY
❑ Gosolims pumps (number) (Raeeised)
Q, Tangy (number) Remarks
Q LPG containers (number)
O Unfired pressuy vessel
O SAM Permit Approved
(� 00W Specify Permit F..
PSTALL EQUIPMENT
AIH CONDITIONING AND REFRIGERATION EQUIPMENT
Approidaff
Number UERS DOW491 ipa NO"Number l+faautacttiirer (��
R