Permit Siding 618 Aquatic 2011 s .! CITY OF ATLANTIC BEACH
.sq vsp `ft ��
% ` '' 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5826
Application Number 10- 00000073 Date 1/25/10
Property Address 618 AQUATIC DR
Application type description SIDING PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
siding repairs work done
Owner Contractor
FORD OWNER
618 AQUATIC DRIVE
ATLANTIC BEACH FL 32233
Permit BUILDING PERMIT
Additional desc .
Permit Fee . . . 55.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 7/24/10
Fee summary Charged Paid Credited Due
Permit Fee Total 55.00 55.00 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 55.00 55.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
i CITY OF ATLANTIC BEACH
' ` 800 SEMINOLE ROAD, ATLANTIC BEACH, FL 32233 I I I
z `; OFFICE (904)247-5826 • • FAX NO.:(904)2475845
�V ' BUILDING-DEPTQCOAB.US
-----p. BUILDING PERMIT APPLICATION DUVAL COUNTY
'1.. JOB ADDRESS:'' - 2. VALUATION WORK' - -' " 3. SQ. FTC UNDER ROOF
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4. LEGAL: DESCRIPTION 5. CLASS OF WORK 8. USE OF STRUCTURE
O NEW BUILDING 0 DEMOLITION '0 RESIDEW11AL
LOT BLOCK SUB DIVISION 0 ADDITION 0 CONVERTING USE 0 COMMERCIAL
DESCRIPTION OF WORK t_ � . �� f 'A ❑ ALTERATION O ACCESSORY BLDG. 8. FIRE SPRINFO Ent;
r REPAIR O POOL / SPA ` O YES V'rWA
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. ". PROPERTY OWNER TRACTOR:' ARCHITECT 1E NGINEER:
15. COMPANY NAME 23. COMPANY NAME
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16. NAME 24. LICENSEE NAME
10. ADDRESS: 17. STATE OF FLORIDA UCENSE NO.: 25. STATE OF FLORIDA UCENSE NO.:
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L. f rL 18. ADDRESS: 28. ADDRESS:
11. OFFICE PHONE 112. FAX NO.: 19. OFFICE PHONE 120. F NO.: 27. OFFICE PHONE :. FAX NO.:
13. CELL PHONE 21. CELL PHONE 29. CELL. PHONE
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14. EMAIL ADDRESS: 22. EMAIL. ADDRESS: 30. EMAIL ADORE -.
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TITt.E.HOLQER. g. DING COMPANY: MORTGAGE LENDER:
, ' .. ; � ' :
31. NAME 33. NAME 35. NA
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32. ADDRESS: 34. ADDR c- : : 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 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 any time after work is commenced. I understand that separate permits must be secured for
Electrical Work, Plumbing, Signs, Wells, Pools, Furnaces, Bolters, Heaters, Tanks, Air Conditioners, etc.
OWNER'S AFFIDAVIT - I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable
laws regulating construction and zoning. I will not occupy or use the referenced building or any part therof, until all inspections are llnaled and
prior to obtaining a certificate of occupancy or completion issued by the building offidal, as required by law.
WARNING TO OWNER: ***-
YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
OWNER or AGENT CONTRACTOR
Of Agent, Power or Attorney r. - Letter Required) (Owner On
S'. - •: -LreA, . Date: Signed: Date:
, - me this day of , 2009 in the county of Before me this day of , 2009 in the county of
Duval. State of Florida. has personally appeared Duval. State of Florida, has personalty appeared
herrn by himself / herself and affinvis that all statements and declarations are herin by himself / herself and affirms that all statements and declarations are
true and accurate. true and accurate.
Notary Public at Large. State of , County of Notary Public at Large, State of . County of
O Personally Known 0 Personally Known
0 Produced Identification - O Produced identification -
Notary Signature: Notary Signature:
BLDG01 Parma Appicatlon Bldg: REVISED: 12/1812008
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CITY OF ATLANTIC BEACH
®WNER / BUILDER AFFIDAVIT
I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION
CONTRACTING" REQUIRES OWNER / BUILDER TO ACKNOWLEDGE THE LAW:
DISCLOSURE STATEMENT FOR SECTION 489A03(7), FLORIDA STATUTES:
STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED
CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT
LAW. THE EXEMPTION ALLOWS YOU, AS THE OWNER OF YOUR PROPERTY, TO ACT AS
YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST
SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE — OR
TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR
IMPROVE A COMMERCIAL BUILDING AT A COST OF $25,000.00 OR LESS. THE BUILDING
MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR
AFTER THE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT
IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT
HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS
YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE
LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING
ORDINANCES.
11. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO
OBSERVE IRS WITHHOLDING TAX AND /OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY
EMPLOY ON THEIR IMPROVEMENT TRADES.
IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY
CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO.
455- 228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT (247 -5826) IF IN DOUBT.
V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER- BUILDER PERMIT.
ADDRESS PHONE NUMBER
PR NT N, E •
SI ATURE • DATE
Before me this day of 20_ in the county of
Duval, State of Florida, has personally appeared herin by himself / herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large, State of , County of
❑ Personally Known
❑ Produced Identfication-
I
Notary Signature:
F: BLDG /Owner- Builder Affadavi0 REVISED. 4/16/2009
BP2OOI01 CITY OF ATLANTIC BEACH 3/10/10
Application Inquiry 16:22:42
Application number 10 00000073
Application status, date . . : PERMIT ISSUED 1/25/10
Property • 618 AQUATIC DR
RE number 171818 -5206- -
NCR OLD ACCOUNT NUMBERS. . . : AB25053
Zoning • TBU TO BE UPDATED
Application type • SIDE SIDING PERMIT
Application date • 1/25/10
Tenant number, name
Master plan number, rev'wd by: SLG
Estimated valuation
Total square footage 0
Public building • NO
Work description, qty . . .
Pin number • 580101
Application desc • siding repairs work done
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