Permit 760 Triton Rd (vault folder) % ' ; 5 �' 7 : BUILDING PERMIT APPLICATION
' s CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach FL 32233
*0 V Office: (904)247-5826 • Fax: (904) 247 -5845
Job Address: 74 Z/ 7. Permit Number:
Legal Description i e,: x x• /0/ ,y.. s /A.,/ 1/.9 Lo f // .%?/ e /
Valuation of Work (Replacement Cost) $ "a oo" 442
• Class of Work (Circle one): New Addition Alteration drI ■ 4 •
• Use of existing/proposed structure(s) (Circle one): Commerci. Resident'.
• If an existing structure, is a fire sprinkler system installed? (Circle one): • es urp /A ��
• Is approval of homeowner's association or other private entity required? (Circle one : Yes (j
Descri filet it the type of wotic to be performed: � o ,p F . 4 /
,— f. __ ' ' ✓1`i' / �y e --v, �c...,i ` FCoo�ci:,if C 7 % f
Property Owner Information
Name: Cs' l €� e-s.nv�.e-k`" Address: - v C - Tv . `C
City $ , AA Cn� = n ( Rc (),c1, State CL Zip 322 3',Phone °►o - t c i Li . '301 0
Contractor Information:
Name of Company: � �',,,/.rf ,, Qualifying Agent: ,� /�- ,....,,.>/e. -r C,.,,,.y�.�,- --L
Address: �' ‘ -t ' Ave/6 City ,4,�,./..� ,*. State , --C Zip ..f eV 2-
Office Phone .7 Oe, — � 6 r- — 5 '.',3 V 5 Job Site /Contact Number ,d v - .5 g 7 7 z
State Certification/Registration # C r /7 .S" / Si. r7Office Fax #
Architect Name & Phone #
Engineer's Name & Phone #
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no worlc or installation has commenced prior to the
issuance ofa permit and that all work will be performed to meet the standards of 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, Boilers, Heaters, Tanks and Air
Conditioners, etc.
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 FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type
ofworkwill be complied with whether specified herein or not. The granting of a ermit does not presume to give authority to violate or cancel the provisions o any
other federal, state, or local law regulating construction or the performance ofconstruction.
Signature of Property Owner: 4 \ ' Ann Signature of Contractor: —<L� L / Ate /� —
Sworn to and subscrib d before me /
this ,50 Da of Swor �q-snd subscri ed before ape
Y FLA- this Day of -M 4 A C&.-
Notary Public: '��. / • P b 'c: ' • '1
e JOANNE DECKER ' y , , , ., . ;`., ; o o 4 .37/ - 0
: �. ; MY COMMISSION # DD 443880 Mad Mlle • • d A• -!, EXPIRES: June 22, 2009 iv Comoddfo � E4il w% 14, • t , Rf : Bonded Thm Notary PubNc Undenwitere COIIMIII�_M 1 OD 51
: T. MC 8o1 Naomi
Assn.
DO NOT WRITE BELOW TITTS T,INF! OFFICE, USE ONT,V
Review -ult (Circle one). ry T • T 1 IT , / /G /'r�