Permit Siding 555 Selva Lks 2011 r foRe CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5826
Application Number 11- 00001815 Date 3/25/11
Property Address 555 SELVA LAKES CIR
Application type description SIDING PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 6200
Application desc
SIDING REPAIRS
Owner Contractor
CLAYTON THEODORE ET AL FISETTE CONSTRUCTION & REMODEL
555 SEVLA LAKES CIR. 2336 PINE ISLAND COURT
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32224
(904) 992 -4782
Permit SIDING PERMIT
Additional desc .
Permit Fee . . . 85.00 Plan Check Fee . . 42.50
Issue Date . . . Valuation . . . . 6200
Expiration Date . 9/21/11
Special Notes and Comments
*2007 FLORIDA BUILDING CODE W/2009 REVISIONS
NATIONALELECTRIC CODE
*REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING
DEPARTMENT IMMEDIATELY.
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 85.00 85.00 .00 .00
Plan Check Total 42.50 42.50 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 131.50 131.50 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
i -iLnr City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
r 3 a r 800 Seminole Road f. J
g Atlantic Beach, Florida 32233 -5445 j
- V z ' ' ' Phone (904) 247 -5826 • Fax (904) 247 -5845
E -mail: building- dept @coab.us Date routed:
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: �S ��-�� De ent review required Yes / No
ildin f/
Applicant: • Planning & Zoning
Tree Administrator
Project: Public Works
Public Utilities
Public Safety
Fire Services
r 3-' -ty r.f' �' t�M�" ` ' [ice _ '�' Y p '9 ,' .,. , I:3*r^�^a. ... � 4
Revie fee $ ZRAMf FINI FT ept xSl gnat u re r X ,.E ...
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
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: �pproved. ['Denied.
(Circle one.) Comments:
BUILDIN
PLANNING & ZONING
TREE
Reviewed by: 171
D ate:
TREE ADMIN. Second Review: Approved as revised. Date:
led.
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: - i f Selo 11ot � el rc f "Jc vrt �, &ahh , Permit Number: J/ - / S i S"
lo. s 1Tw P br-. 11 ' 1'p i 11
Legal Description e ✓Q �� l�v j� �/ A , / (�j ,
Valuation of Work $ , BOO
Class of Work (circle one): New Addition Alteration taIDO Move Demolition pool /spa window /door
Use of existing /proposed structure(s) (circle one): Comme • Residential
If an existing structure, is a fire sprinkler system installed? (Circ • one): Yes No N /A
Florida Product Approval #�S. j 12 %S, I • . i1. '; rt, 12;'. _0 132010 7
For multiple products use approva ' orm
Describe in detail the type of work to be performed: l Woofi - - t V4141,1
4iim cifiace,
Property Owner Information
Name: d C�IGt. Address: 6 - 57 Gi. `�,E9S' 6Ade,
City —! - State K.(Zip WW, Phone ' p'1
E -Mail or Fax # (Optional)
Contractor Information:
Company Name: i , , ,c : '.0 4 t ,v, ,, i t 9 Qualifying Agent: / 1' I I
Address: 11 S ce,, A vF City .. :, ,' , Li State > ( . Zip 37.
Office Phone (P 0 30 Job Site/ o i •
State Certification/Registration # _ — :_.5_ / MA 1 a ? • e
Architect Name & Phone # - ' '
Engineer's Name & Phone # 1 �' 1 :" - �.r` ►� r � y 11 Z��y; 11
Fee Simple Title Holder Name and Address _ ' • '�•_ • • 4411 i 11 i M.1' 1
Bonding Co Name and Address . , ' ' ' • • f
Mortgage Lender Name and Address 1 REVIEWED B • 2 / 3 . I, x , :; ,. ,,a_4.;,,�,._w ,vim - •
Application is hereby made to obtain a permit to do the work and installations as in cer t .. ,
PP Y P - 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 aperiod 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 thisplication and know the same to be true and correct. All provisions of laws and ordinances governing this
type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other federal, state, or local law regulating construction or the performance of construction.
Signature of Owner ,� Signature of Con for , i A t M-
Print Name 7 v (+ o OOL r L 1
C� -in " / P rint Name 4444 :..- fl 5c- , .
Swo to and subsctiped_b a me Sworn to and subscribed before me
this L nDay o'f��f, ' 20 r / f.�. -.C.�t this 22 Day of 44, t�f , 20 1/
/`
Notary Public Notary P It — — - — — — — — —
CHAMtLEB BREWER e " $$$$$$ JUAN E. FERNANDEZ
,. - Notary Public, State of Florida # ' \ Notary PubIicR gtl t�Y 0
.1-
;. - Commisslonif 00946697 �� E My Comm. Expires Dec 7, 2014
i conam. expires Dec. lb, 2013 %�, c' Commission M EE 17906
edh► : ` Bonded Through Netionel Notary Assn.