Permit Bath Remodel 168 Sylvan 2011 . * : Y f CITY OF ATLANTIC BEACH
rj MI E:�:" r } 800 SEMINOLE ROAD
J 7 v , ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5826
Application Number 11- 00001867 Date 4/01/11
Property Address 168 SYLVAN DR
Application type description RESIDENTIAL OTHER
Property Zoning TO BE UPDATED
Application valuation . . . 1450
Application desc
BATHROOM REMODEL
Owner Contractor
GASTON, LOIS GRAY AND GRAY CONSTRUCTION,INC
168 SYLVAN DRIVE 8850 CORPORATE SQUARE COURT
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32216
(904) 724 -7211
Permit RESIDETNIAL ALT /OTHER
Additional desc .
Permit Fee . . . 60.00 Plan Check Fee 30.00
Issue Date . . . Valuation . . . . 1450
Expiration Date . 9/28/11
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 60.00 60.00 .00 .00
Plan Check Total 30.00 30.00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 94.00 94.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247 -5826 Fax (904) 247 -5845
Job Address: \GS SyL6,... 9 r _ Permit Number: `/ 1 , `.-
Legal Description Parcel #
Valuation of Work $ ►, c(' Q Prop Prop osed Work h ted /cooled non q•
�oC7 s"F non- heated /cooled 41
Class of Work (circle one): New Additior'Alteratio Repair Move Demolition pool/spa window /door
Use of existing /proposed structure(s) (circle one): Commercial
If an existing structure, is a fire sprinkler system installed? (Circle one): es N /A
Florida Product Approval #
For multiple products use product approval form
Describe in detail the type of work to be performed: 4,r.04c. a ,X\ dr t-J. A G—A (iv rc- o ck tc,r -.
Y•• 1-. • v of" . Q ,= . c c � . 1 )•. ,rtrJ .
Property Owner Information:
Name: o t o. Address: \ C 1......., 9,
City A' 0.,...1.7r ° a.4 Co . State Zip ,T>D3� Phone CgA S`S' — i S'c'tl
E -Mail or Fax # (Optional) 5k r0.y e da r; (S.. 9 r -"... ) o 1; _ c 0 rr
Contractor Information:
Company Name:( ray G, . � Cork r, 4:: or vi y D. C., roi y
Address: :: • 4 �, , - , � Qua lifying Agent: ,.
Office Phone jatoLl 7 . 4.. "Yl.1 Job Site / C Contact Number `�Q cla.Sc� -��:Ile State P► _ Zip x 7
State Certification/Registration # Fax # (goo) ��� . s - y y7
Architect Name & Phone # -
rc.
Engineer's Name & Phone # .44
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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 aperiod of six 6) months at any time after
work is commenced. I understand that separate permits must be secured for Electrical Plumbing, S Wells, Pools, F urnaces, Bo 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 cert that I have read and examined this a plication 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 , C'' A I ,
of Contracto /�� . . Signature a _
Print Name A 0 IS J 3& Print Name ,��', /
Sworn p and subscribed before me Sworkto and subscribed before me
this Day of IN.- .--;..\ 20 \ \ this Day of Pic ; \ , 20 \\
T T
0.9Y r„ Notary Public State of Florida k - C!l(1,
Notary Pub is , A My Comss E E050483 Notary P b c � � f-
'oi,�o Expires 0l mi /01/ ion 201
/°� Revised 01.26.10
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