Untitled (2) Sep "25 ,07 11 : 10a Coast to Coast R 19048809909 p, 2
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach FL 32233
Office:(904)247-5826 • Fax:(904)247-5845
jb Address: 37 Z£4,is s4 ATl &AA, F'L Permit Number:
egal Description t,-7- S - l E 7 /kz 01rfLS / �
Valuation of Work(Replacement Cost)$ ggoQ-v a
■ Class of Work(Circle onLCt): New Addition Alteration Repa'
■ Use of existing/proposed,rtructure(s)(Circle one): Commerce esiden
• If an existing structure,is a fire sprinkler system installed?(Circle one): es o N/
�
Is approval of homeowner's association or other private entity required?(Circle one): es ,
)escribe in detail the type of Nmrk to be performed:
Kms- S�n•,c � ,n,
'ronerty Owner Information
Jame: F,r,, k-t Z c Ann;e Eve Address: LEr, & Si.
'ity ATS ge.AC 4 State!e Zip 3aa Phone
contractor Information:
Fame of Company: Aj,,FE, Qualifying Agent:
kddress: ��79 5An , r�t�d City SA?c State fir_ Zip 3
Jffice Phone Job Site/Contact Number'1a1V 79S-_-_yoy
State Certification/Registration.# cc-c-f 3,� ,��g Office Fax
ATchitect Name&Phone#
Engineer's Name&Phone#
4pplication is hereby made tv obtain a permit to do the work and installations as indicated. 1 certify that no work or
installation has commencedpr i,'or to the issuance o{{apermit and that all workwill be perficonedto meet the standards ofall
!aws egu
rlating construction r�r this jurisdiction This permit becomes null and void work is not commenced within six(6)
months, ora construction or work is suspended or abandoned for a period of sax (6) months at any time after work is
commenced I understand that separate permits must be secured for Elechlcal Work,Plumbing,Signs, Wells,pools,
Furnaces,Boilers,Heaters, 1'4nks and Air Conditioners, etc.
WARNING TO OWNED.: YOUR FAILURE TO RECORD A NOTICE OF COMNIENCEMENr MAY
RESULT IN YOUR PXING 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.
t hereby certify that 1 have read and examined this appli and know the same to be true and cornorectt . of
laws and ordinances governir,:;�this type of work wiI! co with whether specked herein or . aaf�t o a
permit does not presume to gave authority to viola t o�'Dcance he provisions of any other federal, st �> TO lfaw
regulating construction or the performance of cons iTr
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Signature of Property Owner: ,,
rr Q � Signature of Contractor:
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Sworn to and subscribed before me o _oFy
z �a w Sworn to and subscribed before nae m ,
this ">L �Day of PI -iC.t yes? 2 a
this-!K4 Day of S� Er►�13� �Q7 �`
Notary Public: �O"`" Notary public State of
• , $ ticz�,Z,2, 1
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?o��d� Expires 06108/2011