Permit Siding 563 Selva Lks 2011 -5 LiVI:f-
.
j CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
J ` °���' .` ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5826
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Application Number 11- 00001964 Date 4/21/11
Property Address 563 SELVA LAKES CIR
Application type description SIDING PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 1100
Application desc
replace siding
Owner Contractor
PULTE HOME CORPORATION GENESIS BUILDING CORP
8081 PHILLIPS HWY 2158 MAYPORT RD.
SUITE 14 ATLANTIC BEACH FL 32233
JACKSONVILLE FL 32256 (904) 241 -0320
Permit SIDING PERMIT
Additional desc .
Permit Fee . . . 60.00 Plan Check Fee . . 30.00
Issue Date . . . Valuation . . . . 1100
Expiration Date . 10/18/11
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.
t.A.N:r City of Atlantic Beach APPLICATION NUMBER
iss rt, Building Department (T b e a ss i g nne d � b jr th Buildin D ) i
i l 800 Seminole Road t tfii °ti i ti
j
73 Li s - Atlantic Beach, Florida 32233 -5445 ` } • 4 < r F± . '_-- `- y t 3 ._ '
~ Phone (904) 247 -5826 • Fax (904) 247 -5845 ? Li f it 1;;^F ' - 7 11 ,- R } V l _"7Ta4 =� 5.
_r ;t 9t E-mail: building- dept @coab.us `' `� Date routed -5 '" :` rs
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: . l J /tIs C -'2_ ' '- • - . 1 ent review required Yes No
Buildin •
Applicant: 9\c--,i.55-i S T anning & Zoning
. / Tree Administrator
Project: V & n'' (T ? Cf_ L(EK,1 Public Works
Public Utilities
Public Safety
Fire Services
Freview fee $ r . e ; . ' De V,Si9h: , rr Vir
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: []Approved. ['Denied.
(Circle one.) Comments:
BUILDING
PLANNING & ZONING Reviewed by: Date:
TREE ADMIN. Second Review:
Approved as revised. ❑Denied.
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
1 /'1 S
Job Address: C V 4l L Ke.> C I, C t' Permit Number:
Legal Description _Se =e- I1 L-Ai um ' l 2 Parcel # (7 2-027 - 5 5 z4
i Floor Area of Sq.Ft. Sq.Ft
Valuation of Work S 1 1 (O Proposed Work heated /cooled non- heated /cooled
Class of Work (circle one): New Addition Alteration Repa Move Demolition pool /spa window /door
Use of existing /proposed structure(s) (circle one): Commercial esident••
If an existing structure, is a fire sprinkler system installed? (Circle one): - es 9) N /A
Florida Product Approval #
For multiple products use product a pprova l orm
Describe in detail the type of work to be performed: ArD0 Rl: A??S I7�R 1 -/OP1 : //J5 T�J�v
f;i NACI 35o 4 or 6 /Difli6
Property Owner Information: \
Name:_ P D M uO Ai / Address: l 035 64 $'7 ), -S7 Z
City A N - '"-.) '17:}q4 t State EC -Zip -31233 Phone
E -Mail or Fax # (Optional)
Contractor Information: r2^,., f>1/4. W�
t �t
Company Name: CEJ c •- i_. rJUt //1iC. / c�? lA Qualifyingg Agent: l Z D 0C �5•rv�
Address: 7 t iwpo j b LAi
Cit U'1( L g L C State f L Zip 3 Z 2-33
Office Phone 6/ 1)4- 2.41 - G?) .- Job Site/ Contact Number Fax #
State Certification/Registration # Ci3c. 1 Zf, 2
Architect Name & Phone # kf /t
Engineer's Name & Phone # /V /ik
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
Application is hereby wade to obtain a permit to do the work and installations as indicated. / certi%y that no work or installation has commenced prior to the
issuance of a permit and that all work will be perfinmed 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 (G) months al any time after
work is commenced. l understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, Furnaces, Boilers, Healers,
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.
1 hereby cerlifY that / have read and examined this application and know the same lo be true and correct. All provisions of laws and ordinances governing this
type of work will be complied with whelkspecif,ed herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions gl'aI T other federal, 51 ocal law rep Tenon or the performance of construction. /
J 1
Signature of Owner MO _ Signature of Contrac +r C ' /
I ,�
Print Name ---. a (SL 1, 1 1 / M D /) Print Name /0C 4. , /,ye' " C '
Sworn to and subscribed he ore me Sworn to and subscribed before me
his- 24 Day of ,4 -rt'l , 20 C / this Day of A pr- e 2 0 l
4 ea ,i t WILLIAM t POPE `1l �,��i"" `
\lotary Public Notary Public State No Public WILLIAM l POPE
Y of Florida t r i , fate of Florida
My comm. exp. Oct 19, 2011 Re � b e Oct 19, 2011
,�
Comm. No. DD 714216 Comm. No. DD 714216