Permit termite repairs 5401 Capella Ct 2011 fi
CITY OF ATLANTIC BEACH
r ". 800 SEMINOLE ROAD
J �� °�� ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5826
Application Number 11- 00001969 Date 4/22/11
Property Address 5401 CAPELLA CT
Application type description RESIDENTIAL OTHER
Property Zoning TO BE UPDATED
Application valuation . . . 2200
Application desc
termite repair
Owner Contractor
NAVAL CONTINUING CARE NORTH RIVER BUILDING SOLUTIONS
RETIREMENT FOUNDATION, INC
1 FLEET LANDING BLVD 6771 SHINDLER DR
ATLANTIC BEACH FL 322334599 JACKSONVILLE FL 32222
(904) 838 -9179
Permit RESIDENTIAL ALT /OTHER
Additional desc .
Permit Fee . . . 65.00 Plan Check Fee . . 32.50
Issue Date . . . Valuation . . . . 2200
Expiration Date . 10/19/11
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 65.00 65.00 .00 .00
Plan Check Total 32.50 32.50 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 101.50 101.50 .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: 5 0i 6 tqc, CA. - lid I Permit Number:
Legal Description a Parcel #
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work $ as 00 Proposed Work heated /cooled non - heated /cooled
Class of Work (circle one): New Addition Alteration Repair Move Demolition pool /spa window /door
Use of existing /proposed structure(s) (circle one): Commercial Residential
If an existing structure, is a fire sprinkler system installed? (Circle one): Yes No N /A
Florida Product Approval #
For multiple products use product approval form
Describe in detail the type of work to be performed: Ce eor I n,.„ k 1-vv.a 4. 54- n-.c -4 SA, is
a r Leader , s- kicco , (nbt.i4
Property Owner Information:
Name: N C C A F Address: ., - r1 ee.4 by, a,, ik ✓o)-
City (�-} a.4 $ea State R Zip 32233 Phone
E -Mail or Fax # (Optional)
Contractor Information:
Company Name: ('fa6 Rwe.( � � `l� : ^b E0 WI; A Qualifying Agent: ` T )u.. - /44 an
Address: (1`) ( Sx,■,Jler X(. City lac. s.nvJle Stare pL Zip 3 ZZZZ
Office Phone 83k -ll1' Job Site/ Contact Number Fax #
State Certification /Registration # C&(. (5) 3 0 11 8
Architect Name & Phone # —
Engineer's Name & Phone # —
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. I 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 �f construction or work is suspended or abandoned for a period of six (6) months at any time after
work is commenced. l 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 1 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 w d ork 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 ,6 t^^ 44,4 Si of Contractor
Print Name t.A 1 tA� 6 -CO Print Name ' o p .... • /tit • e
Sworn to and subscn before me Sworn to and subscribed before me
this 2 Day of INIAitc , 20 /1 this /I/ Day of 1oi/ . 2011
- - -—
N otary Pub l t• 41
. ELIZABETH TESKE I Nota y t • l ic f ..., p,, ELIZABETH TESKE
1 1 ` It Notary Public • State of Florida i • .1 4∎ r�r • a Offrot lb`.' Eicpirres A II�j T Sete Florida
• 1 . +�, rs My Comm. Expires Apr 5, 2013 I , I. ,,, , br 5, 2013 l
s, i Commi d► DD 867829 = �. Co 0 OD 867829
u' Bonded Through National Notary Assn. 1 ' „° '., ` Bonded Through National Notary Assn.
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