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Permit Remode 2102 Beach 2011 . ✓ `` CITY OF ATLANTIC BEACH , " �' ` ) 800 SEMINOLE ROAD J ' ' -z" ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5826 Application Number 11- 00001922 Date 4/27/11 Property Address 2102 BEACH AVE Application type description RESIDENTIAL ALTERATION Property Zoning TO BE UPDATED Application valuation . . . 60000 Application desc RENOVATE HALLWAY AND 2 BATHS Owner Contractor ROCHOW OWNER Permit RESIDENTIAL ALT /OTHER Additional desc . Permit Fee . . . 320.00 Plan Check Fee . . 160.00 Issue Date . . . Valuation . . . . 60000 Expiration Date . 10/24/11 Other Fees STATE DCA SURCHARGE 4.80 STATE DBPR SURCHARGE 4.80 Fee summary Charged Paid Credited Due Permit Fee Total 320.00 320.00 .00 .00 Plan Check Total 160.00 160.00 .00 .00 Other Fee Total 9.60 9.60 .00 .00 Grand Total 489.60 489.60 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. .s� -L City of Atlantic Beach APPLICATION; NUMBER \ jt - Building Department (To be assigned by the Building Department ) .� yi v 800 Seminole Road F T Atlantic Beach, Florida 32233 -5445 t ` ""` ° Phone (904) 247 -5826 • Fax (904) 247 -5845 x, ..oi3 S P ' E - mail: building- dept @coab.us Date routed w r 4 . { City web -site: http: / /www.coab.us -` APPLICATION REVIEW AND TRACKING FORM Property Address: ,-2'- /d ■ot €ed Zvi _ Depart review required Yes No CC /1/6,-- �ildji) V Applicant: 0 /I/c ` Planning & Zoning Tree Administrator Project: A i/V.0 VQ' /1 / , „d Public Works Public Utilities c2 Public Safety Fire Services Re /IeVI/rfee ' ' xn� i - . "-^, ' .. , emu vtt�s a p , �r AN , �DeP.!9a #lire , MAO, 5 �� } Other Agency Review or Permit Required Review or Receipt Date �° D of Permit Verified By A Florida Dept. of Environmental Protection b Florida Dept. of Transportation A 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: proved. ❑Denied. (Circle one.) Comments: BUILDING PLANNING & ZONING Reviewed by: Date: ( 1 - / 3- 1/ TREE ADMIN. Second Review: Approved as revised. ❑De ied. 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 rob Address: 20Z- 130ett- AU__ Ay, -3.3a-3 Permit Number: 1l — i 9 o?).- Jegal Description Parcel # Taluation of Work $ / !� Floor Area of Sq.k t. 5 Ft Proposed Work heated/cooled ,f 7O on- heated/cooled /<-/A :Ias of Work (circle one): New Addition (te Repair Move Demolition pool/spa window /door Tse of existing /proposed structures) (circle one) : Commercial • - . - , . f an existing structure, is a fire sprinkler system installed? (Circle one): 4 Le No N /A lorida Product Approval # 'or multiple products use product approva form )escribe in detail the type of work to be performed: ? J9 (4IV /J7lit - 47 AzA a 4M I-S roperty Owner Information: came: k) g6V)1 ) Address: 1 02- PC` 4- /"c. 3x-3 3 ity 4 . State Zi Phone 40c f •--� Sj7- z -( -Mail or Fax # (Optional) 1,4) QC• f0 w ) , k/G T ' ontractor Information: ompany Name n!, Qualifying Agent: ddress: S4 f f} x Xk _ City State PL Zip32- ffice Phone Job Site/ Contact Number Fax # `.ate Certification/R.egistration # rchitect Name & Phone # agineer's Name & Phone # C114 5 t !.) j �v • p - - 7 - r+ :e Simple Title Holder Name and Addr ss etaneie. ,54 ,t--> ' /VC._ onding Company Name and Address /4 [ortgage Lender Name and Address �, L. ' G. r � / 4, ' f `fir )placation is hereby made to obtain a permit to do the work and installations as indicated I certify that no work or installation has commencer prior tto tt .uance 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 : d void (work is not commenced within six (6) months, or if construction or work is suspended or abandoned for a_pereod of six 6) months at any time after )rk is commenced. I understand that separate permits must be secured for Electricar Work, Plumbing, Signs, Wells, Pools, F urnaces, Bo t ers, Heaters, rnks 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. ereb certify that I have r- ad and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this re of work will be compl. -d , th whether specified herein or not. The granting of a permit does not presume to z'q authority, to jzplgt_� he visions of any other fede .1 s ate, or local law regulating construction or the performance of construction. "��`` gnature of Ownek Signature of Contractor int Name / Xt)C F �// Print Name , . k . . , y....,. » vo to and subsori')ed befo e me t � t� is 0 - . *L... ww ■�■r �w � , 20 /) R U *1'1 c 6O E eOM PLIANCE 20 _ :, CITY OF ATLANTIC BEACH I M $ RMITS FOR ADDITIONAL ' )tart' "us lie ?*: : "? MY COMMISSION # DD 957160 NOt ' ` �` ; � „ ?? CONDITIONS. -', 2 ENTS AND 'Mu u Notary Public Underwriters ,u REVIEWED BY: _Z4_,___ � 2��. 1: DA TE: R 1 ,t» CITY OF ATLANTIC BEACH � ,tl � OWNER / BUILDER AFFIDAVIT 1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION CONTRACTING" REQUIRES OWNER / BUILDER TO ACKNOWLEDGE THE LAW: DISCLOSURE STATEMENT FOR SECTION 489.103(7), FLORIDA STATUTES: STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT LAW. THE EXEMPTION ALLOWS YOU, AS THE OWNER OF YOUR PROPERTY, TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE — OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR IMPROVE A COMMERCIAL BUILDING AT A COST OF $25,000.00 OR LESS. THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE. IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES. II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. 111. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING TAX AND /OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES. IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455 - 228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE BUILDING DEPARTMENT (247 -5826) IF IN DOUBT. V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER- BUILDER PERMIT. 1 62- BEA-C/{ AvE- �� 4.307 -3er/ 3 A RESS KI k PHO NE NUMBER PRIN E " �yC� vs SIG / U R E _ 4 /16 DAT Before me this /Z day of / L 20* in the county of Duval, State of Florida, has personal) appeared herin by hi self / herself and affirms that all statements and declarations are true and accurate. 1 �c_� Notary Public at Large, State of / L , County of ❑ Personally Known O.Pr6duced ldensficati•. _ • 1111 ' 'Y P SHIRLEY L GRAHAM Notary Signature. _ r / t :+r_ MY COMMISSION # DD 957760 �" - " ' b = -:or EXPIRES: February 14, 2014 4 , i t ` Bonded 'Nu Notary Public Underwriters F:BLDG /Owner - Builder Affadavit; REVISED: 4/16/2009 10' -b 3/4" r .,z sx ui a o ti k BEDRM BEDRM o m 26 I/2" 1 2' -II 3/4" 21" 5-0" v • PR (( J) m` 1/6 �/ O t�R LS CLO i/b tsfillh a 214 .� 214 CLO ■ 2/6- ..11 2/6 GON5O i _ 3/b I 3 3/6 I I o C/O II O II -1-i 1 - A /A LAUNDRY CHAIR CHAIR D 1/4 CL E TBL. SOFA / 15-1 I/2" ` �Aiv:rj', �y , tkik, CI TY OF ATLAN TIC BEACH . 9 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5814 Application Number 11- 00001922 Date 5/27/11 Property Address 2102 BEACH AVE Application type description RESIDENTIAL ALTERATION Property Zoning TO BE UPDATED Application valuation . . . 60000 Application desc RENOVATE HALLWAY AND 2 BATHS Owner Contractor ROCHOW DONALD W OWNER 2102 BEACH AVE ATLANTIC BEACH FL 32233 Permit MECHANICAL HVAC PERMIT Additional desc . Sub Contractor . AIR EXCELLANCE INSTALLATION Permit Fee . . . 75.00 Plan Check Fee . . .00 Issue Date . . . Valuation . . . . 0 Expiration Date . 11/23/11 Other Fees STATE MECH DCA SURCHARGE 2.00 STATE MECH DBPR SURCHARGE 2.00 Fee summary Charged Paid Credited Due Permit Fee Total 75.00 75.00 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.00 4.00 .00 .00 Grand Total 79.00 79.00 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. MECHANICAL PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd Atlantic Beach, FL 32233 Ph (904) 247 -5826 Fax (904) 247 -5845 JOB ADDRESS: (/ Oa FyoLciv A \J E PERMIT # PROJECT VALUE$ 500 NEW AIR CONDITIONING & HEATING SYSTEM INSTALLATION Air Conditioning: Unit Quantity Tons Per Unit Heat: Unit Quantity BTU's Per Unit Seer Rating Duct Systems: Total CFM REQUIRED REPLACEMENT AIR CONDITIONING & HEATING SYSTEM INSTALLATION ARI # Air Conditioning: Unit Quantity Tons Per Unit REQUIRED Heat: Unit Quantity BTU's Per Unit Seer Rating Duct Systems: Total CFM REQUIRED FIRE PREVENTION Fire Sprinkler System Quantity (Requires 3 sets of plans) Fire Standpipe Quantity (Requires 3 sets of plans) Underground Fire Main Value (Requires 3 sets of plans) Fire Hose Cabinets Quantity (Requires 3 sets of plans) Commercial Hoods Quantity (Requires 3 sets of plans) Fire Suppression Systems Quantity (Requires 3 sets of plans) FIRE PLACES MISCELLANEOUS: Prefabricated Fireplace Qty Automobile Lifts Gas Piping Outlets Boilers BTU's Elevators/Escalators ALL OTHER GAS PIPING Heat Exchanger Quantity of Outlets Pumps # Vented Wall Furnaces Refrigerator Condenser BTU's # Water Heaters Solar Collection Systems Tanks (gallons) Wells OTHER: ?�nS4..11ln 02 , j nc, lL den- - - 110 &Atkrccyv Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for six months. I hereby certify that I have read this application and know the same to be true and correct. All provisions of laws and ordinances governing this work will be complied with whether specified or not. The permit does not give authority to violate the provisions of any other state or local law regulation construction or the performance of construction. D / 2: 1 \1 Property Owners Name ,,,U+v ROC J Phone Number 5q5-9 )S Mechanical Company /ail' bcce /fence s-qc, _Th54 Office Phone x.1,3 -V96.? Fax Co. Address: SF 3 Pv J EAsit L' City :Tax State R- Zip, a57 License Holder (Print): ReAc,(cf G J %�� State Certification/Registration # l'gcig•oa Notarized Signature of License Holder /.6--_- Sworn and subscribed befor me this al +‘..` day oof M 20 # DEBRA A. REN ZELL S gnature of Notary P 7 . I� e n �"2 C Comm DD 804100 1 Expires July 25, 2012 1,;;r w • 8adsdTMu Troy Fr instance l9o-385.7O19 r \Jy_ 0 CITY OF ATLANTIC BEACH ..c1 800 SEMINOLE ROAD !=>," ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5814 Application Number 11- 00001922 Date 5/24/11 Property Address 2102 BEACH AVE Application type description RESIDENTIAL ALTERATION Property Zoning TO BE UPDATED Application valuation . . . 60000 Application desc RENOVATE HALLWAY AND 2 BATHS Owner Contractor ROCHOW DONALD W OWNER 2102 BEACH AVE ATLANTIC BEACH FL 32233 Permit ELECTRICAL PERMIT Additional desc . WIRE ALT JOB Sub Contractor . KNIGHT ELECTRIC LLC Permit Fee . . . 68.20 Plan Check Fee . . .00 Issue Date . . . Valuation . . . . 0 Expiration Date . 11/20/11 Other Fees STATE ELEC DCA SURCHARGE 2.00 STATE ELEC DBPR SURCHARGE 2.00 Fee summary Charged Paid Credited Due Permit Fee Total 68.20 68.20 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.00 4.00 .00 .00 Grand Total 72.20 72.20 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. ELECTRICAL PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd, Atlantic Beach, FL 32233 Ph (904) 247 -5826 Fax (904) 247 -5845 JOB ADDRESS: ;2M,,2 ,,,,G, mi PERMIT # /1" /i JEA INFORMATION REQUIRED ON ALL PERMITS AMPS VOLTS PHASE VALUE OF WORK $ NEW SERVICE ❑ Overhead ❑ Underground nT Underground up Pole Residential (Main) Service ❑0 -100 amps ❑ 101- 150amps ❑ 151- 200amps ❑ amps # of Meters ❑ Commercial (Main) Service ❑ - 100 amps ❑ 101- 150amps ❑ 151- 200amps ❑ amps ❑ CT Service amps Conductor Type Size ❑ Multi - Family (Main) Service ❑ - 100 amps ❑ 101 150 amp s ❑ 151- 200amps ❑ amps # of Unit Meters ❑ Temporary Pole ❑ amps SERVICE UPGRADE L7 amps ❑ CT Service amps NEW FEEDER (ADDITIONS, ACCESSORY STRUCTURES, ETC.) [7100 amps ❑ 150amps 0200amps ❑ amps ❑ CT Service amps ADDITIONS, REMODELS, REPAIRS, BUILD -OUTS, ACCESSORY STRUCTURES, ETC. Outlets /Switches: / 0- 30amps 31- 100amps 101- 200amps Appliances: 0- 30amps 31- 100amps 101- 200amps A/C Circuits: 0- 60amps 61- 100amps Heat Circuits: # circuits @ kw� Number of Lighting Outlets, Including Fixtures: � OTHER ELECTRICAL PROJECTS ❑ Swimming Pool ❑ Sign ❑ Smoke Detectors Qty ❑ Transformers KVA ❑ Motors hp FIRE ALARM SYSTEM (Requires 3 sets of plans & Fire Alarm Checklist) Qty volts /amps VALUE OF WORK $ REPAIRS/MISCELLANEOUS ❑ Replace Burnt/Damaged Meter Can ❑ Safety Inspection ❑ Panel Change ❑ OH to UG Other: Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for six months. I hereby certify that I have read this application and know the same to be true and correct. All provisions of laws and ordinances governing this work will be complied with whether specified or not. The permit does not give authority to violate the provisions of any other state or local law regulation construction or the performance of construction. Property Owners Name l C Phone Number Electrical Company Kitt fk r C-- - LC- Office Phone .2 f 3F K Fax 7` f8 `i1 Co. Address: + / 0 1161' /WC ST Ci ty J State R. Zip 7225-1) 1 ' �e K �f License Hold ' �i * , . , 1 _ State Certification/Registration # +, ') g,o„f ,r� Notarized , v ii a r('ier ;: <.S wo and subscribed before , th'. da of 20 '--- Signature of Notary Public �� "l rt X11 � CITY OF ATLANTIC BEACH ' °� 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 ey, ` INSPECTION PHONE LINE 247 -5814 Alp. - on Number 11- 00002168 Date 6/08/11 Prnrarf y nddrQsc 2102 BEACH AVE RE number 169722 - 0400 -80 -A NCR OLD ACCOUNT NUMBERS . . Application type description MECHANICAL FIRE PERMIT Subdivision Name Property Use Property Zoning TO BE UPDATED Application valuation . . . 0 Owner Contractor ROCHOW DONALD W WAYNE AUTOMATIC FIRE SPRINKLER 2102 BEACH AVE HAZARD FIRE PROTECTION ENG ATLANTIC BEACH FL 32233 222 CAPITOL COURT OCOEE FL 34761 (904) 268 -3030 Permit MECHANICAL FIRE PERMIT Additional desc . Sub Contractor . WAYNE AUTOMATIC FIRE SPRINKLER Permit Fee . . . 85.00 Plan Check Fee . . .00 Issue Date . . . Valuation . . . . 0 Expiration Date . 6/08/11 Qty Unit Charge Per Extension BASE FEE 55.00 1.00 30.0000 EA M FIRE SPRKL 1ST 40 HEADS 30.00 Other Fees STATE MECH DCA SURCHARGE 2.00 STATE MECH DBPR SURCHARGE 2.00 Fee summary Charged Paid Credited Due Permit Fee Total 85.00 85.00 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.00 4.00 .00 .00 Grand Total 89.00 89.00 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. r City of Atlantic Beach APPLICATION NUMBER .c ,� Building Department (To be assigned by the Building Department.) t 800 Seminole Road ! /e0600 N- '" ' = s) Atlantic Beach, Florida 32233 -5445 / Phone (904) 247 -5826 • Fax (904) 247 -5845 /-.V/ _. 0 —119 %' V % / E -mail: building- dept @coab.us Date routed: (7 City web -site: http: / /www.coab.us / APPLICATION REVIEW AND TRACKING FORM Property Address: /i. �' Q () N /OE Department review required Yes No f;zi (Building Applicant: //u„g A � S- Planning & Zoning Tree Administrator Project: 4 I' 12) , e/-r 3/ 6.7 -- Works Public Utilities Public Safety Fire Services Reyieiit fee` V 4. H ,, r . Qept Sig! tune ; Ig, , _ s .11• F 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: APP 'ICATION STATUS Reviewing Department First Review: DiApproved. ❑Denied. (Circl ) Comments: BUILDING PLANNING & ZONING Reviewed by: r ` Date: 6 - 6 I( 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 07/27/10 MECHANICAL PERMIT APPLICATI CITY OF ATLANTIC BEACH '' -'- ------ 800 Seminole Rd Atlantic Beach, FL 32233 Ph (904) 247 -5826 Fax (904) 247 -5845 J ` " JOB ADDRESS: C. c,c\ f\vr v e B y , Tit PROJECT VALUE $ l 60(} , o0 NEW AIR CONDITIONING & HEATING SYSTEM INSTALLATION Air Conditioning: Unit Quantity Tons Per Unit Heat: Unit Quantity BTU's Per Unit Seer Rating Duct Systems: Total CFM REQUIRED REPLACEMENT AIR CONDITIONING & HEATING SYSTEM INSTALLATION ARI # Air Conditioning: Unit Quantity Tons Per Unit REQUIRED Heat: Unit Quantity BTU's Per Unit Seer Rating Duct Systems: Total CFM REQUIRED FIRE PREVENTION 15 ysVe M Fire Sprinkler System Quantity 6- Sp (Requires 3 sets of plans) Fire Standpipe Quantity (Requires 3 sets of plans) Underground Fire Main Value (Requires 3 sets of plans) Fire Hose Cabinets Quantity (Requires 3 sets of plans) Commercial Hoods Quantity (Requires 3 sets of plans) Fire Suppression Systems Quantity (Requires 3 sets of plans) FIRE PLACES MISCELLANEOUS: Prefabricated Fireplace Qty Automobile Lifts Gas Piping Outlets Boilers BTU's Elevators/Escalators ALL OTHER GAS PIPING Heat Exchanger / Quantity of Outlets Pumps 6 ( # Vented Wall Furnaces ` ' ' - °° , Refrigerator Condenser BTU's # Water Heaters AY Solar Collection Systems 861 2011 Tanks (gallons) 36/ Wells OTHER: Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for six months. I hereby c ify that I have read this application and know the same to be true and correct. All provisions of laws and ordinances governing this work will be complied w' h whether specified or not. The permit does not give authority to violate the provisions of any other state or local law regulation construction or the perfori once of construction. Property Owners Name 1�C,\ -,0vJ Phone Number (0,4.) Mechanical Company vA6t 't(S ) a-, - \c.,, Office Phone 6 Fakcl- \)2-07ZIA Co. Address: \ \? - 'cc�,■.)- 4.c,., Lt \\!..)e City -- 0,.c \2. , \ \t StateVL Zip ,S22-S License Holder (Print): cy, 0, \-\NA,r,. ate Certification/Registration # ` \ cs:o12,cc a, Notarized Signature of License Holder . SAMANTHA GON?ALES Sworn and subscribed before me is c)- a )' f a L' 20 < NOTARY PUBLIC 4 `; '_ STATE OF FLORIDA .4 � ; Comm# EE043T64 Signature of Notary Public "�? �i� 1 f 0,01 t 11 /R1/2614 t