Permit Siding & Repairs 33 Lewis 2011 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 11-00002936 Date 11/30/11
Property Address . . . . . . 33 LEWIS ST
Application type description RESIDENTIAL OTHER
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 929
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Application desc
siding, window and door repair
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Owner Contractor
------------------------ ------------------------
HILL, LINDA FAYE BEACHES HABITAT
1671 FRANCIS AVENUE
ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233
(904) 241-1222
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Permit . . . . . . RESIDENTIAL ALT/OTHER
Additional desc . .
Permit Fee . . . . 55 . 00 Plan Check Fee 27 . 50
Issue Date . . . . Valuation . . . . 929
Expiration Date . . 5/28/12
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Special Notes and Comments
*2007 FLORIDA BUILDING CODE W/2009 REVISIONS
NATIONAL ELECTRIC CODE
*REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING
DEPARTMENT IMMEDIATELY.
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Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 55 . 00 55 . 00 . 00 . 00
Plan Check Total 27 . 50 27 . 50 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 86 . 50 86 . 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: 3 3 �` eli'is �7'�e�?" /�T,�aH1`r� 1e/lcA. Permit Number:
Legal Description Parcel#
Floor Area o q. t. q. t
Valuation of Work S 9"�S. �O 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 structures)(circle one):. Commercial esidential
If an existing structure,is a fire sprinkler system installed? (Circle one): es o N/A
Florida Product Approval#
For multiple products use product approval form
Describe in detail the type of work to be performed: Reltac-e RoTTe-o T-lt/
��t�r�, p`�l'��Q•t-•�A}i1►7- hrGNT' 1�06G� ^ ��/�A�R I��RI.I/nJc Wi►+ OGt,�s /+t5 pec>/9eO-
Property Owner Information:
Name: L 1) • /-/t 1/ Address:
City 047-J_,4H),('c Q3oAch State�LZip_323 Phone 8
7,2 9- 94��
E-Mail or Fax# (Optional)
Contractor Information:
Company Name: 13PAc)ei 1=-2 119,*, H, t Qualifying Agent: , p),,4e 906-01
Address: 14YI -i,ANti p e Citv gP,4-eti State l� Zip32233
Office Phone q f•,2y/ / - Job Site/Co mer r A'A M•. ..
State Certification/Registration# 5F� M
Architect Name &Phone# t +'
Engineer's Name &Phone#
Fee Simple Title Holder Name and Address REQUIREMENTS
Bonding Company Name and Address
Mortgage Lender Name and Address BY: . -I3-
Application is hereby made to obtain a permit to do the work and installations as indicated. certify that no w(r or ins s co n r the
issuance of a permit and that all work wall be performed to meet the standards of al[laws regulating construction in this jurisdiction. This]7 mme 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 6)mock alma•a,}i'er
work is commenced. I understand that separate permits must be secured for Electrica Work,Plumbing,Signs, Wells, Pools, urnaclstoBoilet4Ys,
Tanks and Air Conditioners,etc.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE
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 hereb certify that 1 have read and examined this a plication and know the same to be true and correct. All provisions o,f laws and ordinances governing this
type of work will be complied with whether sped aid herein or not. The granting of a permit does not presume to gave authority to violate or cancel the
provisions of any other federal,state, or local law regulating construction or the performance of construction.
r
Signature of Owner dam- Signature of Contractor
Print Name `-i.f11Sa........ .!....I.... .................................................................... Print Name 41..R...M!.c.
I1.......... .......................................
Sworn to and subscribed beforg me Sworn to and subscribed before me
this; �Day of No e-m ►J' e p_ 201 1 this;? N Day of N D UG+»bieP_ 20 1
of ry Public �'_ Notary Public-State of Florida to ublic �
JOYCE M FREEMAN
,ti'Ry Pu4
y "My Comm.Expires Jun 10,2013 e�;. J Y MAN
% �o���.•°�+
Commission#a DD 897794 I�' "° elYdF�fi � of Florida
®y0-° My Comm.Expires Jun 10,2013
''o,' oFf�d;` Commission#t DD 897794
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
SS
800 Seminole Road
Atlantic Beach, Florida 32233-5445 ` •l
Phone(904)247-5826 • Fax(904) 247-5845
E-mail: building-dept@coab.us Date routed: Z
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: � Lo/_5 'X� ent review required Yes No
Building
Applicant: a/ _f 7_517 ng &Zoning
Tree Administrator
Project: Public— !t_/�/V Leo(,c� Public Works
Public Utilities
y Public Safety
Fire Services
Review fee $ Dept Signature
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:
BUILDIN
PLANNING &ZONING Reviewed by: Date:_'&:,2
Of
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