Permit 330 Country Club Ln 12/2011 Demo CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 11-00003031 Date 12/22/11
Property Address . . . . . . 330 COUNTRY CLUB LN
Application type description DEMOLITION
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
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Application desc
demo home
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Owner Contractor
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PARKER LCB WORKS LLC
330 COUNTRY CLUB LANE
ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233
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Permit . . . . . . DEMOLITION PERMIT
Additional desc . .
Permit Fee . . . . 100 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 6/19/12
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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 100 . 00 100 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 104 . 00 104 . 00 . 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
IPL Permit Number:
Job Address: 3.10 co" LJJ0L_t,j
Legal Descriptio Floor Area of Sq.Ft. Parcel Sq.P't
Valuation of Work$ 6C)D Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move emolition 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 oneG): is o N/A
Florida Product Approval 4
For multiple products use product approval form
Describe in detail the type of work to be perfonned:. bP-mo eLr\S rtryNove ui%:s-kc%a k--vu'se Qrnek
1i _J
Property Owner Information:
Name:0-hip 0.4 �_k(4Ck_&XV�ej- Address: 211-3 S(Ir) 105e &VS S Wife 3 0 1
city -:T�CJY�(m. ffl&) StatA�Zip— POne CRA -q 3 8-3
E-Mail or Fax# (Optional.)._bar�e 620 PdAaLg c..exs'rQ,(- corv-,
Contractor Information:
Company Name: 1. " ?) Qualifying Agent:VkAwJoe Gck4&
C W0(_V%5.11LC_ -hartoon
Address- :2. 1211^- r'nAf1d
1--% 43 _% � 1, V, -City1F1_CK,50(\V,1 I Ic State FL- z i p
Office Phoneq 04--5011-0 33 3 Job Site/Contact Numberqoq-Ti 1-033.3 Fax#q j)A-14,X5- 11).p
State Certification/Registrat' n#
e
_5;ncN 6 .
Architect Name&Phon
Engineer's Name &Phone
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
A a, e e ade I lain a e I d he orl andin alai n a *nd ad e that no wor k or installation has commenced prior to the
f
nstructio n this jurisdiction. This permit becomes null
c " 0 ,aWeriod ofsixJ6)months at any time after
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'o k c f "ced de ta d h a ate e be sec d rEe ea k bn gn e Pools, urnaces, Boileis, Heaters,
o'. s
Tanks andAjr Con i loners,el,
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.
lhere certify that I have-ead and examined this application and know the same to be true and correct. Allprovisionso sandord* . cesgoverning this
iyo6 1�work will be complied with whether specified herein or not. The granting of a permit does not presume to ' e uthority late or cancel the
provisions ofany otherfederal,state, or local law regulating construction or the per/brmance of construction.
Signature of Owner ,A14 ignature of Co�17ctor
Print Nam-A Print Name
........ .......... ...�.a ................................ ..................................... .................................
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