Permit Pool 385 Garden Ln 2012 V CITY OF ATLANTIC BEACH
'fa 1114 0 T
800 SEMINOLE ROAD
' � ' " ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
4..1., ) ('� F
Application Number 12- 00000023 Date 1/17/12
Property Address 385 GARDEN LN
Application type description SWIMMING POOL /SPA
Property Zoning TO BE UPDATED
Application valuation . . . 33875
Application desc
pool- spa -paver deck
Owner Contractor
HINES MICHAEL E ET AL AND BLUE HAVEN POOLS & SPAS
HENFLING TIMOTHY J JJTORS 1/3 12041 BEACH BLVD
385 GARDEN LANE STE. 20
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32246
(904) 620 -0090
Permit SWIMMING POOL
Additional desc .
Permit Fee . . . 220.00 Plan Check Fee . . 110.00
Issue Date . . . Valuation . . . . 33875
Expiration Date . 7/15/12
Special Notes and Comments
*2007 FLORIDA BUILDING CODE W/2009 REVISIONS
NATIONA1 ELECTRIC CODE
REQUIRED INSPECTIONS:
*POOL STEEL
*ELECTRICAL GROUNDING AND BONDING
*FINAL (PUMPS MUST BE RUNNING FOR FINAL)
SWIMMING POOL SAFETY INSPECTION REQUIRED
Roll off container company must be on City approved list
and container cannot be placed on City right -of -way.
Contact Public Works (247 -5834) for Erosion and Sediment
Control Inspection prior to start of construction.
Roll off container company must be on City approved list
and container cannot be placed on City right -of -way.
Contact Public Works (247 -5834) for Erosion and Sediment
Control Inspection prior to the start of construction.
Other Fees STATE DCA SURCHARGE 3.30
DEV REVIEW - SINGLE & 2 -FAM 50.00
STATE DBPR SURCHARGE 3.30
Fee summary Charged Paid Credited Due
PERMIT ISBerzukiED Fee( WIQilladIRDANCE W F IJAIQ,Q'ITY OF A' A11 EACH ORDINAN€I 0 AND THE FLORIBJQ O
BUILDING CODES.
r �,. -�►�J J ,�x
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,j CITY OF ATLANTIC BEACH
4
s) 800 SEMINOLE ROAD
') t4r , , " ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
Page 2
Application Number 12- 00000023 Date 1/17/12
Plan Check Total 110.00 110.00 .00 .00
Other Fee Total 56.60 56.60 .00 .00
Grand Total 386.60 386.60 .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: 383— &t rc/& Lett e' Permit Number: / ` 00,27
Legal Description i. of " 3 Sej vet filar/ f 1 4, (--eg ( d e , Z Parcel # /72e20 -57206
,r Floor Area of .l~'t.
Valuation of Work $ ,3 3 i /, Proposed Work h /cooled n heated /cooled
Class of Work (circle one): New Addition Alteration Repair Move Demoli , . ..'� ' ow /door
Use of existing /proposed structure(s) (circle one): Commercial Residential /A r /1 # i Ill/
If an existing structure, is a fire sprinkler system installed? (Circle one): Yes No AN
Florida Product Approval # ,J 0 6
For multiple products use product approva orm ' ; ri
L
Describe in detail the type of work to be performed: " � , ,� ,�, B ,O
ahof sib-, wil4 pe vev deeL
eminin
Property Owner // G . Information:
Name: > I CA a e- f 141 lr1 es Address: 35'5 ( n
&✓ -.vt I.ah B -
City 1- Heti/ k r See e h StateZip 322 Phone ' 4'- 2 13 7
E -Mail or Fax # (Optional)
Contractor Information: / ,
Company Name: 4/ rteifict. h/8 7 /vClyd.✓( 0-- Qualifying Agent: iten.n e....1 1t. • 4 yid
Address: t3 it sit- Tdhn 5 l$ /u f f xet •s 0/0 7 City - tksarl v!/ /e- State f - Zip 3L z it '
Office Phone9D4f Z.0- 6 Job Site/ Contact Number -- - Fax # 9 V- 6 z - o Lo
State Certification /Registration # 1 - r; - - - --- <f •-�
Architect Name & Phone # 1 n►► , . i ' , : _ _ �l .t� ;'I
Engineer's Name & Phone # I . L i g ^ � _ i i IIIII Ill 1
Fee Simple Title Holder Name and Address 11 111= M M LA�:I Y - Y Cpl l� _ _
Bonding Company Name and Address j • _ • ' ADDITIONAL IMIHMENI .
Mortgage Lender Name and Address t
Application is hereby made to obtain a permit to do the wor • inst ations 1 .. i t iv� ^r l tq I as co `. � n * ' • .r . Ellie
issuance of a permit and that all work will be performed tom- - ----,------.-•:-:----....--.......
...... ;:! - .,.,... , .: ■ ' This ' in e 1
and void if work is not commenced within six (6) months, or if construction or work is suspende %or a•an. one. or ape • , i •• ': (6 mo ', a •
work is commenced. 1 understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, Furnac:•. ,Bode
Tanks and Air Conditioners, etc.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE -, ---- - - -.`
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPRO MEN
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
1 hereby certify that I have read and examined thisplication and know the same to be true and correct. All provisions of laws and ordinances governing this
type of work 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 la regulatin co struction or the performance of construction.
Signature of Owner ` -- " ---- 7 Signature of Contractor l2-
Print Name /N' e m4 f . 6. % /^':= Print Name 4 t: n/n0b17/ Al 7 v; •v ,- 7/1-
Sworn to and subsc 'bed befor� me Sworn to and subscribed before me
thisa9 Day of £ 'Ceiv1 , 20 11 this ! •f , r� -- A,,, -,.=. , 20 /(
Notary Public N. : Public
KENNETH M. QUINTAL 01.26.10
_ , . Commission # EE 146719 !ZIA*, P,� JAMES LOV �.. : Expires January 26, 2016 MY COMMISSION # DD 790149 eo�b,atmi r�yF.inrw.r�c.aoo7o1e EXPIRES: May 19, 2012
This Space Reserved for Clerk's Recording
` , " ri -7,7-
J f -cC2
NOTICE OF COMMENCEMENT
This Instrument Prepared by:
Name: North Florida Pools, Inc. DBA Blue Haven Pools & Spas
Address: 12041 Beach Blvd., Suite 20, Jacksonville, FL 32246 Telephone: 904 - 420 -0090 Fax No: 904 - 620 -0206
STATE OF FLORIDA COUNTY OF 'DV 1/et,/
Permit Number 1,. - 00 of 3 Tax Folio Number /72 D Lo -r ‘,
The Undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713,
Florida Statutes, the following information is provided in this Notice of Commencement.
1. Legal Description of property being improved:
Lot 3 Subdivision • r c , / ✓i- ki'l 44 Ca ✓Odeh / w0
Plat Book $g Page 3 9 County ev Val
Street Address 3$,-64 releot t _n e City, State, Zip 4 / ,L / • e 8ear> 3e
2. General Description of improvements:
In- ground Concrete Swimming Pool
3. Owner information: __ // _
Name(s) / f h 4 / fr/ 4 G
Mailing Address 385 aid t! . Cc et e_-- City, State, Zip 4am : G - - 3 43
Interest in Property: Fee Simple
Name and address of fee simple titleholder (if other than Owner): N/A
4. Contractor:
N,? Name: North Florida Pools, Inc. DBA Blue Haven Pools & Spas
Address: 12041 Beach Blvd., Suite 20, Jacksonville, FL 32246 Telephone: 904 -420 -0090 Fax No: 904 - 620 -0206
5. Surety:
Name and address: None Amount of bond: None
6. Lender:
Name _ pmemmipmergrrirmi
Mailing Address: mom
7. Person(s) within the State of Florida designated by Owner r .4 , ` A 0 1 • • . • i as
Ads ,
provided by Section 713.13(1)(a)7, Florida Statutes: Name, s ' u Il • ; N
_ 1 : w lnuaI}..sA ta■
ter
8. In addition to himself or herself, owner designates the folio in_ • 4 1 • : i . "*I ?(!
provided in Section 713.06(2)(b), Florida Statutes: Name, Adl ess :i • `
• ■ •
9. Expiration of Notice of Commencement.
(One (1) year from the date of recording unless a different date is specified)
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
COMMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13, FLORIDA
STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO
OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR
NOTICE OF COMMENC -NT.
X . //L 2 .` - 1 , Z D a
Si na ee o or Owne 's Authorized Officer/Director/Partner/Manager r/Di
g o d O ce rector /Partner/Manager Date
Signatory's Title /Office. Owner
The forgoing instrument was acknowledged before me this z `1 day of D e -cE - .tit BGr/L , t 0 / / ,
By ,K9 / C , 1 c.. E , /,t i N'E S as Owner
Name of Person Officer/Trustee /Attorney in Fact
For N/A .
Name of Party on Behalf of Whom Instrument was Executed
BLUE
H AVEN
Pens
This Space Reserved for Clerk's Recording
V PI ` ' 7 / NOTICE OF COMMENCEMENT
This Instrument Prepared by:
Name: North Florida Pools, Inc. DBA Blue Haven Pools & Spas
Address: 12041 Beach Blvd., Suite 20, Jacksonville, FL 32246 Telephone: 904 - 420 -0090 Fax No: 904 - 620 -0206
STATE OF FLORIDA COUNTY OF P(/ Y
Permit Number l,). - co ;l . T Tax Folio Number /72 O LO —rZo (o
The Undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713,
Florida Statutes, the following information is provided in this Notice of Commencement.
1. Legal Description of property being improved: n
Lot 3 Subdivision _SG f1 ✓A- 4 o.40 l4 4, C�a ✓ol eh 'Two
Plat Book 3g Page 31 County 4
Street Address 3$ " G 4 , , - d Got ( ah C— City, State, Zip 4¢ / 4 , ¢ 7 • e 8e i . 3e4,3
2. General Description of improvements:
In- ground Concrete Swimming Pool
3. Owner information.: // //
Name(s) /> s) % Ch Q ,/ 1�'/ /Z e
Mailing Address ,385' Ca, e k t - G'c ei c..- City, State, Zip j44/- : z f-Z 3 43
Interest in Property: Fee Simple
Name and address of fee simple titleholder (if other than Owner): N/A
()1{ Contractor:
INtA) Name: North Florida Pools, Inc. DBA Blue Haven Pools & Spas
Address: 12041 Beach Blvd.. Suite 20, Jacksonville, FL 32246 Telephone: 904 -420 -0090 Fax No: 904 - 620 -0206
5. Surety:
Name and address: None Amount of bond: None J B P Y 6. Lender:
Name THIS PLAN MUST BE
Mailing Address: s'T F
7. Person(s) within the State of Florida designated by Owner upon hom fc�s JoQ .` cJnrs ybe /''y ie� as
provided by Section 713.13(1)(a)7, Florida Statutes: Name, Addres & EA R :.
S. In addition to himself or herself, owner designates the following person to receive a copy of the Lienor's Notice as
provided in Section 713.06(2)(b), Florida Statutes: Name, Address & Phone
9. Expiration of Notice of Commencement.
(One (1) year from the date of recording unless a different date is specified)
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
COMMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13, FLORIDA
STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO
OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR
fir. " z
4 CITY OF ATLANTIC BEACH
r3 A 800 SEMINOLE ROAD
j :; ATLANTIC BEACH, FL 32233
Jr INSPECTION PHONE LINE 247 -5814
X 33�
Application Number 12- 00000023 Date 2/21/12
Property Address 385 GARDEN LN
Application type description SWIMMING POOL /SPA
Property Zoning TO BE UPDATED
Application valuation . . . 33875
Application desc
pool- spa -paver deck
Owner Contractor
HINES MICHAEL E ET AL AND BLUE HAVEN POOLS & SPAS
HENFLING TIMOTHY J JJTORS 1/3 12041 BEACH BLVD
385 GARDEN LANE STE. 20
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32246
(904) 620 -0090
Permit ELECTRICAL PERMIT
Additional desc . WIRE NEW POOL
Sub Contractor . OCEAN ELECTRICAL CO., INC.
Permit Fee . . . 95.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 8/19/12
Special Notes and Comments
*2007 FLORIDA BUILDING CODE W/2009 REVISIONS
NATIONA1 ELECTRIC CODE
REQUIRED INSPECTIONS:
*POOL STEEL
*ELECTRICAL GROUNDING AND BONDING
*FINAL (PUMPS MUST BE RUNNING FOR FINAL)
SWIMMING POOL SAFETY INSPECTION REQUIRED
Roll off container company must be on City approved list
and container cannot be placed on City right -of -way.
Contact Public Works (247 -5834) for Erosion and Sediment
Control Inspection prior to start of construction.
Roll off container company must be on City approved list
and container cannot be placed on City right -of -way.
Contact Public Works (247 -5834) for Erosion and Sediment
Control Inspection prior to the start of construction.
Other Fees STATE ELEC DCA SURCHARGE 2.00
STATE ELEC DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due n
PERMIT IS ' D WV iP"A � RDANCE WI1 1 AL'[.'ti1TY OF ATLAPCTIP %EACH ORDINANCES ° AND THE FLORID2 °
BUILDING CODES.
t
J
... , t.›, CITY OF ATLANTIC BEACH
l ,, 800 SEMINOLE ROAD
"ft 51
j
al
4'...--4,0119! ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
Page 2
Application Number 12- 00000023 Date 2/21/12
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 99.00 99.00 .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: BI S 6
/zit/ -f PERMIT .## 4= a.3
NEW SERVICE ❑ Overhead ❑ Underground ❑ Underground up Pole
❑Residential (Main) Service
00 -100 amps ❑ 101- 150amps ❑ 151- 200amps ❑ amps # of Meters
•
0 Commercial (Main) Service
00 -100 amps 0101- 150amps 0151- 200amps 0 'amps OCT Service amps
Conductor Type Size
❑Multi- Family (Main) Service
❑ 0 -100 amps ❑ 101- 150amps ❑ 151- 200amps ❑ amps # of Unit Meters
❑Temporary Pole 0 amps
SERVICE UPGRADE 0 amps ❑ CT Service amps
NEW FEEDER (ADDITIONS, ACCESSORY STRUCTURES, ETC.)
0100 amps 0150amps 0200amps 0 amps OCT 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:
OTHE ELECTRICAL PROJECTS
Swimming Pool 0 Sign ❑Smoke Detectors Qty ❑Transfonners 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 /,c / s Phone Number c2 !L '7_ 3 6
Electrical Company ,7 e'4 7 �'s �' �p / /,e_fC Office Phoneakf / /oZ Fax P "-ff'77P
Co. Address: /3773 /9 c-,4 9L &-/ 7 City State C
License Holder (Print): /Q /C4 State Certification/Registration # c-75e;e2�2/7
NOt r „,,,,Y P ,, /, JA S L .GRIZZARO
`' ” Notary Publ - State of Ftori and subscribed before me this o? 0 da f F-e 4 1 - cam / 20 / z--
e = Commission # EE X1005 Comm. Expires Sep 17, 20 5 /
1 �� AS` 5
` ;� — CC ature of Not Public ! G.e Y�
,,,,, :''` Bonded Through National Notary As h.
•
1
, CITY OF ATLANTIC BEACH
v 800 SEMINOLE ROAD
a* s) ATLANTIC BEACH, FL 32233
J;
INSPECTION PHONE LINE 247 -5814
9
Application Number 12- 00000023 Date 3/19/12
Property Address 385 GARDEN LN
Application type description SWIMMING POOL /SPA
Property Zoning TO BE UPDATED
Application valuation . . . 33875
Application desc
pool- spa -paver deck
Owner Contractor
HINES MICHAEL E ET AL AND BLUE HAVEN POOLS & SPAS
HENFLING TIMOTHY J JJTORS 1/3 12041 BEACH BLVD
385 GARDEN LANE STE. 20
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32246
(904) 620 -0090
Permit MECHANICAL GAS PIPE PERMIT
Additional desc .
Sub Contractor . FERRELLGAS L.P.
Permit Fee . . . 150.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 9/15/12
Special Notes and Comments
*2007 FLORIDA BUILDING CODE W/2009 REVISIONS
NATIONA1 ELECTRIC CODE
REQUIRED INSPECTIONS:
*POOL STEEL
*ELECTRICAL GROUNDING AND BONDING
*FINAL (PUMPS MUST BE RUNNING FOR FINAL)
SWIMMING POOL SAFETY INSPECTION REQUIRED
Roll off container company must be on City approved list
and container cannot be placed on City right -of -way.
Contact Public Works (247 -5834) for Erosion and Sediment
Control Inspection prior to start of construction.
Roll off container company must be on City approved list
and container cannot be placed on City right -of -way.
Contact Public Works (247 -5834) for Erosion and Sediment
Control Inspection prior to the start of construction.
Other Fees STATE MECH DCA SURCHARGE 2.25
STATE MECH DBPR SURCHARGE 2.25
Fee summary Charged Paid Credited Due
PERMIT IS i 6 DRL-Y IN wT"CIPA'LL OF A* TIC BEACH ORDINANCE'S ° AND THE FLORIf n °
BUILDING CODES.
r J
:.4
rY CITY OF ATLANTIC BEACH
^ ' - k J 800 SEMINOLE ROAD
j ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
Page 2
Application Number 12- 00000023 Date 3/19/12
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.50 4.50 .00 .00
Grand Total 154.50 154.50 .00 .0
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 2 ? )
JOB ADDRESS: 386' 69 flit/ cy ee4 PERMIT # Z
PROJECT VALUE $ J ba - eo ARI #
REQUIRED
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
Air Conditioning: Unit Quantity Tons Per Unit
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 L Pumps
# Vented Wall Furnaces Refrigerator Condenser BTU's
# Water Heaters Solar Collection Systems
Tanks (gallons) t - •
Wells
OTHER: /3U/Z o2rd 5 .a -1 /o-n -/,pi 4 ,4 c5 4969 4�L
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 , %tl e //title 5 Phone Number
Mechanical Company frr /t 4t5 Office Phone (9/- 3ij.UFax p2 c4
Co. Address: b 5 Vli 3 '� c'/ S. J /YU City 5A-f /iA State /7 Zip 3
License Holder (Print): , /Y) — `e S, e Certification/Registration # OD 'in
Notarize ', • • . • • License Holder' __ _
ti yp••"
; � u • • ••�:a ; . SHIRLEYL GRAHAM Q / %
_: :.1 MY COMM f t D D 957764 rn and subscribed befo i a t his t, �,. y o �12� l 20/2- =>•-�� o EXPIRES: February 14, 2014 I ,
b pd i a `' Bonded Thru Notary public Unde,wrif „ ature of Notary Public 1 .'`,/ l
A
rd k /46
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Ot p
CITY OF ATLANTIC BEACH
BUILDING AND ZONING DEPARTMENT
N SH IC JP
re 66
This building has been inspected and:
11 General Construction a Mechanical
17 Concrete and Masonry Electrical
Plumbing Gas Piping
IS NOT ACCEPTED
CORRECT AS NOTED BELOW, BEFORE ANY FURTHER WORK
P r / ct f &V L'fbc Jt se IT
5er 1 / frue c 4-e few / Ar
DO NOT RENLovE rills NOWDEE
Inspector: late: 3
Failure to respond to &Notice within 10 days will resit in this violation being forwarded
to the
C•DE ENFORCEMENT BOARD.
The posting of this Placard by its contents shall serve as due notice.