Demolition Permit 366 10th St 2012 :� y ° CITY OF ATLANTIC BEACH ii, o J 800 SEMINOLE ROAD
;' - ATLANTIC BEACH, FL 32233
J INSPECTION PHONE LINE 247 -5814
Application Number 12- 00000469 Date 4/23/12
Property Address 366 10TH ST
Application type description DEMOLITION
Property Zoning TO BE UPDATED
Application valuation . . . 2000
Application desc
DEMOLISH SINGLE FAMILY DWELLING
Owner Contractor
CDK AB LLC ELITE HOMES INC.
CHRIS LAMBERTSON 357 12TH ST
357 12TH STREET ATLANTIC BEACH FL 32233
ATLANTIC BEACH FL 32233 (904) 349 -2803
Permit DEMOLITION PERMIT
Additional desc . DEMOLISH HOUSE
Permit Fee . . . 100.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 10/20/12
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
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
Job Address: 3L /6/ . Permit Number: /g 0
Legal Description Parcel #
Floor Area of Sq.Ft. Sq.r't
Valuation of Work $ a PD D Proposed Work heated /cooled non - heated /cooled
Class of Work (circle one): New Addition Alteration Repair Move emolitio poollspa window /door
Use of existing /proposed structure(s) (circle one): Commercial
If an existing structure, is a fire sprinkler system installed? (Circle one): Yes No N /A
Florida Product Approval #
For multiple products use product approva or m //
Describe in detail the type of work to be performed: o ha ✓..5
Property Owner Information:
Name: C D L- 4& 11 G C Address: 34'7 l PI
City 4 & State rt Zip ?Z 233Phone 3 t(f 2803
E -Mail or Fax # (Optional)
Contractor Information: � ��
Company Name: C /fl4 ' P5 Qualifying Agent: t�.� - 3 zz
Address: 36 / 7 e J:? City ,t6 State Zip 33
Office Phone , j y1 - 3 Job Site/ Contact Number Fax #
State Certification/Registration #
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 thu jurisdiction. This permit becomes null
and work void if o menced. understand that separate permits must be secured for suspended or
Plumbing, Si a Welis, Pools, x F u r nac e s, Boilers, time
Heat after
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 MEN BEFORE YOUR NOTICE OF
I hereby certify that I have read and examined this a placation 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 law regulating construction or the performance of construction.
Signature of Owner Signature of Contractor --
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Print Name Mt( 5 —. ' Print Name CAte 5
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Notary Pu `. '°; * EXPl�>rs. }pat] `, do ti „ , ': Notary Public ,,, ` .,} MY COMMISS # EE 057349
' -y Vii.. � = ed'Nu Wotan I'Utl u „,;,6:,;.„; 7� EXPIRES: May , 21 2015
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