Permit Demoliton 176 16th St 2012 51 -=I'1
J ' s' CITY OF ATLANTIC BEACH
J r 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
3• INSPECTION PHONE LINE 247 -5814
Application Number
Property Address 12- 00000470 Date 4/23/12
176 16TH ST
Application type description DEMOLITION
Property Zoning
Application valuation . TO BE UPDATED • 0
Application desc
DEMOLISH SINGLE FAMILY DWELLING
Owner
Contractor
CDL AB LLC
CHRIS LAMBERTSON ELITE HOMES INC.
357 12TH ST 357 12TH ST
ATLANTIC BEACH ATLANTIC BEACH FL 32233
FL 32233 (904) 349 -2803
Permit DEMOLITION PERMIT
Additional desc . DEMOLISH HOME
Permit Fee . . . 100.00 Plan Check Fee
Issue Date 00
Expiration Date . . 10/20/12 Valuation 0
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 WIT1i ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
UMBNC 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: / 7 4. /6 '' ,'f f t�� Permit Number: / I 7 3
Legal Description Parcel # •
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work $ 'OOD Proposed Work heated /cooled non - heated /cooled
Class of Work (circle one): New Addition Alteration Repair Mov= Demolition cool /spa window /door
Use of existing /proposed structure(s) (circle one): Commercial ' esidential
If an existing structure, is a fire sprinkler system installed? (Circle one): - es 1 0 N /A
Florida Product Approval #
For multiple products use product approval form /
Describe in detail the type of work to be performed: P10,7 Gj•.uts ,�-
Property Owner Information:
Name: GPL A 1-1.-C- Address: 357 1 Z- ae f/ 'e.¢�
City State!C -Zip 3eZ3,3Phone 34 ZS°.3
E -Mail or Fax # (Optional)
Contractor Information:
Company Name: k �j u ie'5 . �,,t'c_ Qualifying Agent: Ck45 `.4
Address: 357 / Z' ,f 5i' City ,� 3 State re— Zip3233
Office Phone 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 this jurisdiction. This permit becomes null
and void if work is not commenced within six (6) months, or if construction or work is suspended or abandoned for a of six (6) months at any time after
work is commenced. I understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, F urnaces, Bo Heaters.
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 BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
/ hereby certify that I have read and examined this a plication 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 Contract��
Print Name &/ r'i 5 64 j?//5CX.� QA.1 Print Name (.l S C , 1S
Swoli subscribed bef. - me ' Z Sw d subscribed b; 'ore me c ol
this ay of , 20 ( this g; of , 204
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3.� A- ' EXPIRES: May 21, 2015 I ` . y EXPIRES: May 21, 2015
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