Permit Siding 1842 Hickory Ln 2012 r CITY OF ATLANTIC BEACH
s3 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12-00000653 Date 5/30/12
Property Address . . . . . . 1842 HICKORY LN
Application type description SIDING PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 1900
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Application desc
SIDING
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Owner Contractor
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DOWLING SHIRLEY M TRUST BUILDING DYNAMICS INC.
1 FLEET LANDING BLVD 33 FAIRWAY LANE
ATLANTIC BEACH FL 32233 JAX BEACH FL 32250
(904) 813-4890
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Permit . . . . . . SIDING PERMIT
Additional desc . .
Permit Fee . . . . 60 . 00 Plan Check Fee 30 . 00
Issue Date Valuation . . . . 1900
Expiration Date . . 11/26/12
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Special Notes and Comments
2010 FLORIDA BUILDING CODE, 2008 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 60 . 00 60 . 00 . 00 . 00
Plan Check Total 30 . 00 30 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 94 . 00 94 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITV of ATI,ANTIC` RF,AC 14
800 Seminole Road, Atlantic Beach, FL 32233
Office(904)247-5826 Fax(904)247-5845
Job Address: /Sry2- ' tG�o� Lct z�- 1�0��� �i�� 32233 Permit Number: /) —65 3
Legal Description ;! 7 of -a 57 -29,0' Ak/,-vi. CP.z. parcel#
Floor Area ot
Valuation of Work$ /fO�O.O G Proposed Work heated/cooled Q heated/cooled
Class of Work(circle one): New Addition Alteration a ai Move Demolition pool/spa window/door
Use of existing/proposed structure(s)((circle one): Commercial ide �
If an existing structure,is a fire sprm)kler system installed?(Circle one): es No N/A
Florida Product Approval#
For multiple products use product approval form
Describe in detail the type of work to be performed:_,ice Lj r,
Property Owner Information:
Name: wl /l /��� lshi�it�ll�r;,,�" Z'''�Address: �'J6 Iq� S1 -JC.,f 1A
City_, f1 c �� / State dip Phone 3- SO 5`J1
E-Mail or Fax#(Optional)
Cantrartnr Information! �
Company Name:_ 3Cc 1° t*7 Qualifying Agent:
Address:_ . fz61,wqyy 4-7L City Jl -�.,& State ,--- Ziv 322SG
Office Phone Soy l3-WF6 Job Site/Conta a Fax# >- Z y�pZo
State Certification/Registration# C, z SCS s S+?
Architect Name&Phone# FOR CODE COMPLIANCE
Engineer's Name&Phone# e 1
Fee Simple Title Holder Name d Address S f
Bonding Companv Name and Address REQUIREMENTS AND CONDITIONS. t
Mortgage Lender Name and Address
=M�ys,
�Application is hereby made to obtain a permit to do the work and i wwork o' m d rior to e
issuance ofa permit and that all work will be pe ormed to meet the standards of alegu''ann pe" t b n
and void if work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a period o° nt arty tim a r
work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs, Wells,Pools, urnaces, let
Tanks and Air Conditioners,eta
e
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OIC
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPRO
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH
VOUR LENDER OR AN ATTORNEY BEFORE RECORDING VOITR NOTICE OF
COMMENCEMENT.
I herecertify that I have read and examined this l
a pication and know the same to be true and correct. All provisions of laws and ordinances governing this
type o1work will be complied with whether spect ted herein or not. The granting of a permit does notanresume to give authority to violate or cancel the
provisions of any other federal,state, or local law regulating construction or the performance of construction.
I
Signature of Owner r/ Signature of Contractor Print Name TAIL �I.O M..........�.........../../.mow/, Print Name � 7 YG-�.�"�.........................
................................... -... .. . ....... ... ...................................:
.................................
Sworn to and subscribed before me Sworre�,, subscribed bef r me
this 0� Day of (y'Y_;�.i-j 20 this 20/
f
DEQ
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Notary Publtc WEflQS'FITC}1$--
Not PU 1�, RE
ay 21 0 1 s
n E Notary Public-state of Florida T ota ublie erwrl�er;
_• •• My Comm.Expires Dec 8,2014
evr. 7,6.1 0
Commission Ai EE 47968
Bonded Through National Notary Asia.
City of Atlantic Beach APPLICATION NUMBER
Seminole Road
Building Department (ro be assigned by the Building Department.)
800
Atlantic Beach, Florida 32233-5445 J
Phone(904)247-5826 • Fax(904)247-5845
E-mail: building-dept@coab.us Date routed: �ZS fy
City web-site: http:/AwAy.eoab.ua
APPLICATION REVIEW AND TRACKING FORM
Property Address: Z G6'e (./IW De ent review required Y No
Building
Applicant: �/ a Planning&Zoning
Tree Administrator
Project: "yt Public Works
Public Utilities
Public Safety
Fire Services
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified B
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: pproved. ❑Denied.
(Circle one.) � Comments:
BUILDI
PLANNING&ZONING Reviewed by: Date: 5-c9.5`12-
4
TREE
'o9S/Z--
TREE ADMIN. Second Review-
❑Approved as revised. [:3014ied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: [—]Approved as revised. ❑Denied.
Comments:
Reviewed by: Dom:
Revised 07m110