1220 Selva marina Cir (vault) CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5826
Application Number . . . . . 05-00030856 Date 7/29/05
Property Address . . . . . . 1220 SELVA MARINA CIR
Tenant nbr, name . . . . . . INSTALL DRAIN
Application description . . . PLUMBING ONLY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
Owner Contractor
------------------------ - -----------------------
FITZSIMMONS CHRISTY FIRST COAST PLUMBING
1220 SELVA MARINA CIRCLE P.O. BOX 50446
ATLANTIC BEACH FL 32233 JAX BEACH FL 32240
(904) 396-6706 (904) 247-4419
----------------------------------------------------------------------------
Permit PLUMBING PERMIT
Additional desc . .
Permit Fee . . . . 42 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Fee summary Charged - Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 42 . 00 42 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 42 . 00 42 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
1111,11C
Wfd
BUILDING OFFICIAL
CITY OF ATLANTIC BEACH
PLUMBING PERMIT APPLICATION
TLDate:
Property Address: 4�0 s1ha LLCiL
Owner: Telephone#:
Contractor: Telephone#:
Contractor Address: V250
Fax#:
Contractor Signature: '--p---�)4�-'a �ii�
In consideration of permit given for doing the work as described in the above statement,we hereby agree to perform said work in
accordance with the attached plans and specifications which are a part hereof and in accordance with the City of Atlantic Beach
ordinance and standards of good practice listed therein.
Installation of plumbing and fixtures must be in accordance with the most recent edition of the Southern Standard Plumbing
Code.
Plumbing Type: If other construction is being done on this building or site,
El New list the building permit number:
Q Re-Pipe
Number of Fixtures:
Bath Tubs Showers
Closets Shower Pans
Dishwashers Sinks
Disposals Urinals
Floor Drains Washing Machine
Lavatory Water
Sewer Water Heaters
Sprinkler System
Other
Fees
Permit Issuing Fee: $35.00
Total Fixtures: X$7.00 + $35.00
800 Seminole Road e Atlantic Beach, Florida 32233-5445
Phone: (904)247-SM- Fax: (904) 247-5845- hftp:ltwww.ci.atiantic-beach.fl.us
Revised 1/04
V:r,
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FLORIDA 32233
INSPECTION PHONE LINE 247-5826
Application Number . . . . . 04-00028518 Date 6/22/04
Property Address . . . . . . 1220 SELVA MARINA CIR
Tenant nbr, name . . . . . . HVAC
Application description . . . MECHANICAL ONLY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
Owner Contractor
------------------------ ------------------------
VASSONE, FRANK J DONOVAN HEATING & AIR
1220 SELVA MARINA CIRCLE 315 SIXTH AVENUE SOUTH
ATLANTIC BEACH FL 32233 JAX BEACH FL 32250
(904) 396-6706 (904) 241-3785
----------------------------------------------------------------------------
Permit MECHANICAL PERMIT
Additional desc . .
Permit Fee . . . . 87 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 87 . 00 87 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 87 . 00 87 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING
CODES.
BUILDING OFFICIAL
CITY OF ATLANTIC BEACH -
MECHANICAL PERMIT APPLICATION
Date: 61:�Z/a
Owner of Property: 71t��5'01-E , :To--�ItFtt�c
JobAddress: 12ZO jlelVq A'&OAA,
Contractor:
In consideration of permit given for doing the work as described in the above statement,we hereby agree to perform said work in
accordance with the attached plans and specifications which are a part hereofand in accordance with the City of Atlantic Beach
ordinances and standards ofgood practice listed therein.
III. GENERAL INFORMATION
A- Type of heating ffiel: B.
* Electric IS OTHER CONSTRUCTION BEIN(�L)ONE ON THIS
* Gas: —LP —Natural —Central Utility BUILDING OR SITE?
Q Oil
L1 Other-Specify_ IF YES,GIVE NUMBER OF CONSTRUCTION
PERMIT
IV.
MECHANICAL EQUIPMENT TO BE NATURE OF WORK
12 Residential or Commercial
INSTALLED Q New Building
(Provide complete list ofcompoDents on back ofthis form) 13 Existing Building
0 Heat _Space _Recessed <� —_FiWr 41F Replacement of existing system
LI Air Conditioning: Room (rentral--) El New Installation(No system previously installed)
C3 Duct System: Mnterial_Thicld�� 0 E-xiension or add-on to existing system
Maximum capacity_______---cfirn L] Other-Specify
0 Reffigeration
Ll Cooling tower. C4pacity
Cl Fire sprinklers: Numberofbeads THIS SPACE FOR OFFICE USE ONLY
• Elevator: — Minlift—Escalator_(Number) (Received)
• Gasoline pumps _(Number)
Ll Tanks _(Number) Remarks
0 LPG containers (Number)
0 Unfired pressure vessel Permit Approved by— Date_
El Boilers
13 Other-Speci Permit Fee
LIST ALL EQUIPMENT
AIR CONDITIONING AND REFRIGERATION EQUIPMENT
Number Units Description Model Number Manufacturer Cap—ty Approving
(Tons) Agency
HEATING-FURNACES,BOILERS,FIREPLACES
Number Units Description Model Number Manufacturer Capacity Approving
(BTU) Agency
��O'q4 14 4
TANKS
How Many Nominal Capacity Type Liquid Nameof Serial Approving
And Dimensions Contained Manufacturer No. Agency
800 Seminole Road 9 Atlantic Beach,Florida 32233-5445
Phone:(904)247-5800-Fix:(904)247-5845- http://www.cLatlantic-beactLfl.u3 1/14/03
3568
DEPARTMENT OF BUILDING
CITY OF ATLANTIC BEACH
----- PERMIT INFORMATION ------- -------- LOCATION INFORMATION ------ -
Permit Number: 3566 Address: 1220 SELVA MARINA CIRCLE
Permit Type: RE-ROOF ATLANTIC BEACH, FLORIDA 3223�3
Class of Work : ALTERATION ---------- LEGAL DESCRIPTION ---------
Constr. Type: WOOD FRAME Lot : Block: Section :
Proposed Use: SINGLE FAMILY Township: RNG: 0
Dwellings: I Code: 0 Subdivision; SELVA MARINA
Estimated Value; $0. 00
Improv. Cost : $0. 00
Total Fees: $22. 50
Amount Paid : $22. 50
Date Paid: 3/26/91
Work Desc. : RL,
OWNER INFORMATION ------ - ---- APPLICATION FEES -----
Name: TASS:)ONE PERMIT $22. 50
Address: 1220 SELVA MARINA CIRCLE WATER IMPACT FEE $0. 00
ATLANTIC BEACH, FLORIDA 3223, SEWER IMPACT FEE $0. 00
Phone: (904)641 -0330 WATER METER $0. 00
RADON GAS-H. R. S. $0. 00
CONTRACTOR INFORMATION RADON GAS 5% $0. 00
Name: DUVAL ROOFING COMPANY WATER TAP $0. 00
Address: 2759 ST. JOHNS BLUFF ROAD SEWER TAP $0. 00
JACKSONVILLE, FL 32216 HYDRAULIC SHARE 1$0. 00
License: CCC044053 Type: 0 RE-INSPECT FEE $0. 00
SEC. H IMPACT FEE $0. 00
OTHER $0. 00
NOTES:
NOTICE —ALL CONCRETE FORMS AND FOOTINGS MUST BE INSPECTED BEFORE POURING
PERMIT VOID SIX MONTHS AFTER DATE OF ISSUE
BUILDING MATERIAL, RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC SPACE,AND MUST BE
CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER
"FAILURE TO COMPLY WITH THE MECHANICS' LIEN LAW CAN RESULT IN
THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS.55
ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR
VIOLATION OF APPLICABLE PROVISIONS OF LAW. �64�Vc ILi
CWK:FE
ATLANTIC BEACH BUILDING DEPARTMENT
By:
CITY OF ATLANTIC BEACH
PERMIT APPLICATION ROOFING
Owner(s) :
Address: 'S�-_ i uc� oc� C -Phone:
Lot # Block or Unit # Subdivision
Contractor: -
Address: Phone:
State License No. CC_CnLA40 -5)-,1 3 �.
Describe work to be done:
Materials to be used:
Signature OWNER:- Date:
Signature CONTRACTOR:,
CITY OF
yq&4ft4-C 1&t d- 6
Office of Building Official
REQUEST FOR INSPECTION
Date/0-,2 k 3
Permit No.
Time
Received District No.
J&
Owner's Job Address Locality
Name Contracto*-//em&ztq-4
BUILDING CONCRETE ELECTRICAL VLUMBING MECHANICAL
Framing 0 Footing L1 RoughWiring Rough 0 Air.Cond.& 0
Re Roofing 0 Slab 0 Temp Pole 1:1 Top Out El Heating
Lintel E) Fire Piece
Pre Fab
READY FOR INSPECTION
A.M.
Tues. Wed. Thurs. Friday—P.M.
Inspection Made A.M.
P.M.
Inspector Final Inspection 0
Certificate of Occupancy
Date
CITY (-.IJF- ATl-',,'%l` flC BEACH,
"IL(-T' ICAL P E V, . ,'T
19
E Cf; L E 1,;T P I CA L I N'-'P E CTO R: C;',TIE:—Z!��
:'T
Cl-�NSIDERAT;ON OF PERMIT GIVEN FOR DOING THE VtfORK AS DE-- �BED IN THE FOLLC
3Y AGREE TO PERFORM SAID WORK IN ACCORDANCE WITH THE ATTAC'P'E-:) PLANS AND ST'-`
ARE A P,,,RT HEREOF, AND IN ACCORDANCE WITH HE ELECTR!CAL R—rl'!ATIONS, CODES CITY vic
-1c BEACH, ORDIN?`�NCES.
MASTER E
�-F
co"Am. FW�LIC [�'Dus. NE6
sa. FT.
FEE
SEi:'�V. SQ E
A Y
FEECIERS %0. F!2E 0. S17E
LlG'h7"G 0JTLETS CONCEALEDI i IOTAL
0 EN
F! CEPTACLES CONCEALEDI 31-I.CC AJAPS. TO-iAL J--
0.30 1-imps
5 4",i T"CH Es
?�,�-,AY�IESCENT
7-LUCRESCENT &�M.V.
Fl --ER
IXED 0
APP;-IANCES ELL TRANSF.
A's R H.P. RATING li.P. RATING
CONDITIONING COMP.tv"OTOR OTHER 100TORS AlW.PS %lEIL HEAT:: KW-HEAT
0-1 OVER
H.P VOLTAGE PHS NO. I H.P. VOLTAGE PHS
fl�%)70RS-
ELLANEOUS
TR S F R- �,'F P S: UNDER 600V. Ov'ER 600 V.
INO. KVA A
0 N T P. F. N 0. "'A' *OTOR SIZE FLASHE
S CH SIGN
R D E D
! s
c;
DEPARTMENT OF BUILDING rud' 7
CITY OF ATLANTIC BEACH,FLORIDA PER IT'NO.
M
1 1 U I 0/i i
PERMIT TO BUILD
I GNU
THIS PERMIT MUST BE POSTED ON JOB
Date 10/18 19—L!
I'MCHANICAL Fee$ 42. 00
This permit not valid until above fee has been paid to City Treasurer,and is
subject to reVGC2tion for violation of applicable provisions of law.
This is to certify that LES ' S HEATING & AIR CONDITIONING -
FT
2443 JERNIGAN ROAD JACKSONVIELL, 32207
has permission to I ' 7- 1 — I
AS PLE PTANR
RESIDENTIAL PUD
Classification Zone
Ownedby 14R. TASSONL
Lot Block S/D
House No. 199() q1"T JJA- 14ARTI�x CIR-C! E
According to approved plans which are part of this permit
NOTICE—ALL CONCRETE FORMS
AND FOOTINGS MUST BE IN-
SPECTED BEFORE POURING.
PERMIT VOID SIX MONTHS
-n AFTER DATE OF ISSUE
;0
4— P 0 Building material, rubbish and debris
ZA from this work must not be placed
in public space, and must be cleared
UD--;agd_hauled away by either con-
'trair' owner.
Building Official.
FOR OFFICE PERMIT DATE CONTRACTOR
USE ONLY NUMBER
PLUMBING
ELECTRICAL
SEWER
WATER
BUILDING AND ZONING INSPECTION DIVISION
CITY OF JACKSONVILLE, FLORIDA
APPLICATION FOR MECHANICAL PERMIT q:'�,C6
IMPORTANT — Applicant to complete all items in sections 1, 11, 111, and IV.
LOCATION Street Address:
OF Intersecting Streets: Between '017-1- And CA-
BUILDING Sub-division
11. IDENTIFICATION — To be completed by all applicants
[n consideration of permit given for doing the work as described in the above statement we hereby agree to perform said work in accordance
with the attached plans and specifications which are a part hereof and in accordance with the City of Jacksonville ordinances and standards
of good practice listed therein.
Name of Mechanical Contractors
Contractor (Print) Master
Name of
Property Owner 7�
Signature of Owner Signature of
or Authorized Agent Architect or Engineer
Ill. GENERAL INFORMATION
A. Type of heating fuel: B.
IS OTHER CONSTRUCTION BEING DONE ON-
0 Electric THIS BUILDING OR SITE?
[I Gas LP [I Natural Central Utility
IF YES, GIVE NUMBER OF CONSTRUCTION
0 Oil PERMIT
116 Other Specify 1-t -I--).
IV. MECHANICAL EQUIPMENT TO BE INSTALLED NATURE OF WORK
(Provide complete list of components on back of this form) 0 Now Building
C� Furnace: 0 Spec* 0 Recessed k Central 0 Floor tA Existing Building
1P Air Conditioning: [] Room )9 Control 0 Replacement of existing system
Duct System: Materii�'A/d A'Oe—Thicknost-- Now installation (No system previously installed)
Maximum capacity I%C_24:2 c.f.m. 0 Extension or add-on to existing system.
0 Refrigeration 0 Other—Specify
0 Cooling tower Capacity 9-P.M.
[] Fire sprinklers: Number of head-
C] Elevator [:] Manlift 0 Escalato (number) THIS SPACE FOR OFFICE USE ONLY
D Gasoline pump, (number) (Roceived)
Tanks .(number) APPROVED Remarks
C ITY 01' A 1-1-1N 71C BEA C I
El LPG containe .(number) BUILIDI'�q
G OFiricE
C] Unfired pressure vessel
0 Boilers OCT 17 1983 Permit Approved b Da
0 Other — Specify Permit Fee—
LIST ALL EQUIPMENT
AIR CONDITIONING AND REFRYGERATION EQUIPMENT
Capacity Approving
Number Units Description Model Number Manufacturer (Tons) Agency
HEATING - FURNACES, BOILERS, FIREPLACES
Capacity Approving
Number Units Description Model Number Manufacturer (Irru) AVMCY
/3 14- e
TANKS
How Many Nominal Capacity Type LUjuid Name of Serial Approving
and Dimensions Contained Manufacturer No. Agency
PS-428
5577
DEPARTMENT OF BUILDING
CITY OF ATLANTIC BEACH
----- PERMIT INFORMATION --- - LOCATIUN INFORNATIUN ---------
Permit Number: 5577 Address: 1220 SELVA MARINA DRIVE
Permit Type: PLUMBING ATLANTIC BEACH, FLORIDA 32233
Class of Work: REPAIR LEGAL DESCRIPTION ----------
Constr. Type: WOOD FRAME Lot : Block : Section:
Proposed Use: SINGLE FAMILY Township: RNG* 0
Dwellings: I Code: 0 Subdivision: SELVA MARINA
Estimated Value: $0. 00
Improv. Cost: $0. 00
Total Fet,-:, � $15. 00
Amount -*aid : $15. 00
RFPIA( FMFNT
OWNER INFORMATION ---- APPLICATION FEES -----
Nome: PROPERTY OWNER PERMIT $15. 00
"id( t"!"
1220 c3ELVA MARINA DRIVE WATER IMPACT FEE $0. 00
ATLhNTIG BRACH, FLORIDA 32'
SEWER InPACT FEE $0. 00
(90,1 )727-7008 WATER METER $0. 00
RADON GAS-H. R. S. $0. 00
G0141"PACTOR INFORMATION RADON GAS - 5% $0. 00
Name; ECUNO ROOTER WATER TAP $0. 00
Address: 9020 COCOA AVE SEWER TAP $0. 00
JACKSONVILLE, FL 3221i HYDRAULIC SHARE $0. 00
License: Type: 0 RE-INSPECT FEE SO. 00
SEC. H IMPACT FEE $0. 00
OTHER $0. 00
NOTES:
-3 ` 5�3
NOTICE —ALL CONCRETE FORMS AND FOOTINGS MUST BE INSPECTED BEFORE POURING
PERMIT VOID SIX MONTHS AFTER DATE OF ISSUE
BUILDING MATERIAL, RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC SPACE,AND MUST BE
CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER
"FAILURE TO COMPLY WITH THE MECHANICS' LIEN LAW CAN RESULT IN
THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS.99
ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR
VIOLATION OF APPLICABLE PROVISIONS OF LAW.
ATLANTIC BEACH BUILDING DEPARTMENT
By:
CITY OF ATLANTIC BEACH
APPLICATION FOR PLUMBING PERMIT
JOB LOCATION:
�04
PLUMBING CONTRACTOR:
LICENSE NUMBER:
OWNER:
BUILDING CONTRACTOR:
TYPE OF BUILDING:
SINKS SHOWERS
LAVATORY WATER HEATERS
BATH TUBS DISHWASHERS
URINALS DISPOSALS
CLOSETS MA
WASHING CHINE
FLOOR DRAINS
TOTAL FIXTURE COUNT: + $15.00
-------------------------------------------------------------------------------
INSTALLATION OF PLUMBING AND FIXTURES MUST BE IN ACCORDANCE WITH THE MOST
RECENT EDITION OF THE SOUT�ERN STANDARD PLUMBING CODE.
CITY OF ATLANTIC BEACH
BUILDING AND ZONING
800 SEMINOLE ROAD
ATLANTIC BEACH FLORIDA 32233
INSPECTION PHONE LINE 904-247-5826
Application Number . . . . . 02-00024778 Date 9/18/02
Property Address . . . . . . 1220 SELVA MARINA CIR
Application description . . . F
Property Zoning 0 TED
00
Application valua
A*ft
Owner on rracto'r
----------- -- --
-- -------------
E,
VASSONE, F� K J CLAUDE " MERRITT & SONS
1220 SELV.�. MARINA CIRCLE 3644 PHILLIPS HIGHWAY
ATLANTI$�' BEACH FL 32233 JACKSONVILLE FL 32207
(904) 1,39�6-67061 (904) 398-8537
------ Structure Info=ation RFROOF
--- -------- ------------
-------- ------------ - - - ----------- -------------
Pe=t -BUILDING PERMIT
'tional desc —
Addi.
Permit Fee 17 . 50 Plan Check Fee 7 .50
issue Date �- Valuation . . . . . 900
Fee summary Charged - Paid Credited bhe
--------------- -- -- -------- - - - - - - -- -- - - - - - - - --- ----------
.��,,Fee Total 17 .50 17 . 50 . 00 . 00
PAn -'Check 7 . 50 7 . 50 .00 . 00
Gr al 25 . 00 25 . 00 . 00 . 00
A 7
01,
BUILDING MATERIAL,RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC SPACE,AND
MUST BE CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER. "FAILURE TO COMPLY WITH
THE CONSTRUCTION LIEN LAW CAN RESULT IN THE PROPERTY OWNER PAYING TWICE FOR BUILDING
IMPR
,QVEMENTS"ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO
REZION FOR rLATI01 PROVISIONS OF LAW.
BUILDING OFFICIAL
��? ,rc__
CITY OF ATLANTIC BEACH PERMIT CALCULATION SHEET
AddressA Z 7 0 SOW& t11AA1-ra0 4�)r C�A
Date (4 .
Heated Square Footage _@ $t Ltf Der sq ft = $
k4 I/V --
Garage/Shed $ per sq ft = $
p
Carport/Porch @ er sq ft = $
Deck @ $_per sq f t = $
Patio -@ $_per sq f t = $
TOTAL VALUATION : $
Co . /��N $
Total Valuation 1st $
D - $
Remaining Value $�'. per thousand
or portion thereof
TOTAL BUILDING FEE $
+ 1/2 Filing Fee $
( ) Fireplaces @ $15 . 00 $
BUILDING PERMIT FEE $
WATER IMPACT FEE $
SEWER IMPACT FEE $
WATER METER/TAP $
CAPITAL IMPROVEMENT. $
SEWER TAP $
) RADON (HRS) . 0050 $
SECTION H PAVING $
HYDRAULIC SHARES $
CROSS CONNECTION $
) SURCHARGE . 0050 $
OTHER $
GRAND TOTAL DUE $
ADDITIONAL PERMITS OR FEES : Mechanical Plumbing
Electric/New Electric/Temp_; SwimmingPool
Septic Tank well-; Sign Finish Floor Elevation
Survey Other
CALCULATIONS and/or NOTES:
Ep I n qnnq
CitY of Atlantic Beach
Building and Zoning
City of Atlantic Beach 800 Seminole Road -Atlantic Beach, Florida 32233-5445
Phone: (904)247-5800 FAX (904)247-5805 9 http://www/ci.atlantic-beach.fl.us
PERMIT APPLICATION FOR ROOFING
JOB LOCATION—! S VOL NCW/IY-- C; -)0(0
L
OWNER OF PROPERTY '�!q 5SOnnIe PHONE#
CONTRACTOR � jakdf Oq-r 14
CONTRACTOR ADDRESS 19 30 j�i v/ 074 s ed
3Z 2-0 —ZIP
CONTRACTORS LICENSE NO. PHONE#
shl n lf�
SCOPE OF woRKkenlaei n5 -D kr oar
Ll
DECK SLOPE GREATER THAN 2 : 12 LESS THAN 2 : 12
VALUATION OF WORK s
PRODUCT NAME & MATERIAL
TOBEUSED ASTM DESIGNATIQN(S) _-30 6 0 5 1(�p
REQUIRED INSPECTIONS SHEATHING FINAL
APPROVED
LIBILITY INSURANCE POLICY SUPPLIED YES NO CITY OF ATLANTIC BEACH
BUILDING OFFICE
WORKERS CONP. POLICY SUPPLIED YES NO SEP 2002
CONTRACTOR LICENSE SUPPLIED YES 0
13Y.
OCCUPATIONAL LICENSE SUPPLIED YES NO
SIGNATURE OF OWNER
SIGNATURE OF CONTRA2OR
SWORN TO& SUBSCRIBED BEFORE ME THIS DAY OF 2002-
MYCOMMISSiONf !)%83986 EXPIRES
January 14,2006
AS TO OWNER �)P&& NOTARY PUBLIC 1411,-N.01" BONDED TKRU TRM FAIN INIVRAWA ft
meow marrift
MyCOMMISSION# DW83986 EXPIRES
January 14,2W6
ANC�INC
AS TO CONTRACT(?N,&, NOTARY PUBLIC "DEDTHRU TROY FA*@"
CITY OF,
4&4w4c BeacJz-4V&UAZ
Office of Building Official
REQUEST FOR INSPECTION
Date Permit No.
Time A.M.
Received P.M. District N
-�7 - y
Job Address Locality
Owner's
Name Contractor
;" X
BUILDING CONCRETE ELECTRICAL (!!�L U M B—I NG MECHANICAL
Framing 0 Footing 0 Rough Wiring El --Rou-g-?r'�E) Air.Cond.& Cl
Re Roofing 1:1 Slab 0 Temp Pole E, Top Out 0 Heating
Fire Place 0
Lintel 0 Pre Fab
READY FOR IN4PECTION A.M.
Mon. Thurs. zz�\ Frida
V A.M.
Inspection Made im P. -3
Inspector RERREP, inal Inspection El
Certificate of Occupancy
Date