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705 Atlantic Blvd (book store) 2012 repairs CITY OF ATLANTIC BEACH j 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 12-00001627 Date 11/07/12 Property Address . . . . . . 705 ATLANTIC BLVD Application type description COMMERCIAL ALTERATION Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 18000 ---------------------------------------------------------------------------- Application desc general interior repair ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ DORSCH SALTAIR PROPERTIES LLC ANTHONY GENERAL CONTRACTORS 2517 HOLLY POINT RD E 596 ABERDEEN CT ORANGE PARK FL 320735632 ORANGE PARK FL 32073 (904) 655-9922 --- Structure Information 000 000 INTERIOR REMODEL ADA BATH Occupancy Type . . . . . . BUSINESS ---------------------------------------------------------------------------- Permit . . . . . . W/W/O BUILDING PERMIT Additional desc . . Permit Fee . . . . 280 . 00 Plan Check Fee 140 . 00 Issue Date . . . . Valuation . . . . 18000 Expiration Date . . 5/06/13 ---------------------------------------------------------------------------- Special Notes and Comments 2010 FLORIDA BUILDING CODE, FLORIDA FIRE PREVENTION CODE 2008 NATIONAL ELECTRIC CODE ---------------------------------------------------------------------------- Other Fees . . . . . . . . . STATE DCA SURCHARGE 4 . 20 STATE DBPR SURCHARGE 4 . 20 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 280 . 00 280 . 00 . 00 . 00 Plan Check Total 140 . 00 140 . 00 . 00 . 00 Other Fee Total 8 . 40 8 . 40 . 00 . 00 Grand Total 428 . 40 428 . 40 . 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 DID e 5- f2 7 Pc24?0247-5826 Fax(904)247-5845 Job Address: `, 4T-A kJ4C Ad) Permit Number: r) ` 16d 7 Legal Description t _-o-�s n�4�- rlso Sec. ( , S�l�a.' w, . Parcel# fi 8 (O pc, jut VGG� mor Area of q. t. q. t aluation of Work$ 6n Proposed Work heated/cooled none heated/cooled /Class of Work(circle one): New Addition Alteration Repair Move Demoliti0 ifId Yw/ziv ,p Use of existing/proposed structures)(circle one): 5eiirc Peone): Residentialt If an existing structure,is a fire sprinkler system insta Yes (f o� A f �lorida Product Approval# �—f COPY ' $ For multiple products use product approve orm , ./bescribe in detail the the type of work to be performed: �'/ �c / lve) Property Owner Information: N Nae:�Qg ��+6 Q Address: S _ ��U b 1 44 ►` E City S to aZip ,-?2Q Phone E-Mail or Fax#( ptional) Contractor Information: + Company Name: A� u �1J Ar,"V- Qualifying Agent: /nA4ek Pr' J;Z�N6ft Address:S e Of- City 4,P State- FI—Zip,3— Office PhoneQ04a,7a=q -Job Site/Contact Number S Fax# State Certification/Registration# Architect Name&Phone# -REVIEWED FOR CODE COMPLIANCE Engineer's Name &Phone# Fee Simple Title Holder Name and Address Bonding Company Name and Address Mortgage Lender Name and Address Iq RilitlNT.D 131x': DA1T: Application is hereby made to obtain a permit to do the work and installations as n e r r to the issuance of a permit and that all work will be performed to meet the standards of a YtSIYrrZXies nrd( and void if work is not commenced withirT six(6)months, or if construction or work is suspended or abandoned for a_period of six(6)months at arry time after work is commenced. !understand that separate permits must be secured for Electrical Work, Plumbing,Signs, Wells, Pools, Furnaces, Boilers, 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 INTENT) TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. I hereby certify that 1 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 sped red 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 Owne Signature of ContractorAp�� _V 1 � �. Print Name ..._�....�...L_Y....................ry?...�`....�....0 IJ................. Print Name m.o4ek..a.......CrQ N�...�......�<�_1� .................. Sworn to and subscribed before e Swol o and subse 'bed befo e me this Day of Si 20 [a this �� Day of 201�- AR �-IJBLIC p Notary Pub Ic Not u.16 ',, re hrdM� MIry wM-lw M f w ►► Com 'ssion#EE05336S %ftfte8L Expires: JAN.o! Meed 01.26.10 0 of 2"M BONDED nMU ATLANTIC BONDING CO.,INC. 12 -1627 NOTICE OF COMMENCEMENT State of F/01,Id'a Tax Folio No. County of to)A To Whom It May Concern: The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713 of the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMENT. Legal Description of property being improved: ke {57 q - 9 5-0 !Siect 54-1-t-r4lt K��' i s u m�, Address of property being improved: C/ V- �. r General description of improvements: R��, � 0,-,; Owner: j lt� S 1E ;�,V5� Address: �?2 IJDllu �= Owner's interest in site of the improvement: (V `t`' Fee Simple Titleholder(if other than owner):X25 &711,w(O Name: 1Contractor: Af J T-S Address: . 6t1P5G�9lf 2e Telephone No.: j�`S-�'I� _ Fax No: Sure (if any) Address: Amount of Bond$ Telephone No: Fax No: Name and address of any person ma ' aloan for the construction of the improvements Name: Address: Phone No: Fax No: Name of person within the State o. Florida, other than himself, designated by owner upon whom notices or other documents may be served: Name: Address: Telephone No: Fax No: In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section 713.06(2)(b),Florida Statues. (Fill in at Owner's option) Name: I—cxc i S-E- � Address: ��t' -a'-sec pe' s o_ G ""��! ;;, a-x R 3�-c3��'7 Telephone No: 3d —Q s? Fax No: Expiration date of Notice of Commencement(the expiration date is one (1)year from the date of recording unless a different date is specified): THIS SPACE FOR RECORDER'S USE ONLY OWNER Signed: Date: Before me thisday of� m,U O/ the County of ,e P r ,State Doc#2012208136,OR BK 16081 Page 873, Of Florida,has pers�ppeared Number Pages:1 Notary Public at Large,State of Florida,County of ioval. C/Rt Recorded 09/25/2012 at 10:18 AM, My commission expires: JIM FULLER CLERK CIRCUIT COURT DUVAL Personally Known: yeS or COUNTY Produced Identification: RECORDING$10.00 Mit Cann Au�;;2.2018 I'mm is810n#EE 214258 Sond�d 1*40 N�tbnN Ann. ANTHONY GENERAL CONTRACTORS, INC. I I 4609-1 US Hwy 17 , S. , Orange Park, FL 32003 (904)272-9598 * Fax(904)213-1161 License#: CGC 059263 Tony Knott, Pres. (904)655-9922 Custom Homes Jo Knott, Design Coord. Commercial Buildings (904)707 4957 FAX TRANSMISSION Date: /!' ���a TO: m JyNest, � FAX 4 _ 584- �s I V FROM D N 1,elu v Phone FAX REMARKS:sx�laN c e k sir)(-I-e--* VOu i a, ape A� 1p- f- C) njs TD N 1 A family tradition for more than 30 years. FeP�t �- OW . I II � I � iifi I_D C .I I ' Il � � iitIIIII r - I � i - i I i I I FA TT -14-TT 1 I Sly► NO . -- -- 4 ,-v a � Z5 Rf.AP, 1" Exit" Nov 06 12 05: 19p Suncoast Insurance 9042648680 p. 1 �fill , ANTHONY GENERAL CONTRACTORS, INC. 4609-1. US Hwy 17 , S. , Orange Park, FL 32003 (904) 272-9598 * Fax (904) 213-1161 License#: CGC 059263 Tony Knott, Pres. Custom Homes 1 (904) 655-9922 Commercial Buildings Jo Knott, Design Coord. (904)707 4957 FAX Date: FAX #: '�I r `tS To: r-p e-- ..)D A)e- S From: To 0Lj Ce 1/ j Number of Pages with cover RE: 17 �� �s � �•�ern���� , X-P 6as.5i �1 :C Pe rcni t f 7, 77D o td's �,j mon lV i w s U ta-a� CSG l�- tell'l 0 C 7� � IJ j2 M or") � eG� S i � . tT,(/l4 5, S� A family tradition formore than 30 years ___ Nov 06 12 05: 20p Suncoast Insurance 9042648680 p.2 i , I 291 , • � 14 I . I , I , -. .�...... ..... ...... 1 � i 1 I I � • i , I I ' , I I I . i - , •_ It • � Ir 1.. I � , 1 -_-__ --_._I ._.-. .____�.._.!. ._...__.�_._._; 1...._ _... .__ __._.• _-...I t I_L_� ..._ _ � ... ._ .. .. I I i City of Atlantic Beach �,�0 APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road /Z _ z Atlantic Beach, Florida 32233-5445 Phone(904) 247-5826 Fax(904)247-5845 /1 7 E-mail: building-dept@coab.us Date routed: 16— City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: �_, �7 D ment review required Yes/'-No uilding Applicant: IRTanning &Zoning Tree Administrator Projec : f Z Public Works Public Utilities Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By 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: Approved. []Denied. (Circle one.) Comments: BUILDIN PLANNING &ZONING Reviewed by: Date: 7 iZ TREE ADMIN. Second Review: ❑Approved as revised. Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 07/27/10 CITY OF ATLANTIC BEACH i+ 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5814 DIM Application Number . . . . . 12-00001627 Date 11/09/12 Property Address . . . . . . 705 ATLANTIC BLVD Application type description COMMERCIAL ALTERATION Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 18000 ----------------------------------------- Application desc general interior repair ------------------------------------------ Owner Contractor ------------------------ ------------------------ DORSCH SALTAIR PROPERTIES LLC ANTHONY GENERAL CONTRACTORS 2517 HOLLY POINT RD E 596 ABERDEEN CT ORANGE PARK FL 320735632 ORANGE PARK FL 32073 (904) 655-9922 --- Structure Information 000 000 INTERIOR REMODEL ADA BATH Occupancy Type . . . . . . BUSINESS --------------------------------------- Permit . . . . . . W/W/O ELECTRICAL PERMIT Additional desc . . Sub Contractor . . KEN KOEHLER ELECTRIC INC 00 Permit Fee . . . . 153 . 20 Plan Check Fee Issue Date . . . . Valuation . . . . 0 Expiration Date . . 5/08/13 ------------------------------------- Special Notes and Comments 2010 FLORIDA BUILDING CODE, FLORIDA FIRE PREVENTION CODE 2008 NATIONAL ELECTRIC CODE --------------------- ------------------------------- Other Fees . . . . . . . . . STATE ELEC DCA SURCHARGE 2 . 30 STATE ELEC DBPR SURCHARGE 2 . 30 Fee summary Charged Paid Credited Due ---------- ----------------- ---------- ---------- --- Permit Fee Total 153 . 20 153 . 20 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 00 . 00 Other Fee Total 4 . 60 4 . 60 . 00 . 00 Grand Total 157 . 80 157 . 80 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 ax(904) 247-5845 JOE ADDRESS: 7?O 5" TLi�/1T�c' � y PERMIT# /6 72 JEA INFORMATION REQUIRED ON ALL PERMITS CDU AMPS -)`le VOLTS l PHASE VALUE OF WORK$ /)oa 6_ NEW SERVICE ❑ Overhead ❑ Underground ❑T Underground up Pole ❑Residential(Main) Service ❑0-100 amps ❑101-150amps ❑151-200amps ❑ amps #of Meters El Commercial(Main)Service [10-100 amps El101-150amps El151-200amps ❑ amps OCT Service amps Conductor Type Size ❑Multi-Family(Main)Service 00-100 amps ❑101-150amps ❑151-200amps ❑ amps #of Unit Meters ❑Temporary Pole ❑ amps SERVICE UPGRADE El—amps ❑ CT Service amps NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.) ❑100 amps ❑150amps ❑200amps ❑ 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 Number of Lighting Outlets, Including Fixtures: OTHER ELECTRICAL PROJECTS ❑Swimming Pool ❑ Sign ❑Smoke Detectors KVA ❑Motors hp Qty ❑Transformers FIRE ALARM SYSTEM (Requires 3 sets of plans) "L UE OF WORK$ Qty volts/amps REPAIRS/MISCELLANEOUS ❑Replace Burnt/Damaged Meter Can ❑Safety Inspection ❑Panel Change _OH to UG e0ther: �'LrG�/.PCf C/�ll�l7r5 X02 4Q!¢T5 /TCff D'l�TGN>"s 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 �U�fln L • `�'�sch Phone Number Electrical Company n C'/f C`C's " _/✓r Offi`c�'e�Phone $0 '- ; FO Fax Co.Address: f�X ��s/%�� City .D/lKS4ndl�4° State Z�l Zip License �`" LC�•e State Ce tiification/Registration -,'i!^LEY}.GRAHAM Ze Notarized Signature of 1dcevw4CSA of r February 14,2014 ►/ 20'L_ Bunded Thru Notary Public Underwrhe orn and subscribed be re is day V Signature of Notary Pub CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD r� ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5814 12-00001627 Date 11/08/12 Application Number � � 705 ATLANTIC BLVD Property Address . . . . . Application type description COMMERCIAL ALTERATION Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 18000 -------------- ----------- -------------------------------------------------- Application desc general interior repair ------------------------------- Owner Contractor _ _ ------------------------ DORSCH SALTAIR PROPERTIES LLC ANTHONY GENERAL CONTRACTORS 2517 HOLLY POINT RD E 596 ABERDEEN CT ORANGE PARK FL 320735632 ORANGE PARK FL 32073 (904) 655-9922 Structure Information 000 000 INTERIOR REMODEL ADA BATH Occupancy Type BUSINESS -------------- -- ---------------------------------------------------------- Permit PLUMBING PERMIT Additional desc 2 FIXTURES NEW Sub Contractor HERZER PLUMBING SERVICE 00 Permit Fee 69 . 00 Plan Check Fee Valuation . . • • 0 Issue Date . . Expiration Date . . 5/07/13 ---------------------------- Special Notes and Comments 2010 FLORIDA BUILDING CODE, FLORIDA FIRE PREVENTION CODE 2008 NATIONAL ELECTRIC CODE 2 . 00 Other Fees STATE PLBG DCA SURCHARGE 2 . 00 STATE PLBG DBPR SURCHARGE ________ ------- Fee summary Charged Paid Credited ------------ ---------- ------- 69 . 00 69 . 00 . 00 . 00 Permit Fee Total 00 00 4 . 00 4 . 00 . 00 . 00 Plan Check Total • 00 . 00 Other Fee Total 73 . 00 . 00 . 00 Grand Total 73 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. PLUMBING PERMIT APPLICATION CITY OF ATLANTIC BEACH - 800 Seminole Rd Atlantic Beach, FL 32233 Ph(904) 247-5826 Fax (904)247-5845 ' PERMIT# JOB ADDRESS: C7� �Q I'l+l CJ ( ) �/ NEW OR REPLACEMENT INSTALLATION: Project Value$ TYPE of FIXTURE QTY TYPE of FIXTURE QTY Bathtub Septic Tank&Pit Clothes Washer Shower Dishwasher Shower Pan Drinking Fountain Slop Sink Floor Drain Three Compartment Sink Floor Sink Toilet Hose Bibs Urinal Kitchen Sink Vacuum Breakers Laundry Tray Water Connected Appliances Lavatory Water Heater Other Fixtures Water Treating System RE-PIPE: TYPE of FIXTURE QTY TYPE of FIXTURE QTY Bathtub Septic Tank& Pit Clothes Washer Shower Dishwasher Shower Pan Drinking Fountain Slop Sink Floor Drain Three Compartment Sink Floor Sink Toilet Hose Bibs Urinal Kitchen Sink Vacuum Breakers Laundry Tray Water Connected Appliances Lavatory Water Heater Other Fixtures Water Treating System MISCELLANEOUS: ❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor (Trap) gallons(Requires 3 sets of plans) ❑ Lawn Sprinkler System-Number of Heads ❑ Well ** SJR WD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.** ❑ 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 rovisions of any other state or local law regulation construction or the performance of construction. Property Owners Name ol 1'C'U Y1�Y e Phone Number �n SVC ,-�' Office Phone x(94"�« Fax a-7a'3`{1la Plumbing Company C'J� � S Q��f"R� G � �, City 1-State- Zip Co. Address: Q 7 - � License Holder(Print): (_ t P.nQ 1�J UmQLn State Certification/Registration#LFC�-23�"� Notarized Signature of License Holder_ 1� > n 0!0=4, q1K da ,Sworn and subscribed before me this 20 � Z ,';y r MELANIE GREEN ti'. �;: MY COMMISSION M EE 212195 ignature of Notary Public " EXPSES-July 14,2016 Bonded Thru NOt"PUbRc Urrderw�'he� . I P`' 1 �v, CITY OF ATLANTIC BEACH j 800 SEMINOLE ROAD J ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 12-00001627 Date 11/15/12 Property Address . . . . . . 705 ATLANTIC BLVD Application type description COMMERCIAL ALTERATION Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 18000 ---------------------------------------------------------------------------- Application desc general interior repair ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ DORSCH SALTAIR PROPERTIES LLC ANTHONY GENERAL CONTRACTORS 2517 HOLLY POINT RD E 596 ABERDEEN CT ORANGE PARK FL 320735632 ORANGE PARK FL 32073 (904) 655-9922 --- Structure Information 000 000 INTERIOR REMODEL ADA BATH Occupancy Type . . . . . . BUSINESS ---------------------------------------------------------------------------- Permit . . . . . . MECHANICAL HVAC PERMIT Additional desc . . Sub Contractor . . AIR MAX HEATING & COOLING INC Permit Fee . . . . 75 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 5/14/13 ---------------------------------------------------------------------------- Special Notes and Comments 2010 FLORIDA BUILDING CODE, FLORIDA FIRE PREVENTION CODE 2008 NATIONAL ELECTRIC CODE ---------------------------------------------------------------------------- Other Fees . . . . . . . . . STATE MECH DCA SURCHARGE 2 . 00 STATE MECH DBPR SURCHARGE 2 . 00 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 75 . 00 75 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Other Fee Total 4 . 00 4 . 00 . 00 . 00 Grand Total 79 . 00 79 . 00 . 00 . 00 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)24-77--5845 / .TOB ADDRESS: CUA v' PERNIIT#/� PROJECT VALUE $ 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 ARI# Air Conditioning: Unit Quantity Tons Per Unit REQUIRED 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 Pumps #Vented Wall Furnaces Refrigerator Condenser BTU's #Water Heaters Solar Collection Systems Tanks(gallons) Wells OTHER: 67-35 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 Phone Number i Mechanical Company ,jx' — �ic�. � �r—''C�_- Office Phoned-�fo ax` s Co. Address: IALAC , City State-!El-zip32.�b License Holder(Print): a e Certification/Registration# CAC-O � Notarized Signature of License Holder WAY VAU Sworn and subscribed before m/e s /S ' day of / O £m bei2 2049 W COMMISSION M DD 955354 !=*' EXPIRES:Match 8201 E:';• '�` NNotaryPubkD� Signature of Notary Public OF I'J'