700 Amberjack Ln demo 2012 CITY OF ATLANTIC BEACH
j 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
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Application Number . . . . . 12-00001678 Date 11/13/12
Property Address . . . . . . 700 AMBERJACK LN
Application type description DEMOLITION
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
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Application desc
INTERIOR DEMO
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Owner Contractor
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FORE, FRANCIS HOMEOWNER BLDG SVCS, INC (RC)
700 AMBERJACK LANE 739 BROOKMONT AVE E
ATLANTIC BEACH FL 322334202 JACKSONVILLE FL 32211
(904) 322-1054
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Permit . . . . . . DEMOLITION PERMIT
Additional desc . .
Permit Fee . . . . 100 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 5/12/13
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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 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.
uUIL,"11 " I EKIV111 1irrU1%_AI 1VIN
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904)247-5826 Fax(904)247-5845
Job Address: �'7 &M6::Wyf.4c t Permit Number:
Legal Description 3D Parcel#
Floor Area of Sq.Ft. , q.Ft
Valuation of Work S Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s) (circle one): Commercial Residential
If an existing structure,is a fire sprinkler system installed? (Circle one): Yes No N/A
Florida Product Approval #
For multiple products use product approval form
Describe in detail the type of work to be performed: F.NVQ1,t i ,_j 10A11
Property Owner Information:
Name.fkAm r- ToaE Address:
City A-naNnr hak214 StatelR—Zip 22 Phone
E-Mail or Fax#(Optional)
Contractor Information:
Company Name: 1: #y couppi .Iithees QualiR,ing Agent:
Address: 7,;4 R Legit rn,A iki it City_' �..1 ute!fc State fL -Zip-A-21_1 I
Office Phone 404-4•AZZ-10 B!j� 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
4pplication is 1, re made to obtain a permit In do the ti ork curd instcr/lations as indicated. !certifi that nn N ork or installation has commenced prior to the
issuance of a permii and that all work will be performed to meet the srandardr o>'al!lmvr regulating construction in this jurisdiction. Thir permit becomes null
and void if work is not commenced H ithin six/6/months, or iJ constnrctiat or Innrk suspended or ahandnned fpr a eriod of.rir t6J months at any time after
tivwk is commenced. 1:mderstand that separate permits must be secured jor ,ectricnl Work, Phtmhiug.Signs, fells, Pools, t urttaces, Boileis, Neaten,
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.
I hereby certiJv that I have read and examined this cpplicaiion 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.
C -'
Signature of Owner Signature of Contracto
Name i
Print Name t-rTR C� S •�^-v� .........__ Pr /��✓. ....._��-.' L.�irj�,-+�Q..�2..........
Before me Before
this }� D f Nove n�Q f . ZO r� this Day f 20
'Notary Pu 1 No ublic_
CINDIE HERNANDEZ
Revisez3 Ol 10
��/j MY COMMISSION#EE148600 '' " '
�^M EXPIRES:Novat�a 27,2015
��� Fl.Nasry Discount Assoc.Co.
1-800.1-NOTARY