78 W 4th St fire damage repairs 2013 ,C"� CITY OF ATLANTIC BEACH
1 j 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
rSA
Application Number . . . . . 13-00002363 Date 3/26/13
Property Address . . . . . . 74 W 4TH ST
Tenant nbr, name . . . . . . 78 W 4TH ST
Application type description RESIDENTIAL ALTERATION
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 16000
----------------------------------------------------------------------------
Application desc
FIRE DAMAGE REPAIRS
----------------------------------------------------------------------------
Owner Contractor
------------------------ ------------------------
COX, RUSSELL AARON JONSSON CONSTRUCTION
14003 TOMAKA RD 333 SAN PABLO RD N
JACKSONVILLE FL 32225 JACKSONVILLE FL 32225
(904) 591-0599
--- Structure Information 000 000 FIRE DAMAGE REPAIRS
Occupancy Type . . . . . . RESIDENTIAL
----------------------------------------------------------------------------
Permit . . . . . . RESIDENTIAL ALT/OTHER
Additional desc . .
Permit Fee . . . . 130 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 16000
Expiration Date . . 9/22/13
----------------------------------------------------------------------------
Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 130 . 00 130 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 134 . 00 134 . 00 . 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 Sem' le Road, Atlantic Beach, FL 32233
�y (904)247-5826 Fax(904)247-5845
Job Address: (/ ZzI yA 5- Permit Number:
Legal Description I$3 Y 0-21-Z21:5 &" e_ Parcel# /20,?Z 6 --6 a C"
Floor eat— Ig Ft. —Sq
Valuation of Work$ ed ProposWork heated/cooled non-heated/cooled
li;loov
Class of Work(circle one): New Addition Alteration Repai Move Demolition pooUspa 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:
Property Owner Information: p
Name: /,IuS Frl/�iY�J� LrJX Address:
City State 7/Zip Phone
E-Mail Fax#(Optional)
Contractor Information:
Company Name: Qualifying Agent:
Address: 3 3 3 ity States Zip
Office Phone / ��9,T/- 3 3 5��[_Job Stte/Contact Number Fax#
State Certification/Registration# /®C' 12 r Zd�
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 pade to obtain a permit to do the work and installations as indicated. 1 certify that no work or installation has commenced prior to the
issuance of a permit athat all work will be performed to meet the standards ojall laws regulating construction in this jurisdiction. This permit becomes null
and void:f work is noommenced within six(6)months, or if construction or work is suspended or abandoned for a period of six r6)months at any time after
work is commenced. I 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 INTEND TO OBTAIN FINANCING, CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
I hereby certify that I have read and examined this plication and know the same to be true and correct. All provisions of laws and ordinances governing this
type Pwork will be complied with whether sppeci ted 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 lav regulating construction or the performance of construction.
Signature of Owner Signature of Contractor
Print Name P— A4,c ... 5.................................................. Print Name
Sworn to and subscribed be ore me Sworn to and subscribed before me
this 21 st Dav of <tirc 20 13 of _ _ _ _ _ -20 ) 3
MARILYN M.DAVIS
oft,U BUD
Notary Public No %Day
tc __ Y u c a e oFlorida
i MY COMMIS810N#EE22�dN 3,yWMy Comm.Expires Jan 3,2016
EMRES Aupwt 00.2011 % pF 1�evi�Qtd4s�6�t�E 156961
(40n>te silts