651 Sturdivant Ave (vault) CITY OF ATLANTIC BEACH
APPLICATION FOR PLUMBING PERMIT
JOB LOCATION: ("IS / s 4-cl,Ir j(I�j C .,_�
OWNER OF PROPERTY:
PLUMBING CONTRACTOR:
CONTRACTOR'S ADDRESS:
La-UL(LL. FIA,
STATE LICENSE NUMBER: 0-r_C-0s6qF 7 TELEPHONE: ;),4,7_qqtq
HOW M"Y OF THE FOLLOWING FIXTURES INSTALLED
-SINKS SHOWERS
-LAVATORIES WATER HEATERS
-BATH TUBS DISHWASHERS
-URINALS DISPOSALS
-CLOSETS WASHING MACHINES
-FLOOR DRAINS SHOWER PANS
OTHER
TOTAL FIXTURES: X 3.50 + $15.00
MINIMUM PERMIT FEE = $25.00
SIGNATURE OF OWNER:
SIGNATURE OF CONTRACTOR:7h
-----------------------------------------------------------------------------
INSTALLATION OF PLUMBING AND FIXTURES MUST BE IN ACCORDANCE WITH THE 1994
STANDARD PLUMBING CODE.
CALL A DAY AHEAD TO SCHEDULE INSPECTIONS - (904) 247-5826
SEWER CONNECTIONS MUST BE CALLED IN TO PUBLIC WORKS FOR INSPECTION PRIOR
TO COVERING UP - (904) 247-5834.
PSR-3844
DEPARTMENT OF BUILDING
CITY OF ATLANTIC BEACH
PEP-MIT INFORMRTION ------ LOCATION INFORMATION
Permit Number : 15523 :'.ddress : 651 STURDIVANT AVENUE
Permi"t Type: PLUMBING ATLANTIC BEACH , FLORIDA 32233
'lass of Work:ALTERATION --- ------- LEGAL DESCRIPTION
17onstr . Type:WOOD FRAME Block-, Lot : Twp:
Subd- 651 Rnq :
Prt)posed Use' Section: 0
Dwellings : 1 Subdivision:
Est . Value' 0 . 00
Improv. Cost : 0 .00
Total Fees7 25 .00
Amount Paie 25 . 00
-,WNER TNF6RMATION APPLICATION FEES
JENSON PERMIT
t-51 STURDIVANT AVENUE
ATLANTIC BEAC-H � FLORIDA 3'2
749
Y,4 �2��7-`
CONTRRCTOR INFORMATION --- - - -
Name: CHRISTY FIRST COAST PLUMBIN".1
i�,jdr , P . C,. r,��X 5044E,
jACKSONVILLE BEACH , FL 32"240
CFC0 5 ES 4 9 7 Exp :
NOTES:
NOTICE - INSPECTIONS MUST BE REQUESTED AT LEAST 24 HOURS PRIOR TO INSPECTION
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.
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 DEPAR MENT
By:
PSR-3844 12779
DEPARTMENT OF BUILDING
CITY OF ATLANTIC BEACH
---- PERMIT INFORMATION ------- LOCATION INFORMATION --- ---
Permit Number : 12779 Address : 651 STURDIVANT STREET
Permit Type :RE-ROOF ATLANTIC BEACH , FLORIDA 3221- 1
-'lass of Work:NEW ---------- LEGAL DESCRIPTION
Constr . Type:WOOr FRAME Block: Lot ., Twp : r
Proposed Use: Section: 0 Subd:O Rng:
Dwellings : 1 subdivision:
Est , Value : 0 . OC)
improv . Cost : 1 , 400 . 00
Total Fe", -.
25 .00
25 .00
Amount
,,j r-�r
IIATION APPLICATION FEES
L-rr�tj T T
Name
Addi T STREET
�4N
k B FLORIDA 3,22-,
Phor$*,*
R R FORMATT
Name: SCH LTZ FING
"SUITE R
JACKSON ., BEACH , FL 32250
Exp:
7
-n-;1 W
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 MECHANIC'S LIEN LAW CAN RESULT IN
THE PROPERTY OWNER PAYINGTWICE FORTHE BUILDING IMPROVEMENTS99
ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR
VIOLATION OF APPLICABLE PROVISIONS OF LAW.
tdten
CHECKS
ATLANTIC BEACH BUILDING DEPARTMENT 00100003221000
tL
By:
CITY OF ALANTIC BEACH
ROOFING PERMIT APPLICATION
Owner(s) :
Address:
-5 314 14'12 Phone:
Lot # Block or Unit # Subdivision:
Contractor:
A/
Address :.,. -'�-/0"
City, State and Zip—�-�Y, ;2 ��250 Phonea�'�jza-?/-Y
State License # 4f 26
Describe work to be per formed:
Valuation of Proposed Construction:—
Materials to be used:
Signature of Owner;
Signature of Contractor:
Liability Insurance Supplied
Workers Compensation Insurance Supplied_ All
License Information___a-,;-_
PSR-3844 8532
DEPARTMENT OF BUILDING
CITY OF ATLANTIC BEACH
---- PERMIT INFORMATION - --- - ----- LOCATION INFORMATION -- ------- -
Permit Number: 8532 Address : 651 STURDIVANT AVENUE
Permit Type : RE-ROOF ATLANTIC BEACH , FLORIDA 3223---
Class, of Work: NEW ---------- LEGAL DESCRIPTION --------- -
Constr . Type: WOOD FRAME Lot , Block : Section:
Proposed �Tse: SINGLE FAMILY Township : RNG: 651
Dwell -inas : I Code: 0 Subdivision:
Estimated Value: 15300 .00
. Improv . Cost : $0 .00
Total Fees : 922 . 50
Amourf- Pni $22 . 50
4
OWNFP TNPnRMAT!"�11 APPLICATION FEES -----
Name: JENSON PERMIT $22 . 50
6.51 STURDIVANT AVENUE WATER IMPACT FEE 80 . 00
ATLRNTIC BEACH � FLORIDA 32.- SEWER IMPACT FEE 80 . 00
Phong� : ( 904 ) 297-7749 WATER METER/TAP 50 . 00
RADON GAS-H .R. S . 50 . 00
------- CONTRACTOR INFORMATION RADON CAB 5% $0 . 00
Name : J AND R ' S HOME RO(li- CAPITAL IMPROVE . SO . 00
Adl�tress : 1306 MARLEE ROAD SEWER TAP �0 .00
JACKSONVILLE . FL 32259 CROSS CONNECTION SO .00
License : RC0066587 Type: SEC H IMPACT FEE $0 .00
CONST . SURCHARGE
SCHARGE/ATL �BCH .
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 IMPROVERAt0g.55
OIN 2 /_014
ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR
VIOLATION OF APPLICABLE PROVISIONS OF LAW.
ATLANITIC BEACH BUILDING DEPARTMENT
Byi
CITY OF ALANTIC BEACH
ROOFING PERMIT APPLICATION
owner(s) : M�i -7�?-??; -�Iq Ili!
Address : /y 5 T.f i-d /'/�,q it/7-19 1), Phone:
Lot # Block or Unit # Subdivision:
Contractor :
Address : \T4
City , State and Zip -T 9 A F Phone -�90
L7
State License #
Describe work to be perf ormed: el, �L ('W
el,\ � y4C e— 1(i)It L)I-L),
Valuation of Proposed Construction:
Materials to be used:
Signature of Owner;
Signature of Contractor:
Liability Insurance Supplied
Workers Compensation Insurance Supplied
License Information
7117
PSR-W4
DEPARTMENT OF BUILDING
CITY OF ATLANTIC BEACH
----- PERMIT INFORMATION -------- LOCATION INFORMATION ------- -
Permit Number * 7117 Address : 651 STURDIVANT STREET
Permit Type: WELL ATLANTIC BEACH , FLORIDA 3223"
Class of Work : NEW ---------- LEGAL DESCRIPTION
Constr . Type� N/A Lot : Block, Section :
Proposed Use: UTILITY Township : RNG: 0
Dwellinas : Code: 0 Subdivision-
Estimated Value : $0 .0c)
� Improv . Cost : 50 . 00
Total Fees : S10 . 00
Amount t- , -: $10 . 00
ra t e- v I r)
W f7)r 1� T)e!�C SH -,L FC-1h !RRIGATION PURF
�)WNER INFORMATION APPLICATION FEES
:-'LAhA JFNSEN PERMIT
4:,5, 1 SIPTIRDIVANT STREET WATER IMPACT FEE $0 .0p
r'.TLANTI �-' BEACH ; FLORIT" SEWER IMPACT FEE
WATER 14,,,OE' R
RADON GAS-H . R S � $0 ,or)
CONTRACTOR INFORMATION RADON GAS 5% so �oc
WILLIAMS WATER TAP so .00
Add SEWER TAP SO . 00
HYDRAULIC SHARE $0 .00
Lic ense: ATLANTIC' BEACH Type : CAPITAL IMPROVE . $0 - 0-
SEC .H IMPACT FEE
OTHER
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.99
EA I L)
ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECTJOLRffq§�,ION FOR
VIOLATION OF APPLICABLE PROVISIONS OF LAW.
City of Atlantic Bch.�
ATLANTIC BEACH BUILDING DEPARTMENT
By:
$10.(r,
A'-PPLICATI(V FOR IEU PMjIT
CITY OF ATLANTIC I�FACII
PRDPERTY MNER
Name:_ T-
Address[ ---.j)ay Phona?96
66 zip--
APPLICANT, IF GIIIER THAN WER
Nam:
Address; A �C_
_7ip._72V��
JOB,
Addres! or Location:
Lpgal "Description:
Is well to be used for drinking purposes?
Any person, individual$ corporation or other entity receiving a pernAt as
provided in Section 22-40 of the Atlantic Beach Code, and who plans to use
water froTn the penmtted well for drinking purposes, Must firsi: obtain a
bacteriological test report from the State of Florida Health Departrent,
furnishing *a certified copy thereof to the building departimit of the City of.,
Atlantic Beach. A certificate of occupancy will not be issued until said
report is an file with the building departimnt.
Department Notes:
agree to cclm. ly with regulations stated herein:
Sj�
UaE
6249
PSR-3M4
DEPARTMENT OF BUILDING
CITY OF ATLANTIC BEACH
FERMIT INrURMATION LOCATION INFORMATION
PerLMit NUMber: 6249 Address: 651 STURDIVANT STREET
permit Type: MECHANICAL ATLANTIC BEACH, FLORIDA 3��2j.J
,,'lass of Work-. ALTERATION ---------- LEGAL DESCRIPTION ------- -
Constr. Type: WOOD FRAME Lot : Block: Section:
Proposed Use: SINGLE FAMILY Township: RNG: 0
Dwellings: I Code; 0 $0. 00 ubdivision:
Estimated Value:
Improv. Cost : $0. 00
Total Fees: *37. 00
Amount Paid : $37. 00
Work central arid air
;-�:IATION --------- - APPLICATION FEES
$37. 00
CLARA JENSEN PERMIT
WATER IMPACT FEE $0. 00
6t4 STURDIVANT STREET
ATLAI-4-1-IC REACH, FLORIDA SEWER IMPACT FEE
WAI'Ek METER
P h 6A e RADON UAS-11. R. S. $0. .,
RADON GAS - 5% $0. 00
CIONTPACTOR INFORMATION WATER TAP $0. 00
Name: B&t.'7 SERVICES SEWER TAP $0. 00
Address: !-54 WEST NINTH STREET $0. 00
ATLANTIC BEACH, FL 3223*,� HYDRAULIC SHARE
CAC035585 Type- RE-INSPECT FEE $0. 00
SEC. H IMPACT FEE !V.O. 00
OTHER
NOTE
S
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 $37.0(j
TENDERED $37.O�,'�
.MMMP___ V)
CHANICS' LIEN LAW CAN RESWORF
"FAILURE TO COMPLY WITH THE ME 53
THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS.
ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR
VIOLATION OF APPLICABLE PROVISIONS OF LAW.
FATLANTIC BEACH BUILDING DEPARTMENT
By
BUILDING -AkOb ZONING INSPECTION DIVISION
CITY OF ATLANTIC BEACH
ATLANTIC 131ACII, FLORIDA 3,121,
0
APPLICATI N FOR MECHANICAL. PERMIT CALL..IN NUMBER
-IMPORTANT -- Applicant to complete all items in sections 1, 11, 111, and IV.
Sfro*f Address:
LOCATION
OF Intersecting Sff#@fJ: Off-#on An d
BUILDING
11. IDENTIFICATION — To be completed by all applicants
In consideration of porm;t g;�en (or doing the -o(k as described in the abcve statement we hereby agree to pe,(c,m ta;d o-%
-;th the aftacl�Led plans end specification% which are a part hereof and in accordance w;tn the C;fy of Jacltson�Xe ord;�a,cei a---
of good practice listed therein.
Name of Mechanical Contra for%
Copfrach.r (Print) Malforc
HAM* of
Property Owner
e"4-re
S;qnsf,uro of Omor Signature of
or Awl-horizod Agent Architect or Engineer
Ill. G4NERAL INFORMATION
A. Type Of heating fuel: E3. 15 OTHER CONSTRUCTION BEING DON E III ON
THIS BUILDING OR SITE I
Gas LP [I Natural 0 Control Uf;l;ty
C] 04 IF YES. GIVE NUMBER OF CONSTRUCTION
PERMIT
Otkor spociFy
IV. WICHANICAL EQUIPMENT TO BE INSTALLED NATURE OF WORK
(Pron,49 complete lhf of component%an back of A;s form) Residential or r
Commercial
0--l'H 1 0 Space 0 Ro<ossod 0 Control 0 Fto(w Now Oulldlng
"I Cond'f;o'R;n9: [] Roof" 0 Control [R�16�.Isting Building
0 Dwcf I System: Material T%ickn*uL— 9-"R�placement of existing system
Maximum capacity c.f.m. El New Installation(No system previously Installed)
0 ItirfrigsIrS6001 EJ Extension or add-on to existing system
C] Cooling tower: Capacity 9-1111-M. LJ Other — Specify
[3 Fire tpr;rij": Number of h"
C3 80watew 0 Monliff 0 Escalator THIS'SPACE FOR OFFICE USE ONLY
0 Gasolifto pum— jnvmb*r)
[3 Tank. (number) Remarks
0 LPG confe;Aoft—(number)
UatmW pr*uwr*ve"
0 Permit Approved b Do r
11 O#W — Specify Permit Fee
L19T ALL EQUIPMENT
Ant CONDITIOMNG AND REFRIGERATION FQUIPMENT Capacity A roving
Number Units Description Model Number MiLnufactuivir
"�W&l-'e-A A�&-_//"6 Z"-
�IZATING FURNACES, BOILERS, FIREPLACES
c4pei,dIty Applafts
Number Units I)wription Mo"Number Manufacturer (BTU)
;i'Z4Z1z7- _ 7744��
TANKS
How U&ny Norrins.1 CLpwJty Type Uquid Name of Ap ving
and Dilmonsions Contained Mamufactureir No. ;ncy
-r7
CITY OF -2q4 6'V-//
&�CA-I&Ti4&
Office of Building Official
REQUEST FOR INSPECTION
Date Z/ Permit No.
Time A.M.
Received 3� P.M. District No.
Owner'�,,ldress Locality
Kj._. ontr
BUILD�1# CONCRETE (ELECTRICAL PLUMBING �MMM-4
Framin 11 Footing Rough Wirin Rough 0
Re Roofing D Slab e 0 Top Out 0 Heating
Lintel F_- Fire Place 1-1
Pre Fab
READY FOR INSPECTION A.M.
Mon. Tues. Wed. 1�2 Thurs Friday-P.M.
OU-S
Inspection Mace- I
Inspector e�z!-- Final Inspectio
Certificate of Occupancy
Date
DATE:
PRE-SERVICE DIVISION
JACKSONVILLE ELECTRIC AUTHORITY
2J3 WEST DUVAL STREET
JACKSONVILLE, FLORIDA 32202
THE FOLLOWING FINAL INSPECTION(S) HAVE BEEN MADE AND ARE
SATISFACTORY:
-------------
1,27--- - - ---- - ------------------------
--------------------------------------------------
---------------------------------------------------
-------------------------------------------------
EL
BUILDING INSPECTION DIVISION
cc:FILE
CITY OF ATLANTIC BEACH, FLORIDA
Approved I APPLICATION FOR ELECTRICAL PERMIT
TO THE CHIEF ELECTRICAL INSPECTOR: DATE:— 19 12-
IMPORTANT NOTICE:
IN CONSIDERATION OF PERMIT GIVEN FOR DOING THE WORK AS DESCRIBED IN THE FOLLOWING, 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 ELECTRICAL REGULATIONS, CODES AND CITY OF
ATLANTIC BEACH ORDINANCES.
fl"\ 51�_ 4�5�p.-00�ce�
ELECTRICAL FIRM: MASTER ELECTRICLAA SIGNATURE V JOURNEYMAN
NAME Cilfk -TErl'j% 02-2 ADDRESS: (Os- 1 s�V901VAo'i I RFQ BOX—
BLDG.SIZE —BETWEEN:
RES. 0 APT. ( I COMM. ( PUBLIC INDUS. NEW ( OLD REW.
ADDITION ( ) TRAILER TEMP. ( ) SIGNS I I SQ. FT.
SERVICE: NEW ( INCREASEX) REPAIR FEE
CONDUCTOR SIZE 0 -AMPS __00 COPPER ALUM. X) crb
SWITCH OR BREAKER 0 AMPS PH w 230VOLT- Sok**'O'RACEWAY
EXIST.SERV.SIZE �0 AMPS PH w 27c.7VOLT 5 (--V RACEWAY
FEEDERS NO. SIZE INO. SIZE I NO. SIZE
LIGHTING OUTLETS CONCEALED OPEN TOTAL
RECEPTACLES CONCEALED OPEN TOTAL
0.30 AMPS. 1.100 AMPS.
S TCHES
WI
INCANDESCENT
FLUORESCENT&M.V.
FIXED
0.100 AMPS. 0 V ER
APPLIANCES i
I =BELL TRANS=F.
AIR H.P. RATING H.P. RATING
CONDITIONING COMP.MOTOR OTHER MOTORS AMPS ICEIL HEAT: KW-HEAT
3 10 le-
0-1 OVER
MOTORS H.P. VOLTAGE PHS NO, I H.P. VOLTAGE PHS
MISCELLANEOUS
TRANSFORMERS: UNDER 600 V. OVER 600 V.
NO. I KVA 11NO. IKVA
NO. NEON TRANSF. NO. VA. I MA. I I MOTOR SIZE I SWI CH I FLASHER
EACH SIGN I I
FORWARDED
AL FEES Z-/_2
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
-------------
'R� INSPECTION PHONE LINE 247-5826
Application Number . . . . . og-00001189 Date 8/20/09
Property Address . . . . . . 651 STURDIVANT AVE
Application type description RESIDENTIAL OTHER
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 150
----------------------------------------------------------------------------
Application desc
REPLACE 1 WINDOW IN GARAGE
--------------------------------------------------------------
Owner Contractor
------------------------
------------------------
JENSEN, W. B. OWNER
117 1ST STREET
ATLANTIC BEACH FL 32233
----------------------------------------------------------------------------
Permit BUILDING PERMIT
Additional desc - - 17 . 50
Permit Fee . . . . 35 . 00 Plan Check Fee
Issue Date . . . . valuation . . . . 150
Expiration Date . . 2/16/10 --------------
-------------------------------------------------------------
Special Notes and Comments
*2007 FLORIDA BUILDING CODE W/ 105- 106 SUPPLEMENTS .
2007 FLORIDA BUILDING CODE - RESIDENTIAL.
2005 NATIONAL ELECTRICAL CODE.
WINDOW AND DOOR INSPECTION:
*INSTALLATION INSTUCTIONS REQUIRED
*ALL STICKERS ARE TO REMAIN ON THE WINDOWS
*PROVIDE ACCESS TO ALL WINDOWS TO INSPECT FASTENERS
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 3S . 00 35 . 00 . 00 . 00
Plan Check Total 17 . 50 17 . 50 . 00 . 00
Grand Total 52 . 50 52 . 50 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
_d1'�11fIvr 14V6 .
vivo r Cl TY OF ATLANTIC BEACH
09
F7 800 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233
OFFICE:(904)247-5B26 0 FAX NO.:(904)247-5845
BUILDING-DEPT@CDAE3.US
B DING PERMIT APPLICATION DUVAL COUNTY
UIL
2-VALUATION OFWDRK 3.SQ.FF.UNDER ROOF,
!�J��,�OBADDRESS:
00' 5-/ V C4 4
4.LEGAL DESCIRIPTION`1., 5.CLASSOFWORK 6.USE OF STRUCTURE:
0 NEW BUILDING 11 DEMOLITION XRESIDENTLAL
LOT_BLOCK-SUB DIVISION El ADDITION 11 CONVERTING USE El COMMERCIAL
T DESCRIPTIOA QF WORKt�,' 11 ALTERATION 11 ACCESSORY BLDG. 8.FIRE SPRINKLER.-
19 REPAIR 0 POOL/SPA 11 YES El NIA
A1eA(L1),? 4 4 C, 0-MOVE 0 OTHER 11 No
PROPERTY,OWNER: CONTRACTOR. ARCHITECT I ENGINEER--,7
9.NAME: 15.COMPANY NAME: 23.COMPANY NAME:
OL-4(-
16.NAME' 24.LICENSEE NAME:
10.ADDRESS: 17.STATE OF FLORIDA LICENSE NO.: 25.STATE OF FLORIDA LICENSE NO.:
3 -Ls- I I i-t% �- 18.ADDRESS: 26.ADDRESS:
4+IIJK�L 6C �- F:
11.OFFICE PHONE: --[72� 19.OFFICE PHONE: -T 0-FAX NO.: 27.OFFICE PT��B.FAX NO.:
13.CELL PHONE: -?to- S,49vy 21.CELL PHONE: 29.CELL PHONE
14 EMAIL ADDRESS: 22.EMAIL ADDRESS: 30.EMAIL ADDRESS:
FEE SIMPLE TITLE HOLDER: DING COMP4h� MORTGAGE LENDER:
`�ERTHAN OMER) BON
�:(IFC?
31.NAME: A//&- 33.NAME: 35 NAME:
32.ADDRESS: 34.ADDRESS: 36.ADDRESS:
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this
jurisdiction. This permit becomes null and void if work is not Commenced within six(6) months, or if construction or work is suspended or
abandoned for a period of six (6) months at any time after work is commenced. I understand that separate permits must be secured for
Electrical Wor i k,Plumbing,Signs,Wells,Pools,Furnaces,Boilers,Heaters,Tanks, Air Conditioners,etc. th all applicable
OWNEWS AFFIDAVIT- I certify that all the foregoing information is accurate and that all work will be done in Compliance wit
laws regulating construction and zoning. I will not occupy or use the referenced building or any part therof, until all inspections are finaled and
prior to obtaining a certificate of occupancy or completion issued by the building official,as required by law.
WARNING TO OWNER:
YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
CONTRACTOR
OWNER cir"AGENT
A6enCy Letter Required) (Qu2irfier Only)
(if Agent,Power of Attomey or
Signed: Date: Signed: Date:
, ? _,_r Before me this 1 2009 in the county of
Before me this_day of 2009 in the county of day of
Duval,State of Flodda,has personally appeared Duval,State of Florida,has personally appeared
herin by himself/herself and affirms that all statements and declarations are herin by himself/herself and affirms that all statements and declarations are
true and accurate. , true and accurate.
Notary Public at Larg State Co nty f Notary Public at Large,State of County of
El Personally Known
El Perso ifly Known El Produced Identifirafion-
rod"
El Produ den n
LF-Y L Notary Signa:ire:
Notary 3i atum-!: -1-11, SKI
-iVqAEL9Z4TiTTJUdD FOR eOD MYLIAN
-IMy Comm' id6ion Expires Feb 14,2010 CITY OF ATLANTIC BEACH
Commission#DD 518533
�211 1
Bonded By National SEE PERMITS FOR ADDITIONAL
"1kry-
- REQUIREMENTS AND CONDITIONS.
BLDG01 Permit Application Bldg:REVISED:121
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City of Atlantic Beach APPLICATION NUMBER me
Building Department (To be assigned by the Building Depart
800 Seminole Road 10
X_ Atlantic Beach, Florida 32233-5445
Phone (904)247-5826 - Fax(904)247-5845 Date routed:
E-mail: building-dept@coab.us
City web-site: http://vmw.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: De artment review required Yes 0
Building
P LI CA I?N M BE�rt
(To b�sipgned byTth Bu�Id�ng Dep ment
Applicant: anning &Zoning
Tree Administrator
Project: IR Public Works
Public Utilities
Public Safetv
Fire Services
F7
Review fee $ Dept Signature
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
APPLICATION STATUS
E:]Denied.
Reviewing Department First Review: aApproved.
(Circle one.) Comments:
U I CLD I N�I
PLANNING & ZONING Reviewed by: Date:
Lo 17—
TREE ADMIN. Second Review: FlApproved as revised. F ]Deri'ed.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: F-JApproved as revised. DDenied.
Comments:
Reviewed by: Date:
Revised 05114/09