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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 4. 1i?XVIEVffiD BY.- -1'P IL E COPY co sauoz ou 0 Ammm� 0 C\j cn C\j C\l uj 7�i E tl- ZM!7c t5 -H cf) �3: N B C%j LU U- m LO 15 C%j uj -j Lc) T, 4m �5 CK� uj 0 Lc) & uj LLI LLI LLA & �-r= LU LL, U)LA- 4-4 ct ct ct C) ct -SL ct Ct Ct Ct ct ct ct C) 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