1869 Beachside Ct 2013 WDO CITY OF ATLANTIC BEACH
J 800 SEMINOLE ROAD
s) ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
.sem..,.;
Application Number . . . . . 13-00003677 Date 11/14/13
Property Address . . . . . . 1869 BEACHSIDE CT
Application type description RESIDENTIAL OTHER
Property Zoning . . . . . . . RES GEN MF DISTRICT
Application valuation . . . . 2200
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Application desc
wdo
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Owner Contractor
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UNDERWOOD FRANKLIN C WILLIAMS ATLANTIC CO. , INC
1869 BEACHSIDE CT 1129 NECK ROAD
ATLANTIC BEACH FL 322335954 PONTE VEDRA BEACH FL 32082
(904) 545-4884
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Permit RESIDENTIAL ALT/OTHER
Additional desc . .
Permit Fee . . . 65 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 2200
Expiration Date . . 5/13/14
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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 65 . 00 65 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 69 . 00 69 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
r CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: j-e— ci Permit Number:
Legal Description Parcel#
Floor Area of Sa.Ft. Sq.Ft
Valuation of Work$ 22VC2 Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration (!2p Move Demolition pool/spa window/door
Use of existing/proposed structure(s)((circle one): Commercial tial
If an existing structure,is a fire sprinlder system installed? (Circle one): Yes N/A
Florida Product Approval#
For multiple products use product approval form
Describe in detail the type of work to be performed: 0.0 L 6L.11 u ) U
Property Owner Information:
Name: Address:
City State_Zip Phone
E-Mail or Fax# (Optional)
Contractor Information: CONTRACTOR EMAIL ADDRESS:
Company Name: i ( i w-i ro Qo Quali inggent: v%.(
Address: City � State zip3ao2
Office Phone qQ 1^54S �- 1%� Job Site/Contact Number 964 X4,5 14 I94 Fax#qa4 -z-1?
State Certification/Registr to of n#_t' R CTt)2 3 2-9 Lo
Architect Name&Phone# 0/X
Engineer's Name&Phone# N
Fee Simple Title Holder Name and Address (-J
Bonding Company Name and Address
Mortgage Lender Name and Address
Application is hereby made 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 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. 1 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
�91, �y 3(b ��2_ COMMENCEMENT.
52 UZI0 - d
I hereb certify that 1 have read and examined this application 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.
Si r
Signature of Owner nature of Contracto
Signature
Print Name � ...�..... .� Print Name ..w ........... 9.
Befc � Bef 1 ?
this 1"1' Day of 0 V 201-3 this y of 20
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Notar P bl 3 �'' •;, ibli
MY COMMISSION#FF 011480 �*. Y COMMISSION# -011460
EXPIRES:Ap6124,2017 •, EXPIRES:Ap 24 All i
�= vised 01.26.10
Bonded Ther Notary Public underwriters %?4e h° Bonded Ttxu Notary Pub a Ufil1§Vti%E?f3