475Palmwood Ln 2014 kitchen remodel Jr1
C� `11 CITY OF ATLANTIC BEACH
j 800 SEMINOLE ROAD
±� ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 14-00000387 Date 3/14/14
Property Address . . . . . . 475 PALMWOOD LN
Application type description RESIDENTIAL ALTERATION
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 1000
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Application desc
kitchen remodel
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Owner Contractor
------------------------ ------------------------
NELLIS RICHARD E WHITEHURST BUILDERS INC
475 PALMWOOD LANE 10526 CRAIG INDUSTRIAL DR
ATLANTIC BEACH FL 322335607 JACKSONVILLE FL 32225
--- Structure Information 000 000 KITCHEN REMODEL
Occupancy Type . . . . . . RESIDENTIAL
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Permit . . . . . . RESIDENTIAL ALT/OTHER
Additional desc . .
Permit Fee . . . . 55 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 1000
Expiration Date . . 9/10/14
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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 55 . 00 55 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 59 . 00 59 . 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 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: �t�Jr- luaCU Permit Number:
v� 74.r� arcel#�'��Do (!55191y —
Legal Description 3 y ���907.5��� a-17 x`74
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61
oor Area o q. t. 'q. t
Valuation of Work$ IUD 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 Residentia
If an existing structure,is a fire sprinkler system installed? (Circle one): e N/A
Florida Product Approval # /v/—
For multiple products use product approval form
Describe in detail the ty e of work to be performed:
s • r ..
Property Owner Information: a y
r ,ei �� Address:�L7S
Name: �e - 70/ 3
City /1 4 State /Zip g2e 3 hone
E-Mail or Fax# (Optional)
Contractor Information:
�� ��,,y(��,�� ¢.[ Qualifying Agent:L�
Company Name: _
a / ' C it}�Gu- State ��' Zip, a�5'
Address:/D 1 Fax# 901t=-7Su1-�i �
Office Phone 1,06 Job Site/Contact Number GID -SSS a S�
State Certification/Registration# C7,6C4PT93
Architect Name &Phone# /�-
Engineer's Name &Phone
Fee Simple Title Holder Name and Address 541ru �6
Bonding Company Name and Address IV-1-2
Mortgage Lender Name and Address IU--9
Application is hereby made to obtain a permit to do the work and installations as indicated. l 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 six6)months at any time after
work is commenced. I understand that separate permits must be secured for Electrical Work, Plumbing,Signs, Wells, Pools, urnaces, 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
BE OMENTERECORDING YOUR NOTICE OF
COMMEI her certify
ert w 11 t I have read and examin,complied with whethered t spehis cifiedhereinor not.n and The granting ofw the same to be ta perue a doesnd cnot. �prll esumetto gons ofe autho ity to laws and violatences gor cancel[the
type
of any other federal,state, or local law regulating construction or the performance of construction.
y � Signature of Contractor f
Signature of Owne �"
.( -im�eA� Print Name .....6fll `.
Prmtl�Iame oL� C/�-5 ................
............. ................................
Sworn to and subscribed before me,,7-e-/4/ X /�r S Sworn to and subscribed before in 20/
th. Da / t s
�. C NTHIA J.
r
CYN HI ROOM-MARSEE "+P _ F f a
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N ary Publi = =My Comm.Expires Aug 25,2014 N to v �p Commission # EE 21076
a• Commission # EE 21076 E,,,„o,,
•°�� Bonded Through Nation 2(.1[)
%OF �p` Bonded Thrnugh National Notary Assn.