290 BEACH AVE DEMO f � CITY OF ATLANTIC BEACH
� SSS
J 800 SEMINOLE ROAD
. ' r ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
+�JjD9,
DEMOLITION PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 14-00000883
Job Type: DEMOLITION
Description: INTERIOR DEMO
Estimated Value:
Issue Date: 11/13/2014
Expiration Date: 5/12/2015
PROPERTY ADDRESS:
Address: 290 BEACH AVE
RE Number: 170196-0010
PROPERTY OWNER:
Name: PITLER, ANDY
Address:
GENERAL CONTRACTOR INFORMATION:
Name: BOSCO BUILDING CONTRACTORS
Address: 2158 MAYPORT RD QA TODD ALBERT BOSCO
Phone: - -
PERMIT INFORMATION:
FEES:
PERMIT FEES $100.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $104.00
PERS IT 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 JUN 0 2 20\4
Job Address: Permit Numbe P
Legal Description Parcel #
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work $ Proposed Work heated/cooled N 14 non-heated/cooled 1J
Class of Work(circle one): New Addition Alteration Repair Move emolition pool/spa window/door
Use of existing/proposed structure(s)(circle one):. Commercial est entia
If an existing structure,is a fire sprinkl r system installed? (Circle one : es o a�
Florida Product Approval # z �
For multiple products use product a prova orm
Describe in detail the type of work to be performed: //ATE ,/(1 jZ NOT WHO
0OUS A5
Property Owner Information:
Name: Address:
Citytate ip Phone —
E-Mail-or Fax#(Optional)
Contractor Information:
Company Name: Quali i A ent: 49151' A�asw
Address: City State �Tp
Office Phone — Job Site/Contact Number — — Fax# D 0
State Certification/Registration ication/Registration#
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 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 hermit 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 tf x ork 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 Elec/rica!Work, Plumbing,Signs, Wells, Pools, �urnaces, Boilers, Heaters,
Talks 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.
hereby cerci that 1 have read and examined thisplication and know the same to be true and correct. All provisions o/laws and ordinances governing this
ape o1 work ill be complied with wether sreci ted herein or nqt. The granting of a permit does not presume to give authority to violate or cancel the
)rovisions df other federal,state ocal law regulating construction or the performance of construction.
Signature o Owner Signature of Contractor
Tint Name ('�'�`� Print Name Pbk>
Sworn t and cri be re file Swor to s ribed a re e
his f 20 this 20�
a EN
Notary Public-State of Florida NO b •
My Comm.Expires Jan 26,2015
3N :re My Comm.Expires Jan 26.2015 Comma ion.I E
• �� 6.1
Commission#EE 59080 lot, tse
CITY OF ATLANTIC BEACH
900 SEMINOLE ROAD ,
ATLANTIC BEACH, FL 32333
PHONE (904) 247-5955
cashier Id: aspcust\atlbdas
I'teceipt Date: 11/13/ 014
iceipt Number: OS-65551.
;ab ID: 14--00000993 - INTERIOR DEMO PF PE
R.-IIT FEES $100.00
i:�b ID: 14-00000993 INTERIOR DEMO DC - Sl
TE DCA SURCHARGE L.OD
ob ID. 14-00000993 - INTERIOR DEMO SS - JT
ATE DBPR SURCHARGE $2.00
Amount Due: $104.00
Tender Information: Check # 7956 $104.00 '
Tender Type: CK
Tender Amount: $104.00
Change Due: $0.00