1652 BEACH AVE SIDING JIJ
EACH
CITY OF ATLANTIC B
E ROAD
800 SEMINOL
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
SIDING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 14-SIDE-622
Job Type: SIDING PERMIT
Description: SIDING
Estimated Value: $15,000.00
Issue Date: 12/19/2014
Expiration Date: 6/17/2015
PROPERTY ADDRESS:
Address: 1652 BEACH AVE
RE Number: 169573-0000
PROPERTY OWNER:
Name: JOHNSON, GORDON J
Address: 1652 BEACH AVE
GENERAL CONTRACTOR INFORMATION:
Name: MATHIEU BUILDERS
Address: 1778 OCEAN GROVE DR QA DUSTIN MATHIEU BROWN
Phone: - -
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $62.50
BUILDING PERMIT FEE $125.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $191.50
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
city of A-flande. Boach APPLICATION NUMBER
SLOHding Deparitmeh'.�', o be assigned by the Building Department.)
800 Seminole Road k22-
Atlantic Beach, Florida 322:33-5445
City web-site: littp:
Phone(904)247-5826 - Fax(904)247-5845
Hwww.,.,:)ab.us )ate routed:
APPUCAT90N.) REVEW AND TRACKMAG FORM
Proper�ry Address. '46 -Deparimne-nt review required Yes -No
B -i�)
C uildini�)
Applicant :F45 Planning '3..-Zoning
Tree Administrator
Public Wo,,ks
Public Utilities
Public Safety
Fire Services�.. .
Review fee Dept Signature
EMAIL
CNONTA(
APPMAMN STATUS
Reviewing Departrinent First Review: [VApproved. []Denier!
(Circle one.) connn-lients:
(E�
PLANNING &ZONING Reviewed by. Date: 12--/9-y/Z
TREE ADMIN.
Second Revipvqr: []Approved as revised. nDenie
PUBLIC WORKS
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by:
FIRE SERVICES
Third Reviei,�it�. DApproved as revised. oDenied.
Gn,rnnients:
Reviewed by:_
SED 09252014
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach,FL 32233
office (904)247-5826 Fax (904)247-5845
Permit Nu er:
Job Address: Parcel#
q-
Legal Description——.. Oor eil 0 t. non eated/cooled______
Valuation of Work$J��t%oz, —ProposedWork -eated/cooled—E-11 —
__-1 ) Move Demolition pool/spa window/door
Class of Work(circle one): New Addition Alteration (��pair
Commercial fde
1,�RKe s�i
I s
,isting/pro osed structure(s) circle one): (Circle one): es No N /A
Use of ex flure,is a fire sprin=system installed?
if an existing struc
Florida Product Approval# pprova orm
e pro uct ro
For multiple products Us C44d r-W1 C,Lt
Describe in detail the type Of work to be performed:
Ero r owner information:
Address:
0 ILA'
A
Name: State fL-ZIP
city
E-Mail or Fax#(optional)
ictor information: 1-h A _�rvA)A
Qualifying Agent:, State ip 7-Z 3
company Narrie: city
Fax 4
Address: ob Site/Contact Number
office Phone
state Certification[Registration# ----------
Architect Name&Phone 4 ------
Engineer's Name&Phone# .and Address
Fee Simple Title Holder Nam�
Bonding Company Name and Addres
Mortgage Lender Name and Address do the work and installations as indicated I certify that no work or in�tallation has commencedprior to the
Application is hereby made to obtain a permit to f all laws regulating construction in this jyrisdiction. This permit becomes null
ormed to meet the standards o andonedfor aWeriod of siXP6)months at any time after
issuance of a permit and that all work will be perf f construction or work is suspended or ab P0015, urnaces,Boilers,Heaters,
and void if work is not commenced within six(6)months or i d for Electrical Work,Plumbing,signs, elis
work is commenced. I understand that separate permijs must be secure
Tanks and Air Conditioners,etc. ZE TO RECORD A NOTICE OF S
WARNING TO OWNER: YOUR FAILUT
ULT IN YOUR PAYING TWICE FOR IMPROVEMENT
COMMENCEMENT MAY RES ANCING9 CONSULT WITH
TY. IF YOU INTEN T OBTAIN FIN
TO YOUR PROPER RECORDING YOUR NOTICE OF
YOUR LENDER OR AN ATTORNEY BEFORE
COMMENCEMENT.
�the same to be true and correct. All provisions of laws and ordinqnces governing th
an examined thisfap i permit does not presume to give authority to violate or cancel to
I teb certify that I ve rea ,glication and knom e granting of t
type '7grk will be lie wit whether,speci ied herein or not. Th ormance of construction.
provisions of any other e era te, or loca aw regulating construction or the pe�f
Signature of Contractor L
Signature of Owner
hAPrint Name .................6a .......... ..............................................
..................
Print Name ........... ... ... ..... '11a.. .. .. ..... .............. Swom_to and subs 'bed before RV
swoF and s . 20 this 1� 014
this Day o Day of .2
)I 1pph r "JAI A a Im A Jim
'p,A
Notary PUNIC,State of nodda NotaiYPublic
RiW I RMA I FKANI
Commission#FF 100524
114y comm.expires May 17,2018
toll