1912 SELVA MARINA DR 2015 BATH REMODEL -�'''-A'`j-
CITY OF ATLANTIC BEACH
f 800 SEMINOLE ROAD
j ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
RESIDENTIAL ALT/OTHER
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-RAAR-426
Job Type: RESIDENTIAL ALTERATION
Description: BATH REMODEL
Estimated Value: $2,000.00
Issue Date: 2/26/2015
Expiration Date: 8/25/2015
PROPERTY ADDRESS:
Address: 1912 SELVA MARINA DR
RE Number: 169462-0110
PROPERTY OWNER:
Name: WERNKE, BARBARA
Address: 1912 SELVA MARINA DR
GENERAL CONTRACTOR INFORMATION:
Name: J T CONSTRUCTION & REMODEL LLC
Address: 421 W Church ST STE 400
Phone: - -
PERMIT INFORMATION:
FEES:
BUILDING PERMIT FEE $60.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $64.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach,FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: 2 �'�� �1' Permit Number:
Legal Description 'a `��'K g�'1O �'( `�" Parcel#
d' as oor ea o q. t. Sq.Ft
Valuation of Work$..fie 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/pro osed structure(s)(circle one): Commercial Residential
If an existing structure ,is a fire sprinkler system installed? (Circle one): Yes No N/A
Florida Product Approval#
For multiple products use product app—ro—vaFform
Describe in detail the type of work to be performed: «— tr[-
Property Owner Information:
Name: d,CLym i tiL L 4J 7 5\'1 9, KO Address: tq k Z `�(C`i�IA HU_r:\4-U,. �r
City State Zip23 233 Phone rbl3
E-Mail or F (Optional)
Contractor Information: CONTRACTOR EMAIL ADDRESS:
Company Name: Qualifying Agent:
Address: '� city .!n "'r? State ✓ Zip o
Office Phone Job Site/Contact Number Fax#
State Certification/Registration# .C:f 3 ��
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. 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 aperiod 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, 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 BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
I here b certify that I have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this
type P.work will be complied with whether speci zed herein or not. The granting of a permit does not presume to :ori r cancel the
provisions of any other federal,state, or local law regulating construction or the performance of construction.
Signature of Owner Signature of Co ctor
PrintName Print Name ........ G .......t-................ ...........................................
Before me Befor me
this ay of 20 this ay f 20
Notary Ptl No ary u 1
opAY P4, Notary Public State of Florida o�►A� Notary Publi St a of Florida
%+ , Shirley L Graham f Shirley L d 01.26.
I� p, My Commission FF 086990 �j �,p'� My Commission FF 086990
�orra Expires 02114/2018 7p mss' Expires 02/14/2018
ate.