492 AQUATIC DR DOOR CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
WINDOW AND/OR DOOR PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-WIND-938
Job Type: WINDOW AND/OR DOOR
Description: DOOR REPLACEMENT
Estimated Value: $3,465.00
Issue Date: 5/4/2015
Expiration Date: 10/31/2015
PROPERTY ADDRESS:
Address: 492 AQUATIC DR
RE Number: 171818-5164
PROPERTY OWNER:
Name: STOVER, ERIKA D
Address: 492 AQUATIC DR
GENERAL CONTRACTOR INFORMATION:
Name: FLORIDA HOME IMPROVEMENT
Address: 4070 SW 30 AVE WAYNE T BURNETT
Phone: - -
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $33.66
BUILDING PERMIT FEE $67.33
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $104.99
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
Doc # 2015090384, OR BK 17139 Page 1298, Number Pages: 1, Recorded
04/21/2015 at 04:49 PM, Ronnie Fussell CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10.00
FILE COPY
OV,Cok"MmMENT
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STATE OF FLORIDA
DUVALCOUNTY
UND Clerk of the Ckcuft&County Courts,Duval
County,�E EREBY CER71FY the within and foregoing,
DO H
consisting of g9s,is a true and correct copy of the original
as It appears on teconi and file in 1he office of the Clerk of Circut
&County Courts of Duval
WITNESS myliand ends 01 S
at Jacksowdle,Rotide,this day oA
AT"�-t cm- kll��
RONNIE FUSSELL
Chaft Circuit and olinty Courts
I Deputy Clark
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building DeAartment.)
800 Seminole Road
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 - Fax(904)247-5845
E-mail: building-dept@coab.us L_aate routed: 2-2
Cityweb-site: http://www.coab.us #I i
APPLICATION REVIEW AND TRACKING FORM
Property Address: Jq2- A/'A��/-—14.—6 rtment review required Yes 0
<B ing
�uilding
Applicant: tM—')r Planning &Zon—ing -
1 166 M CA -
I Tree Administrator
Project: 'q t, a ri T Public Works
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Sicinature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
Florida Dept. of Environmental Protection
Florida Dept. of Transportation
St. Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: [�<Pprovecl. FIDenied.
(Circle one.) Comments:
PLANNING &ZONING Reviewed by.- Date:
TREE ADMIN.
Second Review: ElApproved as revised. ElDenied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: E]Approved as revised. FIDenied.
Comments:
Reviewed by: Date:
Revised 07/27/10
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233 FILE COPY
Office (904)247-5826 Fax (904) 247-5845
Job Address: "i q Z A do C.t�c bv'- Permit Number: 15"WI&O -t?3ff
Legal Description A,40Q K C 6c, Parcel#
Floor Area ot Sq.Ft. Nq.Pt
Valuation of Work$ �)4QeS Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration (Re�a Move Demolition pool/spa lwi2�
Use of existing/proposed stru-*,-- Commer:cial �es i d�ei
te )italled? (Circle one): s
If an existing structure i re spvin er s�yst es No N/A
Florida Product Approyal# F(- I
For multiple products m
Describe in detail the type of work to be performed: 2-2 0 LCI, Dkob f:q� S�,�-�e
Property Owner Information:
Name: E r I �g, V-P-v"' Address: 46)Z- 4dUc)'1(_
City-A--&A ii C- F�eck-On State�iLZip 'L;��733 Phone qCj�:t- 504- S5,:�,e)
E-Mail or Fax#(Optional)
Contractor Information:
CompanyName: ',7L4�Lk-AE _'Xry\p4-0V124y,,_W't �6,30r_ Qual*f Agentu- a hjrL'-P_k+
Address: �0'�O—5UD city MgQ-00od) State 4--,- zip ;6 31 Z_
Office Phone Ot 04 -16 1 ',-1 It I Job Site/Contact Number q0Q'6j 1-14 1� -fdl3Fax#
State Certification/Registration# Ck-�, C_D�ze Q
Architect Name&Phone# d
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
A ica io is e eb made b a 'a ermit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the
11 be performed to meet the standards of all laws regulating const . . I ' risdiction. This permit becomes null
to 0 t "k P ruction in t nsjy�
t wor it w
1.pp' c r i d tha d h f construction or work is suspended or abandonedfor a period ofsixp�)months at any time after
s8uan e o ape t an
and oid f work s not co en e in six(6)months, or i
., ,c' '"T c -
,k, omm'ned. I understand that separate permits must be securedfor Electrical—Work,Plumbing,Sikns, Wells, Pools, urnaces,Boileis,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 hereb
,/certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this
The granting of a permit doespot sume to give authority to vio te or ca
work will be complied with whether srecified herein or not. ncel the
provisions of any otherfederal,state, or local law reg&ting construction or the performance of constructiff
Signature of Owner Signature of Contractor
'R*;w
. . . . .... .. . ... .....
Print Name I
Print Name ti-
......................................
Sworn to.and subscrftd Nfor :m 20 Sworn to and subsofibed be ore re 20'C5
this I ")Day oy� ftVc( j-5- this 1 4-0
T% — n�`-,)
Notary Pudfti-c Notary Revised 01.26.10
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