1969 SEMINOLE RD SIDING CITY OF ATLANTIC BEACH
J 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
it
SIDING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-SIDE-1207
Job Type: SIDING PERMIT
Description: SIDING
Estimated Value: $12,000.00
Issue Date: 6/9/2015
Expiration Date: 12/6/2015
PROPERTY ADDRESS:
Address: 1969 SEMINOLE RD
RE Number: 169542-0506
PROPERTY OWNER:
Name: MCHAN, JOSEPH H
Address: 1969 SEMINOLE RD
GENERAL CONTRACTOR INFORMATION:
Name: DAVIS AND ASOC BUILDERS INC
Address: 12627 San Jose BLVD STE 704
Phone: - -
PERMIT INFORMATION:
FEES:
BUILDING PERMIT FEE $110.00
STATE DCA SURCHARGE $2.00
PLAN CHECK FEES $55.00
STATE DBPR SURCHARGE $2.00
Total Payments: $169.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES
City of Atlantic Beach
Building Department APPLICATION NUMBER
'\q7 800 Seminole Road (Tc be assignetl by the Building DepanmeiH.
Atlantic Beach, Florida 32233-5445 / (
Phone(904)247-SM Fax(904)247-584,5 SI G • '2
E-mail: building-dept@coab.us
Cityweb-site: htlp:i/www.wab.us Date routetl:
APPLICATION REVIEW AND TRACKING FORM
Property Address: /
d De nY review Yes required
Applicant: �1/I 5 S �SS� uilding 4 No
` arming&Zoning
Project: Tree Administrator
Public Works
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Perm it Required Review or Receipt
Runde Dept of Environmental Protectlon of Permit Verified B Date
Florida Dept.of Transpomffiion
St.Johns River Water Management District
Any Corps of Engineers
Division of Hotels and Resteum is
Division of Alcoholic Beverages and Tobacco
Other.
APPLICATION STATUS
Reviewing Department First Review;
(Circle one.) Proved. ❑Denied.
Comments:
BUILDING
PLANNING&ZONING
TREE ADMIN. Reviewedby: _
Second Review: �—Date: ? Y 7
PUBLIC WORKS Comments: ❑Proved as revised. []Denied.
PUBLIC UTILITIES
PUBLIC SAFETY
Reviewed by:
FIRESERVICES Third Review: Date:
Approved as revised. —�
Comments: �Denietl.
Reviewed by:
Date:
iced e]/2r/10 �—
BUILDING PERMIT APPLICATIOND
CITY OF ATLANTIC BEACH a 800 Seminole Road,Atlantic Beach,FL 32233
Office(904)247-5826 Fax(904)247-5845
Job Address: 1 IJO Permit Number:
Legal Description 2^ 14 (Y?- zS - 2i9 _E Parcel# 0 N I to 2 GCA/ - S to£
Valuation of Work$ 000 Poor of �o —Sq,F
Proposed Work heated/cooled_JJ 0��— non-heated/cooled 550
Class of Work(circle one): New Addition Alteration (R:epa:i,5 Move Demolition pool/spa window/door
Use ofeaisting/prorsed structure(s) circle one): Commercial C
If an existing structure,is a fire sprinkler e installed"(Circle one): Yes No N/A
Florida ProductApproval# L 1 L 0
For multiple products use pro net approve orm
Js-
Describe in detail the type of work to be performed:_�1
S tot&f-G
Property Owner Information:
Name: Address:J-L_D__'l
City State ip3_ 3.3_-Phone4 C21z1 C-` 6
E-Mail or Fax 1 (Optional)
Contractor Information: I
Company Name: l(,0a�Qualifying Agent: �1 �"�A) �D at's
Address:_1_.Z(o9,7 .4r}n) p,Z4'` Wil[ 0 City .,1]�� !� L Statezip
Oftice Phone r�g� -S Job Site/Contact Number 4Q`(,- S 3 3� Fax#
State Certification/Registration#
Architect Name&Phone# N
Engineer's Name&Phone#
Fee Simple Title Holder Name and Ad
Bonding Company Name anddress
d A
Mortgage Lender Name and Address P
Application u hereby made to obtain apermit to do the work and installations as buftwed J cert that no work or installation hos commencedprior to the
issuance ofa permit and that a//work will be performed to meet the standards ofall laws regulating construction in g inst Nation h canonrmlt be rar to t e
and void sf work u not commenced within six(6)months, or if-construction or work tr sus nded ar abandoned jar aperind ofsion.((6J months at say time atttter
ll
work u commenced !understand that separate permits must be secured jos B/emkvPeN'ork,IMumbing,Signs, Weltr,Pools,parnacrs.Boilers,Nesters,
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 hemV Ven fy that l ha mad and emmimd this plication a d k m the some to betme and correct All provisions of laws aM ordinonces gas�rning!!ds
type o)work will be complied with whether speed herein or not. The graving of a permit does not presume to gave aulhoriry to vim. or conte/the
provisions ojarry miurfedem(slow. m'llocal law regulating construction or the performance ti-construction.
Signature of Owner Signature of Contractor, w•r~
Print Name Print Name
'J X......._ �4a spat._..._......_..__...... ..P4 -ROW............._ _..._�..
.
Sworn t and subsc 'bed before me Sworn to and subscri fo me
this Day of this 'L0 D 20 l S
Notary -blic4/ s ,M�•I .MANA Pu
3
4 Notary Public-6nb as F (rJ € NPMry Public 6bm o1 garias
f MyCpmm.Expire,Sp S.2016 MR M94 AstfleC*N02016
?a n„ - Commission I EE 116021 `'o;!o. .d;+ Commission t EE 1091q