28 17TH ST - SIDING eft
CITY OF ATLANTIC BEACH
;,. 800 SEMINOLE ROAD
-" ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
II
SIDING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-SIDE-1356
Job Type: SIDING PERMIT
Description: SIDING
Estimated Value: $6,000.00
Issue Date: 6/15/2015
Expiration Date: 12/12/2015
PROPERTY ADDRESS:
Address: 28 17TH ST
RE Number: 169590-0010
PROPERTY OWNER:
Name: GAY, CATHY
Address: 28 17TH ST
GENERAL CONTRACTOR INFORMATION:
Name: PRO-BUILDERS OF FLORIDA LLC
Address: 1115 S OAKS RIDGE DR LUIS EDUARDO ROSERO
Phone: - -
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $40.00
BUILDING PERMIT FEE $80.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $124.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
c:-v1}i City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
i BOO Seminole Road
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 Fax(904)247-5845
E-mail' building-dept@wab.us Date routed:
Cityweb-site'. hftp://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: d V 11M M Spopartirmint review required Yes No
QQ ,,/ // / �// Building
Applicant- ,e6&/1o/E/1S Q)( / fevll d� Planning &Zoning
IV Tree Administrator
Project: S/ET7 07 2CEOfij�l. Public Works
T—� Public Utilities
Public Safety
Fire Services
Review fe
Other Agency Review or Permit Required Reviewor Receipt Date
of Pemrit Verified B
Florida Dept.of Environmental Protection
Florida Dept.of Transportation
SL 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: MAAPproved. ❑Denied.
(Circle one.) Comments: /'�
BUILDING p 0
PLANNING&ZONING Reviewed by: Date:G`//'/S
TREEADMIN. Second Review:
❑Approved as revised. ❑Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revhed 07/37110
BUILDING PERMIT APPLICATION
+ FILA COPS CITY OF ATLANTIC BEACH
0 0 d D
Seminole Road, Atlantic Beach,FL 32233
�yOffice (904)247-5826 Fax (904)247-5845 JUN
Job Address: d 7 t6 S T A
Permit Num E3 3
Legal Description jbtjm Hous& Parcel# _
6'_00Z)� olo�eao qFt:�1
Valuation of Work S Proposed Work heated/cooled I1 ,e13 a3 0 non-heated/cooled `_U
Class of Work(circle one): New Addition Alteration Repay Move Demolition pool/spa window/door
Use of existing/propposed structures)(circle one): Commercial esidenti
If an existing strocture,is a tire sprinuer system installed?(Circle one): o N/A
Florida Product Approval#
For multiple products use product approve orm
Describe in detail the type of work to be performed. _
1�3Z1 Gam- C 06 t; ,1 t.1.4 5 I D / rl G -�'�h iZ 1.�� scvg_ (,Ewa91 waw
Property Owner Information• p
Name: -1-�7 Lux 6CWZ Address: / 01 L)( /3CV1.) #�� hel
City T _ StateT(Zip Phone 6 LE/- Q:73- - 3 Cj jr
E-Mail or Fax#(Optional)
Contractor Information: CONTRACTOR EMAIL ADDRESS,
Company Name: "l�6VtLye-p'S o� ef U(. uali ing Agent - Ll9LS 90_14 R7
Address:_1t16 oyfa suu Ci �3OKFVLt.Eyc
t3' state _ zip 3
Office Phone g1—�-T$Gr o 0 y Job Sit I Number Fax#
State Certification/Registration# C fi C- ( $ 1 L4 V
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Tide 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 certf that no work ar installation has commenced prior to the
issuance, 'w permit aruf that all work will be per ormedto meet the standards ofall laws regulating construction in thisjurisdiction. This permit becomes null
and void, is not commenced within six(5 months, or ffconstruction or work u sus ended or abandonedfor a pperiod ajsix/6J months at any time a er
Tanks and Air Condidonert,sand that separate permits must be secured for ElecnicntPWark,Plumbing,Signs, Wells,Pools,Furnaces,Boilers,Healers,
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 Y0a[)R NOTICE OF
COMMENCEMENT.
I hereby cert that l have read and examined thu application and know rhe same m be true and correct Al/provisio oJ'laws and artLnances governing this
type of work will be complied w'th whether supet; Ed herein or not. The granting of a permit does not presume to glue author; ro viafine or cancel the
provisions ojarry other fed al, te,or(oc. !tw t gulaling c tstrucrion or the performance ofcona rection.
Signatureof Owne Signature of Contractor
Print Name Cl.-1-elo. ... ..........� .rZ Print Name «�'1s
...... .........
Befor aBelo
C
this_ Day of 0 this ay of-- 1.1 20 J
Notary Public ota
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