1872 HICKORY LN - BATH REMODEL CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
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-1402
Job Type: RESIDENTIAL ALTERATION
Description: bathroom remodel
Estimated Value: $600.00
Issue Date: 6/16/2015
Expiration Date: 12/13/2015
PROPERTY ADDRESS:
Address: 1872 HICKORY LN
RE Number: 172020-1458
PROPERTY OWNER:
Name: PIERSON,
Address: 1872 HICKORY LN
PERMIT INFORMATION: HANNA BUILDERS
FEES:
BUILDING PERMIT FEE $55.00
STATE DBPR SURCHARGE $2.00
PLAN CHECK FEES $27.50
STATE DCA SURCHARGE $2.00
Total Payments: $86.50
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach,FL 32233
p� Office(904)247-5826 Fax(904)247-5845
Job Address: ):�/czrlpy Lfh,/E Permit Number:
Legal Description 37-A9 9"`�S '�7.9E S _HMtrpA Inc T parcel# ) 7 �k0 7.0- 1Y
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eg our ea o q. t, q, t
Valuation of Work$ Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition <Aker do Repair Move Demolition poollspa window/door
Use of existing/propused structure(s)((circle one): Commercial
If an existing structure,is a fire spnIer system installed?(Circle one): Yes No f..
Florida ProductApproval# U..-
For multiple products use pro uct approve orm
Describe in detail the type of work to be performed: 04+t✓50k- ICAAM o,aW
Property Owner Information: /
Name: r! vn Address: /872 /T,L-(tory FYI. e
City c State&Zip 3Z2 L Phone 904 _ft- Z61B
E-Mail or Fax#(Optional) I ll � ''••
Contractor Information: CONTRACTOR EMAIL ADDRESS, kAbltdabtl.tlaedY ,fit �/th✓cOa cdrL�-
Company Nam
/{[udNa k 11114rS Qualifying Agent:, /�l kt r h4( ka
Address: /3Y 36 _< City- �! 6 State f�L Zip 322_9-0
Office Phone Fol/ Z36 V5-9 Job Site/Contact Number istrtration# R:Zlrl/ Turret Fax# Y7 zy9 pot
State Cenification/Re
g �tQC /2_Sb 9-89 Ti -9L2 - C23
Architect Name&Phone# KA- '
Engineer's Name&Phone# AA-
Fee Simple Title Holder Name and Address 411v*W- 4,6o✓iL
Bonding Company Name and Address As-
Mortgage Lender Name and Address ^^-
Application is hereby made to obtain a permit to do the work and installations as indicated I cerdfy that no work or installation has commenced prior to the
issuance ofa permit and that all work will be performed to meet the standards ofall laws mgu/aging construction to this jurisdiction. This permit becomes null
and void!work is not commenced within six(6)months,or if construction or work is suspended or ahandonedfor a veriod afsk/6)months at airy time aper
work u commenced. I understand that separate permits most be secured for Electrics/Work,Plumbing,Signs, Wets,Pools, Furnaces,Bollets,Healers,
Tanks end 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 YO1)R NOTICE OF
COMMENCEMENT.
I hereby cert that l have read and ezaminedthis plication and know,the same to be true andcorrect. Al!provtsioor oflows and ordmnces governtn this
type of work will be complied with whether srPeci dd herein or not. The granting of a permit does not presume to give authority to violate or cancel the
Provisionsofany otherfederal,-state-,Aor lata![c w regulating construction or the performance ofconstruction.
Signature of Owner �r�c+l/ Pi/ Signature of Contractor cis
Print Name 7v"I t L el eQSON Print Name
fo e II Before t re
tht ay f `L 20 Y this ks 1yv 20
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Nofary Public �7 / No[ Public YtdpOd!
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