1731 PARK TERRACE E - WINDOW / DOOR BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH OFFICE COPY
800 Seminole Road, Atlantic Beach, FL 32233
Office (904)247-5826 Fax (904)247-5845
Job Address: /73/ PRA Tama— E; Perwit Number:
Legal Description LOT t{ f3iot1z P1 5E 1V11 two parcel# /-7.1,2, 020—OIL)
q� Floor Area of Sq.Ft. S . t
Valuation of Work$ I, 143D Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Rep'. Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial Residentia
If an existing structure,is a fires rinkler system installed?(Circle one): • -s . N/A k
Florida Product Approval # S-1 i9 e3 1(07. i 517 3 5/74 . . 761). 5 ��l�• 6�`l�d��s�
For multiple products use product approval form
Describe in detail the type of work to be performed: RE-e llt.E /I wi,t 1 1
Property Owner Information:
Name: C.HJ-iRI6 S U e-o L j Address: 17 31 Pft T Et v'tr /c
City /J rthivr L 13 Efit H State f LZip L -33 Phone 1./ 31p.5157
E-Mail or Fax#(Optional)
Contractor Information:
. rat/rAit
Company Name: t A L I f /eCfIv d Qualifying Agent: SAM S ( )$N o f
Address: Z&7 sUf'Nr4 TEL' s .ACC City 6--. I &i 5 rode_ State 'FL. Zip 32--0 96.--
Office Phone 4/ 3C,--,i SA Job Site/Contact Number 35 env, Fax#
State Certification/Registration#
Architect Name&Phone#
Engineer's Name&Phone#
See Simple Title Holder Name and Address
3onding Company Name and Address
vfortgage Lender Name and Address
Ipplication is hereby made to obtain a permit to do the work and installations as indicated. l certify that no work or installation has commenced prior to the
nuance 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
.nd void if work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a period of six(6)months at any time aver
'ork is commenced. I understand that separate permits must be secured for ElectricalpWork,Plumbing,Signs, Wells,Pools, Furnaces,Boilers,Heaters,
links and Air Conditioners,eta
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.
hereby ertify 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
pe of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the
•ovisions of any other federal,state, or local law reg lating construction or the performance of construction.
/ t
ignature of Owner �� Signature of Contractor IR c"""V"N-int Name 0j� Print Name $R � YANA_
a� t3.i$ t0�
�vorn to and subscrib d before me
is Li Day of u ,20 v Sworn to and subscribed before me
(� / this 1/ Day of Gorr J ,20 IS
Mary Public °""'.'YeN•: BRETT C HAURY — 0 '°68�.
Notary Public G��� : BRETT C HAURY
iii MY COMMISSION#FF136933 `:-,i •� MY COMMISSION#FF136933
?of it.• EXPIRES June 29,2018 ,±, , , VI E J ,e 29,2018
407 3980153 Floridallot Service.cOm
{ _�.__ azY (407)398-0153 FloridallotarvServlCe.COm
s
CITY OF ATLANTIC BEACH
ii 1S\ 800 Seminole Road
-- , It'
1 Atlantic Beach,Florida 32233
j r Telephone(904)247-5800
FAX(904)247-5845
gill 9'
REVISION REQUEST SHEET
Date: 1-Zki S Received by: Resubmitted:
Permit Number: /S IiU l,I I)— I q I Z
Original Plans Examiner: fi K E Project Name: f leet,∎ S
Project Address: 1`731 E . PAM *TEkeAcE
Contractor: 6 eEEA1 t' .t�4v w s Contact Name: Nina S M(,�,,
Contact Phone : '1-713 3 Contact e-mail: &LLIp/10E PSegt• 1-44tfoo .eort r
Revision/Plan Check/Permit Fee(s)Due: $
Description of Proposed Revision to Existing Permit:
Eh1,�UE /097 ' Iwt�Do �� long "
tE Abut . & 7t 1 Z , 5 72" X ego" PAT( PooP-
Additional Increase in Building Value: $ 7 Additional S.F.
Site Plan Revised: Public W/U Approval:
By signing below. I(print name) V844 40— r a MORA affirm that the above revision
is inclusive of the proposed changes.
z1- i S-
ignature of Contractor/Agent(contractor must sign if increase in valuation) Date
Office Use Only
Date: gln.ta Approved: r` Rejected: Notified by:
Plan Review Comments:
pt. #s di ed
rn , o/ p fn 3-ec--f-.
Department review required Yes o
Building `ir • 2k/5
Planning &Zoning TGEWEI Tree Administrator ns Examiner
Public Works
Public Utilities AUG 2 1 2015
u is Safety
Fire Services I/
I Date Created 8/20!15 Rcv.2
S rLy.
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
J'(6 ATLANTIC BEACH, FL 32233
OFFICE CO PY
WINDOW AND/OR DOOR PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-WIND-1912
Job Type: WINDOW AND/OR DOOR
Description: WINDOW RE-PLACE 11 WINDOWS
Estimated Value: $9,430.00
Issue Date: 8/14/2015
Expiration Date: 2/10/2016
PROPERTY ADDRESS:
Address: 1731 E PARK TER
RE Number: 172020-0404
PROPERTY OWNER:
Name: HARRIS, IVY C
Address: 1731 PARK TER
GENERAL CONTRACTOR INFORMATION:
Name: GREEN MACHINE
Address:
Phone: 904-436-5151
PERMIT INFORMATION:
FEES: ----- — -PLAN CHECK FEES $48.58
BUILDING PERMIT FEE $97.15
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $149.73
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.