871 SHERRY DR WINDOW S j`J
CITY OF ATLANTIC BEACH
f 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
30B INFORMATION:
Job ID: 15-WIND-1935
Job Type: WINDOW AND/OR DOOR
Description: REPLACE WINDOWS AND DOORS
Estimated Value: $7,942.00
Issue Date: 8/25/2015
Expiration Date: 2/21/2016
PROPERTY ADDRESS:
Address: 871 SHERRY DR
RE Number: 169982-0000
PROPERTY OWNER:
Name: PALMER ET AL, CHRISTY L
Address: 871 SHERRY DR
GENERAL CONTRACTOR INFORMATION:
Name: HOMERITE WINDOWS AND DOORS
Address: 4801 Executive Park CT N BLDG 200 STE 207
Phone: - -
PERMIT INFORMATION:
FEES:
BUILDING PERMIT FEE $89.71
STATE DCA SURCHARGE $2.00
PLAN CHECK FEES $44.86
STATE DBPR SURCHARGE $2.00
Total Payments: $138.57
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
City of Atlantic Beach APPLICATION NUMBER
rj Building Department (To be assigned by the Building Department.)
r ` 800 Seminole Road
�r Atlantic Beach, Florida 32233-5445 ! J
Phone(904)247-5826 • Fax(904)247-5845
%��'�� �• E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: g� ( ( E�� Department review required Yes o
` ,, Building
Applicant: l--� nnE R t i C— V J I Nf3O� anning &Zoning
Tree Administrator
Project: ( (J O W O O Public Works
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Dateof 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: Approved. []Denied.
(Circle one.) Comments:
=BUILDING
PLANNING &ZONINGDate:
Reviewed by:
TREE ADMIN. ]Second Review: []Approved as revised. Den-
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
CITY OF ATLANTIC BEACH 09-
800 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233
OFFICE:(904)247-5826•FAX NO.:(904)247-5845
BU ILDING-DEPT@COAG.US
on) . BUILDING PERMIT APPLICATION DUVAL COUNTY
1.JOB ADDRESS: - 2.VALUATION OF WORK 3.SD.FT.UNDER ROOF
74�6L� -I u 5 CLASS OF WORK: 6.USE OF STRUCTURE:
4.LEGAL DESCRIPTION:
❑NEW BUILDING ❑DEMOLITION El RESIDENTIAL
LOT_BLOCK_SUB DIVISION ❑ADDITION ❑CONVERTING USE ❑COMMERCIAL
7.DESCRIPTION OF WORK:
❑ALTERATION ❑ACCESSORY BLDG. 8.FIRE SPRINKLER:
❑REPAIR ❑POOL/SPA ❑YES ❑N/A
L Z �C-L-Z"<-L t.J 1...10- o ❑MOVE ❑OTHER ❑NO
PROPERTY OWNER: CONTRACTOR: ARCHITECT I ENGINEER:
15.COMPANY NAME, 23.COMPANY NAME:
9.NAME: 1 I � � ��:��u I-I�C'�..�''S
16.NAME: 24.LICENSEE NAME:
10.ADDRESS: 17.STATE OF FLORIDA LICENSE NO.: 25.STATE OF FLORIDA LICENSE NO.:
`3 e V L, \ 3�a S 18.ADDRESS:ye �- 14 r Z 26.ADDRESS:
rz, t 4.'CfLw Jv4 ��c�� -�
11.OFFICE PHONE: 12.FAX NO.: 19.OFFICE PHONE 2g0�FAX NO.: ✓' 27.OFFICE PHONE: 28.FAX NO.:
L9g4, otso) is
13.G LL PHONE:
21.CELL PHONE: 29.CELL PHONE:
` L;�1
_3e, - SCo L#O Lim t Q 3�l 8 SIUv
14.EMAIL ADDRESS:
22,EMAIL ADDRESS: 30.EMAIL ADDRESS:
FEE SIMPLE TITLE HOLDER: BONDING COMPANY: MORTGAGE LENDER:
(IF OTHER THAN OWNER)
33.NAME: 35.NAME:
31.NAME:
32.ADDRESS:
34.ADDRESS: 36.ADDRESS:
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance 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 and 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 after work is commenced. I understand that separate permits must be secured for
Electrical Work,Plumbing,Signs,Wells,Pools,Furnaces,Boilers,Heaters,Tanks, Air Conditioners,etc.
OWNER'S AFFIDAVIT- I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable
laws regulating construction and zoning. I will not occupy or use the referenced building or any part therof, until all inspections are finaled and
prior to obtaining a certificate of occupancy or completion issued by the building official,as required by law.
WARNING TO OWNER: ***
YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
ON RACTOR
OWNER or AGENT (0 er0 )
(If gent,Power of omey or cy Letter Required)
Signed:
Date: �- t i f`� Signed. ffi
Before m this day of
20 unty of Before me this d !1v �-� e county of
Duval,State of Flo' Duval,State of oPe�4(7i�XLaF4�F#E�DEAREN III
A ES DEAREN IIIA*' �z Commission 8 FF 19s92b
#FF 190928 a
I tions are
nn by himself!h * e M& � . 9t ns are herin by himsel 2- E
t rs t lj� .f F
gpdse 1tWUJ,+F'"t1*U1" -..3 true and aCGUfa
true and accurate. ''„RIS k•'' �`
Notary Public at Lar tate of 1 ' ,County of t�tn✓= I Notary Public at Large,State of �/V"r'�` .County of
[Personally Known
R-Personally Known
� ❑Produced Identifi tion-
❑Produced Identifi n-
Notary Signature:,� � 1 -`
Notary Signature:
BLDG01 Permit Application Bldg:REVISED:12/182008
NOTICE OF COMMENCEMENT
{ oy (PREPARE IN DUPLICATE)
.k-".00111 Col Permit No. 7 ^`�V l ✓ Tax Folio No.
State of 1— I L3 County of O�Vr ll-
To whom it may concern:
The undersigned hereby informs you that improvements will be made to certain real property,and in
accordance with Section 713 of the Florida Statutes,the following information is stated in this NOTICE OF
COMMENCEMENT.
Legal description of property being improved:
"l0 q I(p S 2 1 L 321-1 A—`G.V1�1 L ctC�
Address of property being improved: <gq 1
t—1 -,� a� 3 3 -i
General description of improvements: 5 �L e- M L-.L �,.�I,
Owner T-tl ' O
Address 1 4, L//�, (�� (.2-ft-(, £�-�1 1 r 3 as 3.3
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor ��c3m g "^ ar,� i b c - s
Address e4 'r�(-t Perk C-�- ,1 S-L l"l 3 cl-a i L Stirlf aU'- OJI 3a'
Phone No. �� '02 10' 5 is Fax No.
Surety(if any)
• Address Amount of bond$
Phone No. Fax No.
Name and address of any person making a loan for the construction of the improvements.
Name
Address
Phone No. Fax No.
Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other
documents may be served:
Name
Address
Phone No. Fax No.
In addition to himself,owner designates the following person to receive a copy of the Lienor's Notice as provided in
Section 713.06(2)(b),Florida Statutes.(Fill in at Owner's option).
Name
Address
Phone No. Fax No.
Expiration date of Notice of Commencement(the expiration date is o�ie(1)year from the date of recording unless a
different date is specified):
THIS SPACE FOR RECORDER'S USE ONLYWNE
41-1
SignedDATE
Before a ay of i Y in the
County o val State of Flori he a na ly appeared
' herein by
�rm&fftve-r-sela-ndllafftfrrvs that all sta eme t nd declarations herein
are true attLIA
Doc#2015186313,OR BK 17267 Page 1379,Number Pages:1Recorded 08/13/2015 at 11:36 AM, Z Am sandxRonnie Fussell CLERK CIRCUIT COURT DUVAL 0� =
COUNTY Not Puco h+ T'.
RECORDING$10.00 Mycommission e p
Personally Knownor
Produced Identific ion
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