81 5th ST - INTERIOR DEMO :� 'S f CITY OF ATLANTIC BEACH
A s� 800 SEMINOLE ROAD
J Pr X ATLANTIC BEACH, FL 32233
e -i.*'r's
INSPECTION PHONE LINE 247-5814
'vJ131,�
DEMOLITION PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-DEMO-2207
Job Type: DEMOLITION
Description: INTERIOR DEMOLITION
Estimated Value: $4,500.00
Issue Date: 9/18/2015
Expiration Date: 3/16/2016
PROPERTY ADDRESS:
Address: 81 5TH ST
RE Number: 170151-0000
PROPERTY OWNER:
Name: HOLMES, HARRIET E
Address: 81 5TH ST
GENERAL CONTRACTOR INFORMATION:
Name: Inc, Surfside Homes LOUIS
Address: 108 Osprey Cove LN
Phone: 904-534-3904
PERMIT INFORMATION:
FEES:
STATE DCA SURCHARGE $2.00
Demolition Fee $100.00
STATE DBPR SURCHARGE $2.00
Total Payments: $104.00
PERNIIT IS APPROVED ONLY IN ACCORDANCE. WITH AI,I. CITY OF ATLANTIC BEACH ORDINANCES AND 771E FLORIDA
BUILDING CODES.
4
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH •
800 Seminole Road,Atlantic Beach, FL 32233
Office (904) 247-5826 Fax(904)247-5845
Job Address: el I 5 4 L, S fi l Permit Number:
Legal Description
Floor Area of Sq.Ft. Parcel#
Valuation of Work$ 4,5C/0 Proposed Work heated/cooled t
non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial Residential
If an existing structure,is a fire sprinkler system installed? (Circle one): Yes o N/A
Florida Product Approval#
For multiple products use product approva orm
Describe in detail the type of work to be performed: Q,Q h'1 f J C., 1 It i--)0 I a • tk J a tI £ -1i 00 t 1
Property Owner Information:
VA,
Name* ■ � •
1 • SA C� i 1 elZ, . Address: I Of. &S •r' (o e it 14 02. ,
City ira11 :tai State 1 ip 2Phone + P,is •
E-Mail or Fax#(Optional) na_ I l'1 0.5 Cr L ttA-teR- II o u ' . �p t- cl. ,
Contractor Information: • CONTRACTOR EMAIL ADDRESS: So�,Ie,r -nop D � �crtl t i e
Company Name: S't>QFS 1.06- b y7p- '
Address: )Name:
v_sf1�Fy /..04,1)e-S /,JC, Qualifying Agent: Lo[.// y Si4A4r j,r�_,
Office Phone �1' 1� City ,l k& YF State rL Zip a8 Job Site/Contact Number p �
State Certification/Registration# e' s c, 04 DV�� � - 3A1 0 Fax# ,,z r4,-n�1
Architect Name&Phone# '
Engineer's Name&Phone#
Fee Simple Title 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 certi.15,that no work or installation has commenced prior to the
anissuance oid work shot commenced w thin six(6) to or f construction or of is susp ended or abandoned or this iod of six(6)Tmon permit at becomes y i aftelr
work is commenced I understand that separate permits must be secured for Electrical-Work,Plumbing,Signs, Wells,Pools, Furnaces,Boilers,Heaters,
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 hereby certify 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
type of work will be complied with whether speci aed herein or not. The granting of a permit does not presume to give authority to violate or cancel the
vrovsios of any other federal,state, or local law regulating construction or the performance of construction.
signature of Owner ,B Sc;k I�1(2.4li Signature gn of Contractor
Tint Name N( k1 ht, S
'` ���< teTZ. Print Name '
3efore me Before tne '
his i Day of Seek,texte � , 20 S this of
C�( , `�����"' ELLEN R. THIGPEN �• pro�•�
rk
a;." °� ,, r +' / 1 .a.► Ue','', ELLEN R.THIGPEN
To ublic :r•�. Nbr�ty Pula•State of Flo '� �� — +A::i!`. late of Florid
� • a :•5 My Comm.Expires Oct 23,201 uty PUbIiC , My Comm.Expires Oct 23,201
• •' Commission a FF 065638 s. �i
•�,'E d;.• +,��� °: Commission # FF 065638
'" , Bonded Through I Re'vfifii'l.
ough National Notary Assn. lidr+cic�Through National Notary Ass
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