4203 FLEET LANDING BLVD - ALTER. SHOWER TO WASHER DRYER : ,..;
r ` , 1 f CITY OF ATLANTIC BEACH
ri,-� A s) 800 SEMINOLE ROAD
J :,, 2 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-2096
Job Type: RESIDENTIAL ALTERATION
Description: shower to shower/washer dryer
Estimated Value: $3,750.00
Issue Date: 9/18/2015
Expiration Date: 3/16/2016
PROPERTY ADDRESS:
Address: 4203 FLEET LANDING BLVD
RE Number: LOC ID-0000
PROPERTY OWNER:
Name: NAVAL CONTINUING CARE
Address: 1 FLEET LANDING BLVD 1 FLEET LANDING BLVD
GENERAL CONTRACTOR INFORMATION:
Name: NCCRF
Address: JASON PAUL HOLDER JASON PAUL HOLDER
Phone: - -
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $34.38
BUILDING PERMIT FEE $68.75
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $107.13
PERMIT IS APPROVED ONLV IN ACCORDANCE WITH ALL CHI' OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BI ILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233 ELL117 COPY
Office(904) 247-5826 Fax(904) 247-5845
Job Address: /.O3 17tvii4achii i5/dd, 'lcs, ) Permit Number:/5 kf/)i2n -�O9()
Legal Description V Parcel #
r10 Floor Area of Sq.Ft. y. t
Valuation of Work 3 0 Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alterati Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial id ti
If an existing structure, is a fire sprinkler system installed? (Circle one): No N/A
Florida Product Approval#
For multiple products use product approval form
Describe in detail the type of work to be performed: &iliac j ,.9iflvr aft# talk wo- - .//, ',
Property Owner Information:
Name:NCCRF dba Fleet Landing Address: 1 Fleet Landing Blvd
City Atlantic Beach State FL_Zip 32233 Phone 904-246-9900 xt 431
E-Mail or Fax#(Optional)jholder @fleetlanding.com f•--- L _ ; , 1
Contractor Information:
Company Name:NCCRF dba Fleet Landing Qualifying Agent: Jason Holder '
Address:! Fleet Landing Blvd City Atlantic Beach State FL Zip 3223
Office Phone 904-246-9900 xt 431 Job Site/Contact Number 904-219-40 2 Fax •
State Certification/Registration#CBC 1254586
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 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 penod ofsix PS)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 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 specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other federal,state,or local law regulating construction or the performance of construction.
Signature of Owner Signature of Contractor
Print Name Jason Holder Print Name Jason Holder
Sworn/o and subsc i ed before me Sworn to and subscribed Wore me
this aZ Day of .20 i'S this 2 Day of �. , 2015
Notary Pub is Notary Public
t.°rSHARI R QUEST ::*rw SHARI R �OS' 111.26.10
MY COMMISSION#FF0AA247 f:°.'V.,,'2',5,. EXPIRES November 4.2017 .N, ,gl MY COMMISSION #FF(1RR?a7
`. pry::
••.' aF".cr. EXPIRES November 4.2017
(407)398.0153 FlorldallotaryService.com O......•
(407)398-0153 FloridallotaryService.com 1
syay;. City of Atlantic Beach APPLICATION NUMBER
s Building Department (To be assigned by the Building Department.)
u p I..; 800 Seminole Road q/A
e Atlantic Beach, Florida 32233-5445 hi— AO- / ,
Phone(904)247-5826 • Fax(904)247-5845
Q.-on g'
E-mail: building-dept@coab.us Date routed: 9 l4--
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: Z z 1 J ii f`✓ ent review required Yes o
Building
Applicant: /V c C4F "—Planning &Zoning
Tree Administrator
Project: S M it - SAilidde - 4()/A Public Works
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of 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:
II APPLICATION STATUS
Reviewing Department First Review: 1 pproved. ❑Denied.
(Circle one.) Comments: Iv a G
BUILDIN
PLANNING &ZONING O ' 1 S�
Reviewed by: Date: 7
TREE ADMIN. Second Review: Approved as revised. ❑Denie .
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