4307 FLEET LANDING BLVD 0 KITCHEN CONVERSION oIAPi;. City of Atlantic Beach APPLICATION NUMBER
{ r Sly Building Department (To be assigned by the Building Department.)
1 Y"k
800 Seminole Road 1 SPRAA� f��02/1
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 • Fax(904)247-5845 �J 1t
~L_01119 E-mail: building-dept @coab.us Date routed: 5
City web site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: �%/`r l Pt . 14Y1 . D- • .rtment review required Nrf Buildin.
1/
Applicant: I C-0,25 Panning &Zoning
• Tree Administrator
Project: K1 kiaNCIA GAM CiesSldYN, 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:
APPLICATION STATUS
Reviewing Department I First Review: ❑Approved. ['Denied.
(Circle one.) Comments:
BUIL ING fl) 0 C-
PLANNING &ZONING 31 S--
Reviewed by:
Date:
TREE ADMIN. Second Review: Approved as revised. _peened.
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
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office(904) 247-5826 Fax(904) 247-5845
Job Address: V / am
•Y...561 //, /54,:t Permit Number:'S.repsA€ " 2m 1
Legal Description Parcel#
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work $ „�jrd 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 esidenti
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: ‘97 H.p5�;p i'/e/e/C 1t/#,i// r:
Property Owner Information: / OO
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
Contractor Information:
Company Name:NCCRF dba Fleet Landing Qualifying Agent: Jason Holder
Address:1 Fleet Landing Blvd City Atlantic Beach State FL Zip 32233
Office Phone 904-246-9900 xt 431 Job Site/Contact Number 904-219-4002 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 pet formed 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 j6)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 plicalion and know the same to be true and correct. All provisions of laws and ordinances governing this
type ofwork will be complied with whether sped ied 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 H er Print Name Jason Holder
Sworn to and subscribed before me Sworn to and subscribed before me
this Day of `4-tkr1— , 201 5" this Day of , 20/c
Notary ub is , Notary Pu lic
;"A SHARI R QUEST
""" . SHARI R GltmBiRi 01.26.10
i•' I't MY COMMISSION#FF088247 MY COMMISSION #FF068247
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980153 Floridallota Servlce.Com
(a07)3 ry (407)398-0153 Florida'1c4arcService.com