1 FLEET LANDING #126 - SHOWER CONVERSION City of Atlantic Beach APPLICATION NUMBER
c ,• Building Department (To be assigned by the Building Department.)
) 800 Seminole Road I °AY 2426
3N, Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 • Fax(904)247-5845��
1"L 0;)0 E-mail: building-dept @coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
100.60-F. -Property Address: _ ' eel �• "�` ' • - • - ment review required Yes . No
/�
� :uilding
Applicant: NI /r►w k I Planning &Zoning
' Tree Administrator
Project: .1W r
OC r 1 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 First Review: ltpproved. ['Denied.
(Circle one.) Comments:
BUIL I v C—
PLANNING &ZONING
Reviewed by: Date: .a•
TREE ADMIN. Second Review: ['Approved as revised. ❑Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: lApproved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
BUILDING PERMIT APPLICATION
plaii r" CITY OF ATLANTIC BEACH
o.....r COPY 800 Seminole Road, Atlantic Beach, FL 32233
Office(904) 247-5826 Fax(904) 247-5845
Job Address: / . /// Permit Number:
S-RAAit• 2.0214
Legal Description Parcel #
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work $ 6;5419 Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition terati Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s) (circle one): Commercial
If an existing structure,is a fire sprinkler system installed? (Circle one): No N/A
Florida Product Approval#
For multiple products use product appro�form
Describe in detail the type of work to be performed: Oftiouer Sowrr �.r'n'r' s
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
Contractor Information:
Company Name:NCCRF dba Fleet Landing Qualifying Agent: Jason Holder
Address:! 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 performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null
and void f work is not commenced within six(6)months, or if construction or work is suspended or abandoned for aperiod of six j6)months at any time after
work is commenced. I understand that separate permits must be secured for Electrical IVork, 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 YOiJR NOTICE OF
COMMENCEMENT.
I hereby certi 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 re ating construction or the performance of construction.
Signature of Owner Signature of Contractor
Print Name Jason Holder Print Name Jason Holder
Sworn to and subscrib d before me Sworn to and subsc ibed before me
this Ale Day of 20\S this 19Ft_Day of , 2418
Notary Public Notary Publi
'`'"Y�` Revised 01.26.10
�_ °Sf;� SHARI R QUEST
'% MY COMMISSION#FFO68?47
`••.'.?'ornd°.'•` EXPIRES November 4.2017
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