872 AMBERJACK LN - SIDING -jOh Iii.
��" s';, CITY OF ATLANTIC BEACH
�1 _ 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
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SIDING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-SIDE-2255
Job Type: SIDING PERMIT
Description: HARDI LAP SIDING
Estimated Value:
Issue Date: 9/25/2015
Expiration Date: 3/23/2016
PROPERTY ADDRESS:
Address: 872 AMBERJACK LN
RE Number: 171146-0000
PROPERTY OWNER:
Name: MCKENZIE, JEROME & CHARLENE, *
Address: 509 CAMELIA ST
GENERAL CONTRACTOR INFORMATION:
Name: PLUMBING BY JOSH
Address: 5677 FLORAL AVE THOMAS R PORTER
Phone: - -
PERMIT INFORMATION:
FEES:
Total Payments: $0.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
r
BUILDING PERMIT APPLICATION
A rl 11V CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach, FL 32233
....................7.........................................L...............
Office (904)247-5826 Fax (904)247-5845
Job Address: cZ 'Z Ili '' a C iL L
Permit Number:j
Legal Description
oor ea o Parcel#
Valuation of Work O� Proposed Work heated/ cooled o' t
non-heated/cooled
_
Class of Work(circle one): New Addition Alteration Re s.•
Use of existing/proposed structure(s)(circle one): Move Demolition pool/spa window/door
If an existing structure,is a fire s rinkler system installed?(Circle Residential
Florida Product Approval# p y (Circle one): Yes No N/A
For multiple products use product apps ova orm
Describe in detail the type of work to be performed: •
Property Owner Information• A 4 I.4A Si piF/ Fee VT. Of -._1417-.ar.E 144? t A i t,,
Name: (.r A i R 1-4o cH -c---< 1/44:- - . Address: 22 (e, .-r-Au_wcoza R.6
City J,�,� AzoT�i_ State
E-Mail or Fax#(Optional) Zrp —Phone - _ 6
Contractor Information: CONTRACTOR EMAIL ADDRESS:
Company Name: (/ A`t 1 .
Address: 7 A Qualifying Agent: OrtAS pe--
Office Phone ' Jc- City
�a33 7000 Job Site/Contact Number State-�Zip !
State Certification/Registration# 'Ai. Fax#
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 cert j that no work or installation has commenced prior
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 void if work is not commenced within six(6)months,or if construction or work is suspended or abandoned for a eriod of six((6)months at any time
work is commenced. I understand that separate permits must he secured for Electrical-Work,Plumbing,Signs, ells,Pools, Furnaces,Boilers,Heaters,
Tanks and Air Conditioners,etc. s null
ers,
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING CONSULTMENTS
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE
MENCEMENT. OF
'2ereby certi that I have read and examined this plication and know the same to be true and correct. All provisions of laws and ordina es gov rning this of work will be complied with whether specified herein or not. The granting of a permit does not presume to iv- author of any other federal,state, or local taw regulating construction or the performance of construction.
1 g or to .ate o cancel the
;nature of Owner _� -J 1
Signature of Contract°• L
nt Name 014 V'rtZ a l2.17fl\/`r
Print Name '' v9',s ie
459 0 1 _/ 20 Befo - �: ......
� this -i, of tv a,y tary Public State of Florid:
Shi -y L Graham otary Pub lc -�
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My C mmission FF 088990 •mmission FF 088690
or res 02H4l2018 • •' •tros 02/14/2018