1416 JASMINE ST - SIDING r ,`•\'\.1
w!
s, CITY OF ATLANTIC BEACH
' %. ` 800 SEMINOLE ROAD
j11, -:f" ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
.0.21Wr'
SIDING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-SIDE-2303
Job Type: SIDING PERMIT
Description: SIDING
Estimated Value: $4,000.00
Issue Date: 10/12/2015
Expiration Date: 4/9/2016
PROPERTY ADDRESS:
Address: 1416 JASMINE ST
RE Number: 171081-0070
PROPERTY OWNER:
Name: MARSHALL JR, CHRISTOPHER J
Address: 1416 JASMINE ST
GENERAL CONTRACTOR INFORMATION:
Name: A-Z ROOFING, INC. (GC)
Address: 1032 W EDGEWOOD AVE QA ETHELYN ROSEBORO
Phone: - -
PERMIT INFORMATION:
FEES: - - -- _.----
BUILDING PERMIT FEE $70.00
STATE DCA SURCHARGE $2.00
PLAN CHECK FEES $35.00
STATE DBPR SURCHARGE $2.00
Total Payments: $109.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH All. CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
r"''�/ri; City of Atlantic Beach APPLICATION NUMBER
`" Building Department (To be assigned by the Building Department.)
r •= �.- Y �S2 800 Seminole Road /�S
J ,.,. - ,2 303
Atlantic Beach, Florida 32233-5445
v. �V~ Phone (904)247-5826 • Fax(904) 247-5845 /Q A/,("�
'''=to�i19r E-mail: building-dept @coab.us Date routed: J
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address:
/9/ó V/)1 Sr De artment review required Yes o
Buildin�
Applicant: A - Z '?tea d66,1 Manning &Zoning
Tree Administrator
Project: Si /.—>l,7 Works
9 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:
APPLIC_ TION STATUS
Reviewing Department First Review: Approved. ❑Denied.
(Circle one.) Comments: Attic
QUILDING
PLANNING & ZONING Reviewed by: tri Date:/O—/O /r
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
FILE COPY
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: t H 1 ip `TSm A+��'�' h' 5' �� 03
. FL 3 22 Permit Number: j � S / /��
Legal Description/4-1 f?yCh Sea 1 1± 131 Parcel # I-7 10_ 1 —QOM
F oor Area of q. t. Sq.r't
Valuation of Work S c roposed Work heated/cooled `-f non-heated/cooled /L///E'
It JOd •OO 4t;�
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 No N /A
Florida Product Approval #
For multiple products use product approval form
Describe in detail the type of work to be performed: �`' L Dt 6- (' p,i tZ
Property Owner Information: y I
Name-, 1- $a 0.4,6 icwnDbI I lent Ike Address:I l �* I V.
City /_ a �w.� I �.' .:I State a_Zip, 22,J Phone py. 2Ll 1, .1 an-7
E-Mail or Fax#(Optional)
Contractor Information:
• Company Name:Pi -Z ' I Agent:E- heI yn �dSe c
Address:I 501
T. City C h5O(\v i i 1e. State FL Zip 2 l8
Office Phone C - r]lp(p_ •—Ip I('7 Job Site/Contact Number q0.4. 910. 2222Fax
State Certification/Registration# 'c C- /C 57 3% /
Architect Name & Phone#
Engineers 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 certif'that no work or installation has commenced prior to the
issuance of a permit and that all work will be perfJomed 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(61 months, or If construction or work is suspended or abandoned for appex nod of six(6%months at any time after
Ivor*is commenced- I understand that separate permits must be.secured for Electrical Work, Plumbing, Signs, Wells, Pools, Furnaces, Boilers, Heaters,
Tasks 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.
hereby certify that I have read and examined this a plication and know die same to be true and correct. All provisions of lasts and onlinances governing this
ipe of work'will be complied nidl nhether specified herein or rot. the granting of a permit does not presume to give authority'to violate or cancel the
Timmons of imlty other.federal,slate,or local law regulating construction or the peiforniance of construction.
- --
--'Z
/ „... .. ..--
,--,
Signature of Owner Or' Ili
Signature of Contractor PA' ',
Print Name He Imo+ sinfzx h(39 . .-7 .
Print Name -6174-/2/0 A4 41,)
Sworn to and subscribed before me , Sworn to and subscribed before me
this 3") Day of Tao," aa, —1 . 20 this.a--) Day of5=1:21- 'f•I'\101e_ , 20 In.
Notary Pub 7.0.1=111111110-aiii■--"m■-■ otary Pub ic --"""` 411•117■■■■•
• ---_______
MICHELLE OLESZEK
my COMMISSION#FF058766 Revised 01.26.10
' ,./.;,;''' •il:;,, MICHELLE OLESZEK
.. . .
EXPIRES September 30 2017 :• - •: MY COMMISSION#FF058766
.
I 1407)398-0153 FloridallotaryService.com ,..!:i0;05:V EXPIRES September 30,2017
(407)398-0153 FloridallotarySerVice.corn
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