162 MAGNOLIA ST - WINDOW CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
j-- ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
WINDOW AND/OR DOOR PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-WIND-2557
Job Type: WINDOW AND/OR DOOR
Description: windows
Estimated Value: $3.000.00
Issue Date: 11/19/2015
Expiration Date: 5/17/2016
PROPERTY ADDRESS:
Address: 162 MAGNOLIA ST
RE Number: 170617-0000
PROPERTY OWNER:
Name: BLACK, CHRISTINE
Address: 162 MAGNOLIA ST
GENERAL CONTRACTOR INFORMATION:
Name: PRO-BUILDERS OF FLORIDA LLC
Address: 1115 S OAKS RIDGE DR LUIS EDUARDO ROSERO
Phone: - -
PERMIT INFORMATION:
----------- --
FEES:
BUILDING PERMIT FEE $65.00
STATE DCA SURCHARGE $2.00
PLAN CHECK FEES $32.50
STATE DBPR SURCHARGE $2.00
Total Payments: $101.50
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
1 BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH OFFICE COPY
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: 140. /ha-5/101i w Stree Ptfkirk L B.24-c-+\1 Permit Number: /9 ad/1/O'-a55 b7
I * S&_�# r 6x lO I:0)Parcel#
Legal Description LOf Co�f�,.s '
3 ,JV 0 t loor ea of Sq.Ft. Sq.Ft
Valuation of Work$ Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one):. Commercial esident
If an existing structure,is a fire sprinkler system installed? (Circle one): es No N/A
Florida Product Approval#
For multiple products use product approval form
Describe in detail the type of work to be performed: R6P 5 w iN90(P5
Property OOwner Information: I
Name:0_11 r'l film B i Address: I [ a ��Yl Dho_ Srr-��f
City ,flan h c_ 3ea_cA State TI-Zip 32 233 Phone ( QO ) 2'70-i137
E-Mail or Fax#(Optional) e_b/Q Clc&.0 k 5.(sa t)&Z.o 1. CO n i
Contractor Information:
Company Name: PeoP7Q i 1--T,E ES of 4-4 OA LLC' Qualifying Agent: LA-)1 ' CZ � ,
Address: t i l .V OA-1Z- V*6' X - So e City ,,,,__5 c to vi.G State ft- Zip-3 Z.-I-
Office Phone Job Site/Contact Number Fax#
State Certification/Registration#
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 months at and
work is commenced.ommenced.not I understand that separate permits or must be secured for Electrical-Work,Plumbi g,Signs,a Wells, Pools,xFuraces,Boiler,time
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 hereb certify that 1 have read and examined this a plication and know the same to be true and correct. All provisions o 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 : ve authority to violate or cancel the
provisions of any other federal,state, or local law regulating construction or the performance of construction.
•mow;
Signature of Owner _ ,/.J - 4_ -4•-' A Signature of Contract• ���. 1-
Print Name eAr' y� 1li., ....k_ Print Name 1...._v t S •'f Q
•
_ G or 1
n,,r'_ I /1
Beso�" Day of � 'Cr 21 gh: .y of f� OC I , 20
.�-!� �.
PAOLA FABIO v
No ary Pub • 00.1ns.., Commission 8 EE 843442 `otary Pub • ;, Shirley L Graham
i.e" 4,2018 Q My Commission FF 088990
My comm.mm expires Oct, 'N 'or Expires ovi tlised 10.24 .2
Hof w
, 1.A1P,i..;, City of Atlantic Beach
APPLICATION NUMBER
Building Department (To be as igned by the Building Department.)
z= '!•s� 800 Seminole Road
' Atlantic Beach, Florida 32233-5445 l — V Y f*/Y D Z 7
Phone(904)247-5826 • Fax(904)247-5845
`/rt;t 9%' E-mail: building-dept @coab.us Date routed:
City web-site: http://www.coab.us fQ z7 l
APPLICATION REVIEW AND TRACKING FORM
Property Address: / 72. /'Z?1.'JA /l t , par m review required Yes
q No
Building
Applicant: j l/d e eS ng &Zoning
i Tree Administrator
Project: -r))Q 10c Public Works
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt
of Permit Verified By Date
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:
APPLI TION STATUS
Reviewing Department First Review: Approved. ❑Denied.
(Circle one.) Comments:
BUILDIN
PLANNING &ZONING
Reviewed by: 11/ Date: /r'6 '/
TREE ADMIN. Second Review: A
❑ pproved as revised. [1]De ed.
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