162 MAGNOLIA ST - SIDING i."--
\S CITY OF ATLANTIC BEACH
$ 9 800 SEMINOLE ROAD
J- ATLANTIC BEACH, FL 32233
\ INSPECTION PHONE LINE 247-5814
SIDING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-SIDE-2552
Job Type: SIDING PERMIT
Description: SIDING
Estimated Value: $1,800.00
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:
PLAN CHECK FEES $29.50
BUILDING PERMIT FEE $59.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $92.50
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH OFFICE COPY
800 Seminole Road,Atlantic Beach,FL 32233
Office (904) 247-5826 Fax (904)247-5845
Job Address: Ica IN A D)L w Street,/7i&Ph t_b QCcot;r FL Permit Number:7.5-- S,/Or- '02 S'S 2-
Legal Description Lot (o44-, loll Jod Sid fey g Olct(0 t e4 . g Parcel# S r t
Valuation of Work$ 4-'i'00 - Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration (Repa)r Move Demolition pool/spa window/door
Use of existing/proposed structures)(circle one): Commercial (Btrsident
installed? )
If an existing structure,is a fire sprinkler system nstalled?(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: '
(2 .(0v e 4)0 0,1317 1..b-E,t t'0 (t c uJ c 9 Sc 0 t J 6
Property Owner Information: .
Name: l�t �li`tsflrt 131/1-Ck Address: Ro)- M ai(1o(ta- lr-1
City a ... Staters Zip 32-2-)3 Phone (90(I) ., ?0—1 13 rf
E-Mail or Fax#(Optional) C' Q..Lk.4c-7Gst9 2.B/ • c-'ri
Contractor Information:
Company Name:12124R>''1t P is t EA� 1_l._<v Qualifying Agent: Lu I S (Lep-e" _
Address: 5 " oA- 0106E V2 SOL'TA City jfrcCe-so'N 'J i 44.F State Ft— Zip "5ZZV-
Office Phone 904---5 6 c 09 Job Site/Contact Number i 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 certibi that no work or installation has commenced prior to ti
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 nu
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(6)months at any time afte
work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs, Wells,Pools,Furnaces,Boilers,Heater.
Tanks and Air Conditioners,etc
WARMNG 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 grplication and know the same to be true and correct. All provisions of laws and ordinances governing th
type of work will be complied with whether specified herein or not. The granting of a permit does not presume to gi e authority to violate or cancel tl
provisions of any other federal,state,or local law regulating construction or the performance af construction. Wair-
Signature of Owne .L1 !_a. i` �4 _ Signature of Contractor i imimminzifir
T MI
Print Name Ct.r//_, f 7 __ 3...L.Ck Print Name I-u 1 se 2_.6
Before 0 i} /n ,S Bef�,tir'Da if ��dr�i- ,201
this O�S Day of OCl^ V thi�� Day
i / PAOLA FABIO
/.aL�: AP• N. i •'. .1 1. . I.iv ���
Not.'% •ublic ,-,, Commission*EE 843442 Notary 'ublic MI
My comm.expires Oct 14,2016
I1 A 1 n
1.A? :•,. City of Atlantic Beach APPLICATION NUMBER
js r ;ol Building Department (To be assigned by the,Building
800 Seminole Road 9 _ y g Department.)
)
, Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 • Fax(904)247-5845 %A
• ....on 9%- E-mail: building-dept @coab.us Date routed: /d ///c
City web-site: http://www.coab.us /
APPLICATION REVIEW AND TRACKING FORM
Property Address jr: i `/ / / i Department review required Ye No
/ / (uilding
Applicant: 2O (,L J ` f DD c &Zoning
Tree Administrator
Project: 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: [pproved. nDenied.
(Circle one.) Comments:
UILDIN
PLANNING & ZONING
Reviewed by: /77 Date: //•
TREE ADMIN. Second Review:
['Approved as revised. ['Denied.
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