148 W 14TH ST - RESIDENTAL ALTERATION S A CITY OF ATLANTIC BEACH
y j 800 SEMINOLE ROAD
/= ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
RESIDENTIAL ALT/OTHER
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-RAAR-2667
Job Type: RESIDENTIAL ALTERATION
Description: drywall/siding
Estimated Value: $2,000.00
Issue Date: 11/19/2015
Expiration Date: 5/17/2016
PROPERTY ADDRESS:
Address: 148 W 14TH ST
RE Number: None
GENERAL CONTRACTOR INFORMATION:
Name: JWB CONSTRUCTION GROUP LLC
Address: 7563 Phillips HWY # 109
Phone: - -
PERMIT INFORMATION:
FEES:
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
BUILDING PERMIT FEE $60.00
PLAN CHECK FEES $30.00
Total Payments: $94.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
0.!-A;`i,4,, City of Atlantic Beach
ti' e Building Department APPLICATION NUMBER
� 800 Seminole Road (To be assigned by the Building Department.)
tali- . Atlantic Beach, Florida 32233-5445 -����. Z/_�
Phone(904)247-5826 • Fax(904)247-5845 / c`
o oz-;t . E-mail: building-dept @coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: /v:9 w 1/Tw ST Department review required
efhiTtekel-7'ern q ed Yep/No
lit) ' in g g Applicant: Planning &Zoning
Tree Administrator
Project: /1 Public Works
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature .
Other Agency Review or Permit Required Review or Receipt
of Permit Verified B 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:
_APPLICATION STATUS
Reviewing Department First Review: Rarpproved. ['Denied.
(Circle one.) Comments:
UILDING
PLANNING &ZONING
Reviewed by: Date: ///3.15—
TREE ADMIN.
Second Review: ['Approved as revised. LID led.
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
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH OFFICE COPY
800 Seminole Road, Atlantic Beach,FL 32233
Office(904) 247-5826 Fax(904) 247-5845
th Permi Number: / ,-/')� R-.9 67
Job Address: "�u� (U I� 5� c) 2 � 1,1 11D (mac.b- of
Legal Description SEC A A+IQ t C E crack Lo--- q ( A Marcel# 1"7-1��Lt -c=G�o
door Area of Q•1't• non-heated/cooled
Valuation of Work$ Proposed Work heated/cooled It
20 00 . 00
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed installed?(circle one): Commercial Residential
i
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 /0001 Describe in detail the type of work to be performed:��P(1 v' � dt'll1 � or 3W v15 .
Property Owner Information:
Name:_ .�(U_ `) L Address: �S(o t�t\t�t ) kft tq Swkre -fto c(
City a.JL On u�I�k State��l-Zip 7:1�5(Phone Toil- (, 4-T 6 1- -4
E-Mail or Fax#(Optional) $55i pJbQcsti1pcwA\(4.S •QOrl'\
Contractor Information:
Company Name: '\1.1Q� C Y(.S Y LC- Q(t ( MX L[) Qualifying Agent: , c�.0 J'\ MOJA\4 `i
5 )q Su-i% f 10 C1 City ,3c. .c t�.Sllv��:t� State &L Zip �D2 SZo
Address: �56� ()VOW; ill
Office Phone '1O1-C 7 -(,1- l' Job Site/Contact NumberCx,g f QUN-. 3`1—OD�Fax#
State Certification/Registration# CC-1L ic-n x,53` e
Architect Name&Phone# AJ/
Engineer's Name&Phone# nl/Pc
Fee Simple Title Holder Name and Address AU /H
Bonding Company Name and Address Al%I■
Mortgage Lender Name and Address Aj//h
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 er ormed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null
and void of work is not commenced within six(6)fmonths, or if construction or work is suspended or abandoned for a period of six(6)months at any time after
work is commenced. I understand that separate permits must be secured for ElectricalpWork, 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 MBEFOEIERECORDING YOUR NOTICE OF
C .
I hereby certify that I have rea• ad 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 comp ' d whether spped red herein or not. The granting of a permit does not pres ' o give a h. ity to violate or cancel the
provisions of any other fe,era!, * , • o afla v regulating construction or the performance of construction.
��- Signature of Contractor ►// / . ��
Signature of Owner OF l { r l /
/ ' rhi/
Print Name file/ /0l�'�S�g /r V P Print Name J _,.. ', Mt'3''Y.S:
Sworn to and subscribed before me Sworn to and subscribed be ore me ,20n this'Y ' Day of ('v' V-''( ,20 l5 this ) Day of I y
Nota ublic
,-- Notary Pu• is
Revised 01.26.10
Y*i'•• KASANDRAJOYNER .. .
°:�.h KASANDRAJOYNER '
`� MY COMMISSION f FF 229035
t' .«: MY COMMISSION f FF 229035 •.i. '
a -„ EXPIRES:July 4 2019 ' .y. l € EXPIRES:July 4,2019
�'�fl.';h�, Bonded ThroNoWyPubkUndenmkrs �I 1�p��, tionMadThruNotaryPub6cUnd�ikn