455 Selva Lakes Cir - Replace 2 Doors r ''� ss CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
K ir �'' ATLANTIC BEACH, FL 32233
,..,....._____ INSPECTION PHONE LINE 247 -5814
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WINDOW AND /OR DOOR PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247 -5814
JOB INFORMATION:
Job ID: 15- WIND -2973
Job Type: WINDOW AND /OR DOOR
Description: RE PLACE 2 DOORS
Estimated Value: $2,350.00
Issue Date: 1/4/2016
Expiration Date: 7/2/2016
PROPERTY ADDRESS:
Address: 455 SELVA LAKES CIR
RE Number: 172027 -5016
PROPERTY OWNER:
Name: DICKERSON, ROGER & SHELLEY K, *
Address: 425 E WOODHAVEN DRIVEE
GENERAL CONTRACTOR INFORMATION:
Name: THE REVERED GROUP OF AMERICA
Address: 4338 W CHELSEA HARBOR DR KEVIN ANDREW RIVIERE
Phone: - -
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $30.88
BUILDING PERMIT FEE $61.75
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $96.63
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
i L vr City of Atlantic Beach APPLICATION NUMBER
J ILA ? Building Department (To be assigned by the Building Department.)
A si 800 Seminole Road _
�. Atlantic Beach, Florida 32233 -5445 t 5 Ohl i N E' Zq 7 3
Phone (904) 247 5826 Fax (904) 247 -5845
a; �' E -mail: building- dept @coab.us Date routed: Zi3o1( j
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 4 5S ELY ' L Es - nt review required Yep.- No
`_ Buildin 1
Applicant: h e_ Re r € R c p o f r l P an ning
lam\ Tree Administrator
Project: P PLAC.e t JOO RS 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. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: / y � / ' Date: / y` /S
TREE ADMIN. Second Review: Approved as revised. ❑De ied.
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 1 A PIN �
� ` `""'"
800
Seminole Road, Atlantic Beach, FL 32233
Office (904) 247 -5826 Fax (904) 247 -5845 1 5-WI N' _ z973
Job Address: _ y 5S d �,�c a � & - 1.
Permit Number:
Legal Description III -SS 17.25 - AC Sc h a LeileS Floor Area of Sq.Ft. Parcel # 17 t py
Valuation of Work $ 2,..504- Proposed Work heated /cooled t
� 13? n on - heated /cooled 9 17
Class of Work (circle one): New Addition Alteration ep it Move Demolition pool/spa window /door
Use of existing /proposed structure(s) (circle one): Commercial iii• esidentia
If an existing structure, is a fire sprinkler system installed? (Circle one):
Florida Product Approval # ft # 15)..15. 17 ® N /A
For multiple products use product approval f orm
Describe in detail the type of work to be performed: hrpldac -r04 4- r^p,4, f (Axis
(L 13)
Property Owner Information:
Name: R np r b f(i1Ptry)Vl Address: 'OS' E,
City 'N V 1.4 State FL Zip 3aoX - ! / 7r. trey. E -Mail or Fax # (Optional) p Phone pay- y _ 29-.6 3 DR
Contractor Information: CONTRACTOR EMAIL ADDRESS: Rp,��yt 1,U (�
� • q mr�.+ � _ C�InO
Company Name: RPw,od C,,,,C,A >rn ►rn Lte Cl
Address: Ft) 6410.15 Cit S oc � o4 A Qualifying Agent: �',�,jp Rrvl er�
Office Phone 141, a'�Uz /l'. State 1 - Zip 32
4 zi - 76 33 Job Site/ Contact Number (qi$i) 6 - q ig q Fax # No) g2J- q' -
State Certification/Registration # CPC !25'-)
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. 1 certifi, 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
and void f work is not commenced within six (6) months, or if construction or work is suspended or abandoned for a of six (6) months at any time after
work is commenced. I understand that separate permits must be secured for Electrical Plumbing, Signs, Wells, Pools, Furnaces, Bo 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.
1 hereb certi, that 1 h. e r;.. • d examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this
ape of work will be c. • . •d wi whethe s eci ied herein or not. The granting of a permit does not presume to give .uthority to violate or cancel the
7rovisions of any other • . • .1, sta e, or loc aw 1 gulating constructio or the performance of construction.
>ignature of 0 400 i.Ii !. `� •
11. 1 Signature of Contractor
Tint Name ( r `
``` - it I C . L � Print Name �� //'I /!/ /e y,e'
Iis "`-D . . .•• NO L .� Before me
a l �' p = j 4 , co , � s .. this ,?0.1-A ; y of I ec b
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� �� iw : Jams , . pire Ek ,
rotary Public — - ,v Fp & era • / ' _�..� SANDRA C 8EMR0
t g �st3 : iy Public •= MY COMMISSION # EE204196
�� `w`J�LIG ,.•' QQ' dP' EXPIRES June 03, 2018 • : °' 1 °F FLOW ��� t � Pi O l . 2C No ys.,v�. „
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