65 19TH ST - INTERIOR REMODEL U' 1 "= S, CITY OF ATLANTIC BEACH
_ 9.:-) 800 SEMINOLE ROAD
ii;
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
\01-11>�
RESIDENTIAL ALT/OTHER
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-RAAR-144
Job Type: RESIDENTIAL ALTERATION
Description: INTERIOR REMODEL - BATH ROOM
Estimated Value: $2,000.00
Issue Date: 1/25/2016
Expiration Date: 7/23/2016
PROPERTY ADDRESS:
Address: 65 19TH ST
RE Number: 169723-1040
PROPERTY OWNER:
Name: SWEENEY,DAVID & PATRICIA, *
Address: 65 19TH ST
GENERAL CONTRACTOR INFORMATION:
Name: RADON PROFESSIONAL SERVICES
Address: 336 14TH AVE QA WILLIAM TONY DAVENPORT
Phone: - -
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $30.00
BUILDING PERMIT FEE $60.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $94.00
II PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF NI LANTIC BEACII ORDINANCES AND THE FLORIDA
BUILDING CODES.
Serif, City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
v ' 800 Seminole Road r o_ R�'t 1rt 1p f1 n ! (44-
j�. Atlantic Beach, Florida 32233-5445 y `
Phone(904)247-5826 • Fax(904)247-5845
rr E-mail: building-dept @coab.us Date routed: z.O/t CO
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 7 5 l tc ' ! - ; - • ent review required Yes, No
Buildin. �/
Applicant: RRIOk PRO SE;(Z.V " Zoning
Tree Administrator
Project: P T (4 4 \ M O ( 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: Approved. ❑Denied.
(Circle one.) Comments:
BUILDIN)
PLANNING &ZONING Reviewed by: (1/ n Date: /-) 5"76
TREE ADMIN. Second Review: Approved as revised. ❑D 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
t BUILDING PERMIT APPLICATION OFFICE COPY
CITY OF ATLANTIC BEACHI
800 Seminole Road,Atlantic Beach,FL 32233
Office (904)247-5826 Fax (904) 247-5845 1 RA (9 - M4
4
Job Address: f /ci Ik S Zie e 7 Permit Number:
Legal Description if 7. 71 a y-Z S-2q E M. 71.r,AT•e t u APT"
Re #
Floor Area of Sq.Ft. q, t
Valuation of Work$2,o oo 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 Retial
If an existing structure, is a fire sprinkler system installed? (Circle one): e No N/A
Florida Product Approval#
Por multiple products use product approval orm
Describe in detail the type of work to be performed: (,q -1-Z £elk oIe 4 - Blcke et 4(34 Act-t. i 1 Le
Property Owner Information:
Name: AUKci-t PA T/2r c;A c.) e e dt e y . Address: kr G RI -4 S%.
City TL.AiJ 7'c aPhck State Zip 32233 Phone 3 S- XSZ
E-Mai or Fax#(Optional)
Contractor Information: CONTRACTOR EMAIL ADDRESS:
Company Name: g,4 j 6 ti t I°2b Sew L' .es Qualifying A ent: IA 7- £)41/e iJ (cAT
Address: 33e /yT/ Ad. A). City TA 1- �pte4 State FL Zip 322So
Office Phone 2 y 4 - ssq 7 D Job Site/Contact Number '-q/-/Z/d Fax# 2 co -3 g yo.‘
State Certification/Registration# l GC OS 77 13
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 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
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 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 BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
I hereby certify that I have read and examined this goplication and know the same to be true and correct. All provisions of 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 give authority to violate or cancel the
provisions of any other federal,state, or local law re:ulating construction or the performance of construction.
•Signature of O er 1,1I . . •
Signature of Contractor W 7� ,
G�Z�
Tint Name lI ��
-eferttc, I Print Name W T pn i c..D..p.o...R-T
3efore me
Before ffi�...._—_
his /0 Day of SANV � ,20 l(0 this Da ref,;� 20
— — — — — =:° ,' `o: Notary Public-State of Florida
"" STEPHEN HAFT -
l a 1, i ? My Comm.Expires May 5.2016 _
ary l�lb► 1• Notary Public-State of Florida otary 171.•;1x--� Commission#EE 195483
• .• My Comm.Expires May 5,2016 ( °F"�`�,
' - "'!�����•` Bonded Through National Notary Assn.
I-',�, -�� P;� Commission#EE 195483 • — — — — —;<m i,.�d�01�2 10
''"•a.P ids Bonded Through National Notary Assn.