1980 MIPAULA CT - WINDOW/ DOOR (2) BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH FILE COPY
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845 1 (0-- WIN D c-- ` J z
Job Address: 1980 Mipaula Court Permit Number:
Legal Description 39-94 08-2S-29E Selva Norte Unit One Lot 9 Parcel # 169506-1018
Floor Area of Sq.Ft. Sq.Ft ,�p�
Valuation of Work$ .7()7 I . d(n Proposed Work heated/cooled iV4 non-heated/cooled /�i
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window door
Use of existing/proposed structure(s)(circle one): Commercial 'esiden
If an existing structure,is a fire sprinkler system installed?(Circle one): •es o N/A
Florida Product Approval # id,1c• ti
For multiple products use product approva orm
Describe in detail the type of work to be performed: riepIGre 02 eX14 'frfrC1- d oo/
Property Owner Information: RPA —20/ &(L5puT1.(.t,4Ej
Name: Mills E& Rebecca D. Rowland Address: 1980 Mipaula Court, /01 /q '3Z66
City Atlantic Beach State FL Zip 32233 Phone 904 307-0886
E-Mail or Fax#(Optional)rowlanddarlene @comcastaiet millsrowland @comcast.net
Contractor Information: / Q
Company Name: A'�arcu/1 Conch 1 ae't,ur- 6rok— ,ln( . Qualifying Agent: ICohP4 1"1 i' ';sot' ,J f .
Address: 0'4 Re,.;,,,,``kv. 1"-:ores ter , 1r City &)( State cl Zip '32Js 5
Office Phone GUS 4rori-awe Job Site/Contact Number 56r( 3o7-OW,, Fax# 90t( 30-03$
State Certification/Registration# ($ -C 44ciC LQ-,
Architect Name&Phone# k
Engineer's Name& Phone# ea ` i
Fee Simple Title Holder Name and Address ,l t.1 a' ei ' ',NA 1 n, is ,. A C i IMETi r
Bonding Company Name and Address I*
Mortgage Lender Name and Address_N/A
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
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 ElectricalWork, 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.
/hereby certify that I have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordina,c s governing this
type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give auth• ity to o ,to or .ncei the
provisions of any other federal,state, or local law regulating construction or the performance of construction. /
2 Signature of Contractor ,,i, /��
Signature of Owner be/,o, b. la,e A� iI
Print Name /5_ r /"l. ,1f� ' ,J lJR.
Print Name Rebecca D. Rowland
Sworn to and subscribed before me
Sworn�tq and subscribed before me this Day of ■a V c L ,2016
this 7 r'1 Day of `-N1 u- rc _ ,2016
S� Notary v _ St° LaA.10 .)
ry Public
Notary Pub is
I Revised 0c. .10
ANGELA V.SCARBOROUGH
I •..en"• ,- ANGELA V.SCARBOROUGH •tom '
�,"'": MY COMMISSION#FF197931
6 ;': MY COMMISSION FF197931 '4 EXPIRES March 14.2019
•;.46:-,398.t• EXPIRES March 14.2019 I■w7,�39g-O'53 r +ES March 1.cam
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