454 INLAND WAY - WINDOW/ DOOR (2) BUILDING PERMIT APPLICATION FILE COPY
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845 ( (p--W(N .-545
Job Address: 1{5 Lf lqN(1- WD� Permit Number:
2 _I , ocean WattK (l el- Lo-1- L I
Leal Description I( CN - IF - J 7 — as a l e Parcel # f (Q? 96Q 3 t_5 ya..
Legal 1
p / Floor Area of Sq.Ft. Sq.Ft
Valuation of Work$ 3 70g <<J Proposed Work heated/cooled ^ non-heated/cooled
i
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa w ndow/door
Use of existing/proposed structure(s) (circle one): Commercial Residential
If an existing structure, is a fire sprinkler system installed? (Circle one . o I /A N,
Florida Product Approval # L « L 7. 1 fl-- 1734/ 7. c?'-.
For multiple products use product approval form
Describe in detail the type of work to be performed: fa.j4OA_Q. a aAOC-S ( (--,
Nt)M,`e
Property Owner Information: I (�r
Name: e�11 e- Address: l 7 Li xr' ' L W Ox y
City 'L State Zip 3 Z 2.3 hone J
E-Mai or ax#(Optional)
Contractor Information:
Company Name: ,4 £ n do w 1 C-�Or (-{-j4-( -€
p y � e ��a� �I Qualifying Agent:
Address: / LP, ? tome_ (\A- City ,J-'O'.-V State �Z Zip 3 22 1 1
Office Phone / ,7 63q. /f t Job Site/Contact Number \`�t+O( Q Fax#7a-7--Co g( � _
State Certification/Registration# (Q, C d 1 g9`5 7
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 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 Electrical Work, 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 thisplication and know the same to he 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 regulating construction or the performance of construction.
Signature of Owner 464-1U— Signature of Contractor EGG
Print Name ,c- ( I-e_ Print Name
C.--KY tAgte,
Sworn to and subscribed before me Sworn to and subscribed before me
this u Day of 00(L1'\ , 20 1) this Lk Day of 'MGYC1 -1 20 1 (p
k-L
Notary Public Notary Public
""O BARBARA BLAIR LIIPFERT Revised 01.26.10
♦♦ p Iy'
Pell���_ Commission# FF 239191
♦""" BARBARA BLAIR LIIPFERT
♦ p,I y''i'i
;!,ii i'o`,� My Commission Expires ;�. B`�= Commission M FF 239191
June 09, 2019 _ ��p=
^!� ;�� -i �o` My Commission Expires
y '',"$ .4$ June 09, 2019
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