571 SAILFISH DR - FOUNDATION REPAIR (2) BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233 FILE COPY
Office(904) 247-5826 Fax (904) 247-5845
Job Address: S7 I SAID FIS,11 a,21 vg. Permit Number: /6 -Rig/QR- 7(0
Legal Description 3o -9'I36-ZS-VIE /ZoyAC?'?4( S u A.rit Co14 &K 7 Parcel# / 7 Z&S•—O000
0. Floor Area of Sq.Ft. Sq.Ft
Valuation of Work$ 7Vo o Proposed Work heated/cooled ZUo non-heated/cooled A00
Class of Work(circle one): New Addition Alteration Move Demolition pooUspa window/door
Use of existing/proposed structure(s)(circle one): Commercial < ia
esident
If an existing structure,is a fire sprinkler system installed? (Circle one): Yes o ttlie
Florida Product Approval#
For multiple products use product approval form
Describe in detail the type of work to be performed: FicJA4),4Ztw1.) geiok, - (..,itdoR/4JAdk
Property Owner Information:
Name: 7 io r,v y Z ( Address: 3o Z 7 NF 1N $LRCiAI R1)•
City 'S e KSoAIVI LLt.. State FL Zip 3zzz. Phone 90V- 537- 3 Z o7
E-Mail or Fax#(Optional)
Contractor Information:
Company Name: 1 A7io4_) 57S7Xi iS .pt..0 Qualifying Agent: &//r f'. /115-/k/449.<_.
Address: ZoS-Z 61:444 S Tget:r City,.07loiv7,L 8s nN State A. Zip 3tz A3
Office Phone goy- ZYI- V1f2I---. Job Site/Contact Number got- 29Se-z ass- Fax#.9014.2.0-e c c 3
State Certification/Registration# CB COS'9 306
Architect Name&Phone#
Engineer's Name& Phone# Silly C.ft 4■k+ti 7-Z• lie. Y2 6 77 - 10V- ZY7'yyZ.
Fee Simple Title Holder Name and Address 404
Bonding Company Name and Address 111x°
Mortgage Lender Name and Address A/i9
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.
/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 ordinances governing this
type of work will be complied with whether speci led herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other federal,st• -, .r b al law regulating construction or the performance of construction.
•
4etrile"9"-A---)
Signature of Owner�//� �/11 Signature of Contractor
Print Name f�/YIQ 1►1■ �,�4 Y Print Name
///r e‘ /:. /274.4,4
Sworn to and subscribed before me Sw rn to and subscribed before me
this .tt Day of MA 2C44.4 ,20 /4 is • ' -Day of .474 ee4- ,20 16
Public a 'u. is
Revised 01.26.10
• i "* UILLY C MCMAHAN — — - -A. -AL.
���IP ALBERT MORENO 0
• 'ii MY COMMISSION>r FF230603 `,'0.V PVe
_�� „`�; Notary Public-State of Florida
4-t`,• EXPIRES May 13,2019
,.,».'_ Commission#FF 239295••
im»geo rnra.nonrys.rvw•aar %�,,-w- .cc My Comm.Expires Jun 9.2019 L% %,F OF Pi,,° Bonded through National Notary Assn. ■