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179 PINE ST - SIDING w \� CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 �S31�r SIDING PERMIT MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 JOB INFORMATION: Job ID: 16-SIDE-860 Job Type: SIDING PERMIT Description: SIDING Estimated Value: $2,400.00 Issue Date: 4/13/2016 Expiration Date: 10/10/2016 PROPERTY ADDRESS: Address: 179 PINE ST RE Number: 170635-0075 PROPERTY OWNER: Name: PERRY, SUSAN Address: 179 PINE ST GENERAL CONTRACTOR INFORMATION: Name: RADON PROFESSIONAL SERVICES Address: 336 14TH AVE QA WILLIAM TONY DAVENPORT Phone: - - PERMIT INFORMATION: FEES: PLAN CHECK FEES $31.00 BUILDING PERMIT FEE $62.00 STATE DCA SURCHARGE $2.00 STATE DBPR SURCHARGE $2.00 Total Payments: $97.00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. 01".11J-",1 City of Atlantic Beach APPLICATION NUMBER r Building Department (To be assigned by the Building Department.) its 800 Seminole Road //_ -54.4e - /�/O Atlantic Beach, Florida 32233-5445 !!�� U Phone(904)247-5826 • Fax(904)247-5845 s t• E-mail: building-dept @coab.us Date routed: i /Z//6' City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: /79 l/ if 1! J7 ent review required Ye No ildin Applicant: 'n2� ,i/ / / 4 LSS7:M C Planning &Zoning -/ Tree Administrator Project: � / /V 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: APPLI ATION STATUS Reviewing Department First Review: Approved. ❑Denied. (Circle one.) Comments: Con I-roc/0R Ska I w 64--e ft/ .g n --1,.e PL. =/ o n BUILDIN 44A e Ca l icc' ion PO r re% 6 have ,rke %h s46, I c J iin 1 r S4ruc.- PLANNING &ZONING 7F'OAS ors SI r prog rosy sA /•ni =n s fkci`"''.• Reviewed by Date: y'/off'/6 TREE ADMIN. Second Review: ['Approved as revised. ['Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ['Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05/14/09 BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH FILE C®rr 800 Seminole Road,Atlantic Beach, FL 32233 Office (904)247-5826 Fax (904) 247-5845 Job Address: (7 cl P(°A) e S(. Permit Number: /6-- 5'/L7e=- k6 d Legal Description PE /0-la / -25 — 29 f Parcel # ,L —Floor Area of Sq.Ft. Sq.Ft Valuation of Work$ 2V op. Proposed Work heated/cooled I 0 8'Z- non-heated/cooled / ti 1- Class of Work(circle one): New Addition Alteration pair Move Demolition pool/spa window/door Use of existing/proposed structure(s)(circle one): Commercial :-si��iti. If an existing structure ,is a fire sprinkler system installed? (Circle one): 41C774 O N/A Florida Product Approval # (J7p For multiple products use product approval form Describe in detail the type of work to be performed: i r'(14:'e rvd 44 ty CAI s 1 t tr eel 114 Qc ' s iii AI d A) A.J. �i,i'I , r (4u 0S C `f Property Owner Information: Name: '5 ti 5 h,-) l7 c r2/2--y e)i1 7 41 i',>-) e- 5 7 City A 7 L.i.,� f rc 8 h` State it Zip Phone E-Mail or Fax#(Optional) Contractor Information: Company Name: �� r , �Ro "- eft tlre ei Qualifying Agent: Les 7- O,9 ti(......;Po Be 7 Address: 3 3( /it yd 40 its. City jr,i.yc j2 o,.c/, State (--L Zip -3 2 z 6-0 Office Phone Job Site/Contact Number -9t - /l /U Fax# State Certification/Registration# C ( a••17 9 3 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 cert5 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_period of six(6)months at any time after work is commenced I understand that separate permits must be secured for Electrical !York,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 thisplication 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 loco , .: lating construction or the performance of construction. r-""I Signature of Owner ''� -C '"l Signature of Contractor tt I 7()/P-//e /t,t 7 Print Name s.L.24 C --(e/"'l Print Name 4) 70 eAtei.77,-2....c--------- Sworto and subsc ••-d jte •rent_ _—1—— — — Sworn to and subscrilled before me ' I L Day of : S T i this I L Day of K414 — — — — — — — �1� LI, %*�.`� Notary Public-State of Florida ��S V PCB STEPHEN HAFT •: �!� :•E My Comm.Expires May 5,2016 t +° `N� Notary Public-State of Florida • Public �,F Commission#EE 195483 No u lic � 'J My Comm.Expires May 5,2016 "' Bonded Through National Notary Assn. ' - .F--�opt' Commission#EE 195483 r „JF F�,�� —— — — — —— — — — — "'"" BRAI 9©fia l$1 Nary Assn. NOTICE OF COMMENCEMENT FILE COPY // /� �} (PREPARE IN DUPLICATE) ! Permit No. 6 Sl ,e2Z- — o 6O Tax Folio No. State of FL County of >J U✓AL. To whom it may concern: The undersigned hereby informs you that improvements will be made to certain real property,and in accordance with Section 713 of the Florida Statutes,the following Information is stated In this NOTICE OF COMMENCEMENT. /0- / ( : Z S Z ' Legal description of property being improved: 1e• I _ /Al 5 it - wwwirm- as a-- - -- - Address of property being improved: 17 `j P o e 5 7' 4 7 1--I-A) 1 e.c 4 General description of improvements: R '/t-4G r �/I en,A-Ly /'Al 5 74-L ' ,`e( (WI 0,cJ F ' 5 '/e or //PM c -e `?.9-mot C3) Ne & 'Ale(vcJ✓ Owner 5 !J s 2vf 19e 1 #2 y Address i ? y P/,c5 e 57. A-7 Li,.J 7-c 8 fie% Owner's interest in site of the improvement Fee Simple Titleholder(if other than owner) Name / a/ 0- Address t Contractor 12 A-el 'pl J,A_e).. $ e4-V,-G-ed Address 3 3 / V 71 41/ /d 1 ei-c/t ,J-t 12_2_6—a Phone No. Fax No. Surety(if any) Address Amount of bond$ Phone No. Fax No. Name and address of any person making a loan for the construction of the improvements. Name i1/1 A Address /" Phone No. Fax No. Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other documents may be served: J �L Name I- / // Address Phone No. Fax No. In addition to himself,owner designates the following person to receive a copy of the Lienor's Notice as provided in Section 713.06(2)(b),Florida Statutes.(Fill in at Owner's option). Name /if Address Phone No. Fax No. Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a different date is specified): THIS SPACE FOR RECORDER'S USE ONLY CTA / /- Signed: — 4 • DATE Lf 1 41 Before me this f day of ir:rt /1411 In the County of Duval,State of ride.has perso ally a•peared it54x �?ryt,/ herein by Doc#2016081492,OR BK 17524 Page 341, himself/herself and affirms that all statements and d laretions herein Number Pages:1 are true and accurate q, a. A Recorded 04/12/2016 at 12:49 PM, :i'" , STEPHEN HAFT .�Pnv ode•. Ronnie Fussell CLERK CIRCUIT COURT DUVAL ;?°.'1.`� Notary Public-State of Florida COUNTY •. "� :•= My Comm.Expires May 5,2016 RECORDING$10.00 " o . ' mission r. EF 195483 Notary Public at Large,State of C• ∎ .y vdt.o gal Notary Assn My commission expires: S! 10 Personally Known Produced Identification C L D�