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157 BELVEDERE ST - WINDOW t r J', rj ', s CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD J ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 WINDOW AND/OR DOOR PERMIT MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 JOB INFORMATION: Job ID: 16-WIND-801 Job Type: WINDOW AND/OR DOOR Description: WINDOW REPLACEMENT Estimated Value: $4,500.00 Issue Date: 4/13/2016 Expiration Date: 10/10/2016 PROPERTY ADDRESS: Address: 157 BELVEDERE ST RE Number: 170584-0000 PROPERTY OWNER: Name: BURCH, ROBERT & LESLEE ANN, * Address: 157 BELVEDERE ST GENERAL CONTRACTOR INFORMATION: Name: JEP CONTRACTORS INC Address: 1416 FOREST AVE QA JOHN EWEL PEARSON, III Phone: - - PERMIT INFORMATION: FEES: BUILDING PERMIT FEE $72.50 PLAN CHECK FEES $36.25 STATE DCA SURCHARGE $2.00 STATE DBPR SURCHARGE $2.00 Total Payments: $112.75 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. rr"'��i''%; City of Atlantic Beach APPLICATION NUMBER NJ` t jA\'1Building Department (To be assigned by the Building Department.) 2 800 Seminole Road /',/ / _ fed' `° f2 Atlantic Beach, Florida 32233-5445 !� (N /v O,� V~ Phone (904)247-5826 • Fax (904) 247-5845 s/n��:i p,t»%" E-mail: building-dept @coab.us Date routed: /(J/ City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: /c7 /31,wL dai £T _ Department review required Yes No Buildin 9� Applicant: :IC p a n%en an — Pt:11111 41g &Zoning Tree Administrator Project: IV 1 110)0 IV -,P1A F nT- 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: APP ICATION STATUS Reviewing Department First Review: Approved. Denied. (Circle o Comments: NO6.....UILDING PLANNING & ZONING Reviewed by: Date: o ^/-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 COPY 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247-5826 Fax (904) 247-5845 Job Address: �' , �` x r�,r-f # f ` s(c::.. - yc57 / g c--� Y Permit Number: ` Qom, L 27 595., 5EcTt on.� /(1220- I A,3 refc'orz,[.a( �10` Lt1//ji/}-O''� Legal Description/r /red iv," /o d' g' Parcel # 'jl Flo r Area of Sq.Ft. q t Valuation of Work$ s©© Proposed Work heated/cooled -- non-heated/cooled --- Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa mdow / •' Use of existing/proposed structure(s) (circle one): Commercial 1e idea If an existing structure,is a fire sprinkler system installed? (Circle one{ o N/A Florida Product Approval # /Y© $$./) /5!B S'S, �., 33? 0 For multiple products use product approval form Describe in detail the type of work to be performed: ■ /i c l'-' t 4 c c� i 61 rt(. 1 c v v< ct 4-- v !- " S 12-7.1W 7 Property Owner Information: Name: g o b f_r + N g f L t Address: [ S 7 g ,1 Li e der e City G CA • I. ' e_ State F/ Zip 3 al 33 Phone r' E-Mail or Fax • (Optional) `� 5 3- 6 L ( p ) �L T � co i'y jai_C.A S r: N Z 7 Contractor Information: CONTRACTOR EMAIL ADDRESS:•� 27EPGoti r'actar•G — iAe.` - Company Name: 3£� �cc' r4 e.f c-4 �i1c Qualifying Agent: ,-J.4 I 1 PC #'S.E>ivc Address: /51/L /vr s1 ,v City 1p fu v Be 04-11- State FL- Office Phone 2if7.- 1525 Job Site/Contact Number 2-2 Zip���(g(a State Certification/Registration# CGG �.r-�(.j 4 3 �°g3� Fax# — Architect Name&Phone# ,�..4. Engineer's Name&Phone# ILIA Fee Simple Title Holder Name and Address c c.....c—— Bonding Company Name and Address 1J4 Mortgage Lender Name and Address /1J4 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 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 a plication and know the same to be true and correct. All provisions of laws and ordinances governing this ±ype of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to viol to or cancel the 9rovisions of any other federal,state, or local law regulating construction or the performance of construction. signature of Owner LLY_Lti, Signature of Contractor Amt 7 -Ca".*••-, Tint Name AC) + C.u.r Cf h Print Name To 1 C Fe.t r son 3efore me Befor- e its 22. Day of te6 2 thi, �♦ D,y of O I a L 20 - 1 ) 4d% TREBOR M.DEVERTER r �� e totary Public Z.6:1 Notary Public-State of Florida otary Pub " " ,3 e My Comm.Expires Mar 30,2018 ( r 5 irley L Graham 4t;; d;:•''• Commission#FF 107621 ; E mss Ses��l.2 0 '•gnu.'•• '�oF. Expires 0211