980 CAMELIA ST - WINDOW / DOOR \s� CITY OF ATLANTIC BEACH
,-� 800 SEMINOLE ROAD
J ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
i __________.0.219%`'
WINDOW AND/OR DOOR PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-WIND-972
Job Type: WINDOW AND/OR DOOR
Description: door replacement
Estimated Value: $423.00
Issue Date: 4/29/2016
Expiration Date: 10/26/2016
PROPERTY ADDRESS:
Address: 980 CAMELIA ST
RE Number: 170971-0000
PROPERTY OWNER:
Name: SYMONS, MARK
Address:
GENERAL CONTRACTOR INFORMATION:
I Name: LOWES HOME CENTERS INC
Address: 4948 TELSON PL QA PETER ANTHONY CAFARO III
Phone: - -
PERMIT INFORMATION:
FEES: ----- --- ------
PLAN CHECK FEES $27.50
BUILDING PERMIT FEE $55.00
ISTATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $86.50
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACII ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH MME E COPY
800 Seminole Road, Atlantic Beach, FL 32233 ,,
Office(904)247-5826 Fax(904)247-5845
Job Address: 9150 -/t'/LL/X1 S7 Permit Number: / -47/4D 72_
Legal Description - 3'7 3g - S — 2-11-q. Parcel# / 2 9'7/ -- /Ddb
,,/ ec- vor rea o q. I. q. t
Valuation of Work$ 4 3 '` Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(eject• ! , • : Commercial esidential
If an existing structure,is : re s rmlder s ste , • tailed?(Circle one): o l
tu /A
Florida Product Approval • / / ` a„ •/
For multiple products use , t ,uc approva orm ,6-ial-A--e-4.Describe in detail the type of work to - pe ormed: Coa'- SlZe--- /c -
Sl7e- Loc..4-z. --d/ /0,e--,e— G�•e' i-1�id,p
Proncrty Owner Information:
Name. �A t\ • (..A10\1�f\S e t Address: 9so ��`
City d�>* . 1 1. A► StateWip, ?3-Phone `i - �� '
E-Mail or Fax P(Optional)
Contractor Infor)OCJ€\tioa:
Company : e: 01',46 -7 ezouid in Age t: It' 4. ■ e
Address: i aftrt City Y-All State . Zip VAT. .
Office Phone Job Site/Contact Number Fax tl
State Certification/Registration P _ . 04. 7
Architect Name&Phone ft /VI— -
Engineer's Name& Phone P_ it /�—
Fee Simple Title Holder Name and Address
Bonding Company Name and Address •
Mortgage Lender Name and Address
Applicatio u hereby made to obtain a permit to o the work and installations as indicated. I certify that no work or installation has commenced prior to the
issuance o�a permit and that all work will be per1ormed to meet the standards of all laws regulating construction in this jurisdiction. This permit beoomts null
and void if work is not commenced within six(6)months.or f construction or work is suspended or abandoned for a period of six(6)months at any time after
work is commenced. 1 understand that separate permits must be secured far Electrical!fork,Plumbing,Signs, Wells,Pooh, Furnaces,Boilers,Healers,
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.
1 hereby certify that I have read and examined this plication and know the same to be true and correct. All provisions of laws and o finances erning this
type of work will be complied with whether specipeed herein or not. The granting at a permit does not presume to give authors to viola or cancel the
1 provisions of any other federal,state,or local law• ing construction or the performance of construction. _ /
•Signature of Owner �t '� t149i,(,c1... .rte Signature of Contrac or
8
Print Name .-..e. ..4i1,u.f"-i..I .._. ....i11..4J.35'.. Print Name .. .__e Tam ._.._ xe„......._. . ...:. .
Sworn is . d subscri� before me // Sworn tgand-subscri. - before me
this _. • • ''//--- 20/G this 2-(t e • • =►.j — - 20 /
./ F, _.,/Ari d !
o .ry 'II• , , DEBRA L CARTER
o°s —� DEBRA L CARTER .:;.0�a� t Notary Public-State BdaI 1.26.10
i. Notary Public-State of Florida .% ...., .• My Comm.Expires Mar 18.2017
My Comm.Expires Mar 18,2017 Commission#EE 874638
--;,„•14r,......,1,...4,'a Commission#EE 874638 - - , « rte. ..;;"; ::'''
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� 1.4 jjitb City of Atlantic Beach APPLICATION NUMBER
Js Building Department (To be assigned by the Building Department.)
800 Seminole Road �� i.1 g�Z
�p Atlantic Beach, Florida 32233-5445 W
v Phone(904)247-5826 • Fax(904)247-5845 t� ZG
��11,1M ' E-mail: building-dept @coab.us Date routed: /�Q
City web-site: http://www.coab.us I
APPLICATION REVIEW AND TRACKING FORM
Property Address: 9Ji C/ii-Yr?1//it._. cc7- Department review required Yr No
CB.uL.ding-Th
Applicant: Z I &LE S L Planning &Zoning .
Tree Administrator
Project: ) oo f�/ 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:
APPLICATION STATUS
Reviewing Department First Review: proved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: ! / ' Date:
TREE ADMIN. Second Review: ['Approved as revised. ❑De ed.
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