388 4TH ST - INTERIOR DEMO \S, CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
J�- ` j ATLANTIC BEACH, FL 32233
.� INSPECTION PHONE LINE 247-5814
\01319`'
DEMOLITION PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-DEMO-1078
Job Type: DEMOLITION
Description: INTERIOR DEMO
Estimated Value: $1,000.00
Issue Date: 5/9/2016
Expiration Date: 11/5/2016
PROPERTY ADDRESS:
Address: 388 4TH ST
RE Number: 169826-0000
PROPERTY OWNER:
Name: AYCOCK III, THOMAS J
Address: 491 SATURIBA DR
GENERAL CONTRACTOR INFORMATION:
Name: DKB ENTERPRISES INC.
Address: P 0 BOX 331458 QA DONALD KEN BERGERON
Phone: - -
PERMIT INFORMATION:
FEES: -- ----
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Demolition Fee $100.00
Total Payments: $104.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
pe
;S ''t BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach FL 32233
\�J';I9r Office:(904)247-5826 • Fax: (904)247-5845
Job Address: -3 ?`$' u
-L tik S Permit Number:
Legal Description RE#
Valuation of Work(Replacement Cost)$ Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s) (Circle one): Commercial Residential
• If an existing structure, is a fire sprinkler system installed?(Circle one): Yes No N/A
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal
Describe in detail the type of work to be performed:
l7)TVide J -ww --
Florida Product Approval # for multiple products use product approval form
Property Owner Information ff�� r
Name: '�''n4J tW4�- 3 444 ''i
Address: J
City -/- States-Zip 2.1-1,33 Phone `}- -71$- Y-4-3-1
E-Mail -tcr» j e ""CaY 'ACT
Owner or Agent (If gent,Power of Attorney or Agency Letter Required)
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.
Contractor Information:
Name of Compan � �
1Y 72 )ZS k S�j a1c Qualifying Agent: "f�L(, 7R4G cj,J
Address: I City/'t-rt.,t s id/State Zip 32L Ka
Office Phone gay —2VL SSf.T Job Site/Contact Number
State Certification/Registration#('et.(4,a cfj? E-Mail '---4g/t/2.45"j7/ B0'4450,47 14 _Nr-IN
Architect Name&Phone#
Engineer's Name &Phone#
Worker's Compensation -
nsurer ease mp oyees xpiration late
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 oJ'six(6)months at any time after work is commenced. I understand that separate permits must be sect . . Electrical Work,Plumbing,
Signs, Wells,Pools,Furnaces,Boilers,Heaters, Tan s and Air Conditioners,etc.
Sig re of Pro. •caner: � �� Signature of Con At'
B o e 11 / �_
this Day of�' A. � 1. Before me this Day'Mr
'n . . 1_,�
Notary Public. - �� 1 ,,1I �•>♦�� Notary Public: � /_
if: • '` MY COMMISSION#FF 924951 I r •
" TONI Gi: ±:.PEERGER
I hereby certi t�` .F.e iEXiiifk5 rc�21 ;::i•i ,pplication and know the same to t ' F924�1
ordinances go » ' isa 1h'Y''il• � ,';�,.___. ��i•�w ••�• d dt�ltri@�! � � i nti 1.
tdinan
ordinances o : - - plied with whether specified he,It s;,, . PR5 i^ Wit!__:-.:-----"n doe, not
presume g L =--•• " r cancel the provisions of any other federal, st.l Ic t • akdr+ad> ••li 1'iiU._:_.:_..--- ion or the
performance o construction.
Rev. 3/14/16