1635 W PARK TER FOUNDATION REPAIRS (j * la CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
\J s-) ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
RESIDENTIAL ALT /OTHER
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247 -5814
JOB INFORMATION:
Job ID: 16 -RAAR -878
Job Type: RESIDENTIAL ALTERATION
Description: FOUNDATION REPAIRS
Estimated Value: $9,004.00
Issue Date: 5/2/2016
Expiration Date: 10/29/2016
PROPERTY ADDRESS:
Address: 1635 W PARK TER
RE Number: 172020 -0320
PROPERTY OWNER:
Name: MARSHALL ET AL, SHELDON
Address: 1635 W PARK TERR
GENERAL CONTRACTOR INFORMATION:
Name: RAM JACK
Address: 2075 S US HWY QA ERLEWINE A SCOTT
Phone: - -
PERMIT INFORMATION:
FEES:
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
PLAN CHECK FEES $47.51
BUILDING PERMIT FEE $95.02
Total Payments: $146.53
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION FI L E COPY
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233 � Q
Office (904) 247 -5826 Fax (904) 247 -5845 /6 -g R - R.7
Job Address: I (035 lAi Poe K Der a re. Permit Number: i7aoa ( - 0320
Legal Description 31-52 O9 -aS 9 E •39(0 Parcel # /12 020 - 03.20
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work $ 9 �7 Proposed Work heated /cooled non - heated /cooled
Class of Work (circle one): New Addition Alteration art Move Demolition pool/spa window /door
Use of existing/proposed structure(s) (circle one): Commercial _� N /A
If an existing structure, is a fire sprinkler system installed? (Circle one): es
Florida Product Approval #
For multiple products use product approval form
Describe in detail the type of work to be performed: 7325 7 /4'1 7' h e /, e 4 / R /es 4 '
I p Uri c(Cc. O. f n . :
Property Owner Information: /- _
Name: /3YU(e S/ /dc�t7 Address: A 0'35 �ar K /errare ix(
Cit Alumwarrozim. Stat- "'' Zip, g 3 Phone 9t)i/ - ..76/ In - 0 ,-V tO 1
E -Mail or Fax # (Optional)
Contractor Information:
Company Name: R/9n" (If/ a Qualifying Agent: - E/ - /rw: n e
Address: /N5/03 /v• mt4 /w .3T City -.IA (Ksen.i' /1 . State F Zip 3.09.a/ t3
Office Phone q0" /- 570 • .3l )5I Job Site/ Contact Number Fax #
State Certification/Registration # CG C /5/ S 9a
Architect Name & Phone #
Engineer's Name & Phone # q(.4 A L /Y7/9 /2T l NEL S 113 - f 339 - / (o 420
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
Application is hereby made w obtain a permit to do the work and installations as indicated. 1 certify that no work or installation has commenced prior to the
issuance ofa 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. 1 understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, Furnaces, Bo 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 / have read and examined this a pli 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 ted t J 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 local law regul construction or the performance of construction. /�
v
Signature of Owner 4'. i 1 ! r
r tl t � A Signature of Contractor Y oil
A__
Print Name ......_ 0e► 6 ...................._................... ............................... Print Name ....... ..... kou!}! 'e._ ......................_..
Swo.• and subsc.. • before me Swo r • : d subs '.ed .efo e me
thi ; .-a . %1 �,! . 2 IA*. this `� Day of jo.(i . 0 is
Notary Public Notary Pus is
P Revised 01.26.10
� ALLEN CATOE WHITE
MY COMMISSION ll PH 21448
EXPIRES: May os,2ols • ANGELA 1 BURDEN
'' MY COMMISSION 0
'ko:d EXPIRES Februar: FF 26, 96472 2018
(407) 398 FlcridallotaryService.com
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Doc # 2016070623, OR BK 17509 Page 181, Number Pages: 1, Recorded 03/30/2016
at 01:34 PM, Ronnie Fussell CLERK CIRCUIT COURT DUVAL COUNTY RECORDING $10.00
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0rl11F City of Atlantic Beach APPLICATION NUMBER
J� S, Building Department (To be assi ned by the Building Department.)
800 Seminole Road �7' 7 D
J
�� Atlantic Beach, Florida 32233 -5445
Phone (904) 247 5826 Fax (904) 247 -5845 �
,;,19%- /
E -mail: building- dept @coab.us Date routed: �A
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: / ? � t(/ / Tr ' - .. ment review required Ye No
/y � Building
Applicant: -fJ / 7 (: fanning & Zoning
Tree Administrator
Project: , e 17 P Y ff7 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: Ij pproved. ['Denied.
(Circle one.) Comments:
BUILDI
PLANNING & ZONING Reviewed by: Date: / .0) ��
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