1365 ROSE ST - SIDING ter\J�r
>" y `S, CITY OF ATLANTIC BEACH
j 800 SEMINOLE ROAD
J T vN ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
,f.
40
SIDING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-SIDE-1033
4 Job Type: SIDING PERMIT
Description: HARDIE SIDING OVER BLOCK WALL
Estimated Value: $500.00
Issue Date: 5/18/2016
Expiration Date: 11/14/2016
PROPERTY ADDRESS:
Address: 1365 ROSE ST
RE Number: 171064-0110
PROPERTY OWNER:
Name: SOVEREIGN INVESTMENT GROUP LLC, *
Address: 2728 DAVIE BLVD SUITE 134
GENERAL CONTRACTOR INFORMATION:
Name: PLUMBING BY JOSH
Address: 5677 FLORAL AVE QA THOMAS RALPH PORTER
Phone: - -
PERMIT INFORMATION:
FEES:
BUILDING PERMIT FEE $55.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $59.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH A1.1. CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
di
° J
0 1..iv ,yV, City of Atlantic Beach
APPLICATION NUMBER
�� { • , •,. Building Department
:.._ Sa (To be assigned by the Building Department.)
800 Seminole Road
1:5 __. Atlantic Beach, Florida 32233-5445 1 —
S t&C - 103.3
� � Phone(904)24,7-5826 • Fax(904)247-5845
\jst 0 E-mail: building-dept@coab.us Date routed: -5/4 l 1 Co
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 136, Ram & ( De ment review required Yes No
Building
Applicant: PLV►YIS(NDc &--i �O,s k crrirrirrgtZoning
Tree Administrator
Project: t I NCS Public Works
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature j
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: { jjApproved. ❑Denied.
(Circle one.) Comments:
BUILDI '
PLANNING &ZONING t� S /2-16
Reviewed by: / Date:
TREE ADMIN. Second Review: A roved as revised.
❑ pp ❑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
'' BuILDrNG PERMIT APPLICATION OFFICEaX
. f
t,'v �� CITY OF ATLANTIC BEACH •
800 Seminole Road,Atlantic Beach FL 32233
"IJr Office:(904)247-5826 • Fax: (904)247-5845
l(o-St Oe — 1 C,.%_-
Job Address: 1 3 6c ' _ 124Sa S-I- ,
Permit Number: N/4 .
Legal Description PIA-• RE# 111064-0t1 V
Valuation of Work(Replacement Cost) $ .40- Heated/Cooled SF PIA-
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 C`" /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:
t6 1 A21. [- t-6 t tU t, 1-0 Flo f __ OF &9/1-1A/iv& Otic' 17/21/J6 ETA',AS
Florida Product Approval# Or. (, 31 C-I' 2 4
` for multiple products use product approval form
Property Owner Information
Name: yT�I� � I N�(,�1..1,��Zlz- `
Address: 2249Ooh PQ ,
City A.A arFl- State -Zip 3226.0 Phone ('d
E-Mail �.. c�`_ 9j3�'--��07
Owner or Agent (If Agent,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 Com any: ��li i— ,6 ,S4 (Qualifying Agent: 0I,.}S de, AA-TO''
Address: ...56S, TA) 1 .4Cit
y Office Phone pL a37—SX)6 Job Site/Contact Number 237 tat pG��a //
/ 510
State Certification/Registration# GiC_mS wits E-Mail ,'� 'I 6.01 E 40L. C 0,1
Architect Name&Phone# /sf
Engineer's Name&Phone# MA-
Worker's Compensation AA
Exempt / Insurer / Lease Employees / Expiration Date
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 thi urisdic 'on.
This permit becomes null and void if work is not commenced within six(6)months, or if construction or.work is s-pelletized or ab done or a
period of six(6)months at any time after work is commenced I understand that separate permits must be secured f.'Electri 1W, k,P1 burg,
Signs, Wells,Pools,Furnaces,Boilers,Heaters, Tanks and Alr onditioners,etc.
Signature of Property Owner: 0 J Signature of Contractor L 411.1040%
Before me
this 3 Day of 11 Cu/
I,0 1 b Before me this D ay of 01
J
Nn to n •
,'
NAD C.IMOREIRa( s-`v� Notary Public: ,
I lie �i - No Pu'6lic,State of Florida NADYA C.MOREIRA
-ety ty that�o woof f S�xariene this application and know the same to be tru and corre, .J4 4 i�'S '92336 5
pordhan ir_,,;;ol�r•r �s 3 2011a 114/ e complied with whether specified herein or not. The : c i ,._., ,Sr '
res m ► _ive a i cel the provisions of any other federal, state, or local law r::_ii, ""'' c as s i �t {1C 1.2019
perf•ruction.
Rev.3/14/16