1369 ROSE ST - SIDING ,c,, ,
r.I \,v r,
„" ,f .,„ CITY OF ATLANTIC BEACH
,. . .. -,; , 800 SEMINOLE ROAD
\J ATLANTIC BEACIl, FL 32233
INSPECTION PHONE LINE 247-5814
l;/ 0.HIWr
SIDING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-SIDE-1034
Job Type: SIDING PERMIT
Description: HARDIE SIDING OVER BLOCK
Estimated Value: $500.00
Issue Date: 5/18/2016
Expiration Date: 11/14/2016
PROPERTY ADDRESS:
Address: 1369 ROSE ST
RE Number: None
GENERAL CONTRACTOR INFORMATION:
Name: PLUMBING BY JOSH
Address: 5677 FLORAL AVE THOMAS R PORTER
Phone: - -
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $27.50
BUILDING PERMIT FEE $55.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $86.50
I
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
�sf:av; City of Atlantic Beach APPLICATION NUMBER
�� • �3� BuildingDepartment�- ,t� p (To be assigned by the Building Department.)
�([ 8tla SeminolecRoad
1(40.-- (
,_J r _ '/,
-`t �r Atlantic Beach, Florida 32233-5445
I l C
Phone(904)247-5826 • Fax(904)247-5845 r
x Jg 9� E-mail: building-dept@coab.us Date routed: `/4/1 t:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
22
Property Address: (Jim Q l OSS ( Department review required Yr No
uilding)
Applicant: PLU/v,, !�1 ,��E1 �ing &Zoning .
Tree Administrator
Project: ( E t fv6 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: ILKproved. []Denied.
(Circle one.) Comments:
CUILDI
PLANNING &ZONING Reviewed by: f / Date: 5'12'/‘
TREE ADMIN. Second Review: ❑Approved as revised. ❑Denie .
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
ive".
,a�L' BUILDING PERMIT APPLICATION
'i-.) OFFICE COPY
CITY OF ATLANTIC BEACH
r4 0
800 Seminole Road,Atlantic Beach FL 32233
\�`�'; �� Office: (904)247-5826 • Fax: 904 247-5 (
( ) 845 ` —S `�E ` 1034
Job Address: ` 13 6 9OSE- Si--- . Permit Number: Pt/4 •
Legal Description NIA-• RE# 111 °64-0110
Valuation of Work(Replacement Cost)$ .00- Heated/Cooled SF NA- Non-Heated/Cooled Nli¢-
• Class of Work(Circle one): New Addition Alteration (Repair) Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial C Residential
• If an existing structure, is a fire sprinkler system installed?(Circle one): Yes No (JN/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: 2> 4 .Fl�1 x7G
AIM PA0.6,t (.6 t tk)6 -To r'i 0 _ OF &911-,A i'vG ()fife? 1://2/,06 S`Tat Its
Florida Product Approval# F----A* 3I 9 2 a 1 for multiple products use product approval form
Property Owner Information
T Ai J� tri i Ddu Krl Address:ess: 22(4v 4C-s0 )26
City J,� Q•SK F-1--- State 1_Zip 3226.0 Phone 9'O((— 333-66 o7
E-Mail NA-•
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:io ,p
Name of Company: ! /✓tVh/.Jy r6}' ZS4-TA (Qualifying Agent: 1)10"/ S 4, POg7 �\
Address: ,s-6,S9 j/01eg f Alec City lS4Ou WC State Zip j da 1/
Office Phone pLJ a.37-S70 b Job Site/Contact Number 237— 570(o
State Certification/Registration # G6—/AS /3V E-Mail ;-- 'A 6-01 `v 4 01. C 0,1
Architect Name& Phone# N/ .
Engineer's Name &Phone# N ti
Worker's Compensation Olt -
Exempt / Insurer / Lease Employees I 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 constriction in thi urisdic on.
This permit becomes null and void if work is not commenced within six(6)months, or if construction orwork is s pended or ab done or•a
period oJ'six(6)months at any time after work is commenced. I understand that separate permits must be secured f Electri l W k,PI bung,
Signs, Wells,Pools,Furnaces,Boilers,Heaters, Tanks and Air orrditioners,etc.
Signature of Property Owner: 90,1A;APJ Signature of Contractor•
Before me
this Day of --- 0 1 ' Before me this Day of a i ,o
N. .. . . . A`_ /
NAD C.— � Notary Public: .
�+ _• No P ic,State of Florida NADYA C.MOREIRA
I he •• ' a hat l g f�9ffi$6 an re' this application and know the same to be tru and corre, .1):. 'A'%foe 'State ic t 923365
ordr an j9,, of rr� r 1120%1 11 .e complied with whether specified herein or not. The _ ,.__-,, , pe • ;