1717 BEACH AVE DOOR PERMIT CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
U ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
WINDOW AND/OR DOOR PERMIT
MUST CALL BY 4PM FOR NEICT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-WIND-1161
Job Type: WINDOW AND/OR DOOR
Description: REPLACE 2 DOORS
Estimated Value: $11,346.00
Issue Date: 619/2016
Expiration Date: 12/6/2016
PROPERTY ADDRESS:
Address: 1717 BEACH AVE
RE Number: 169662-0000
PRDPERTYOWNER:
Name: HADLOW, NANCY P
Address: 1717 BEACH AVE
GENERAL CONTRACTOR INFORMATION:
Name: PELLA WINDOW AND DOOR
Address: 7818PHILIPSHWY QA JAMES SAMUEL ROWLAND
Phone; - -
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $53.37
BUILDING PERMIT FEE $106.73
STATE OCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $164.10
PERNIFT IS APPROVED ONLY IN ACCORDANCE WFUH ALL CITY OF ATLAN'FIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach,Florida 32233-5445 1 L2
Phone(904)247-5826 I=(04)247-5845
E-mail: building-dept@wab.us Date routed:
City mb-site: http://�.mab.us 45�It
APPLICATION REVIEW AND TRACKING FORM
Property Address: 1 -717 'Pv,/e- nt review reguired Y
No
Applicant: pet�oMuNdou-)s �— P\00r-�s PMrintrig-&-Zoning
Tree Administrator
Project: Z L)oor-�, Public Works
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Reviev!
of Pemn't=pty Date
Florida Dept.of Environmental Protection
Florida Dept.at Transportation
St.Johns River Water Management District
Amy Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other.
APPLICATION STATUS
Reviewing Department First Review: [IrApproved. ElDerded.
(Cincle one.) Comments:
(B:U1:L2DlN�)
PLANNING &ZONING Reviewed by: Date:,E'�
TREEADMIN. Second Review: DAPproved as revised. []Den!
ed.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: [:]Approved as revised. DDenied.
Comments:
Reviewed by: Date
Revised 05114109
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH Cd7lml1*rPkIktIp72mv4wW
FILE COPY , 800 Seminole Road,Atlantic Beech,FL 32233
Office(904)247-5826 Fax(904)247-5845
Job Address: 1:11-7 'Reke,\x 4q4O- Permit Number:
Legal Description 15-- 10 0 1- Parcel# /49&6.)--0130(�
Ivor�d 01 Sq.1-t. 7q Ft
Valuation of Work (1� Proposed Work heated/cooled. non-heated/cooled
Class of Work(circle one): New Addition Atasseliter Repair Move Demolition pool/s
Use of existing/prgosed structure(s)�ircle onc)(: t�t.1.rcijl ...). den '
If an existing stru um,is a rim strut er system installed?(Cin e Sil;!;bN.
Florida Product ASproval# If 0
For multiple pro nets use-L!L�O
product approvafro—r-
Describe in detail the type of work to be performed: _R:�tg 4 NWI-el b,TA.
Property Owner informatiow
Name: "Q- lioi)vr - l-Q10u, Address: 1-111 beyxn, J�
,A:�, State k Zi cl� Phone
City
E-Mail or Fax#(Optional)
Contractor information:
Company Name: Pelb VA-dows&Dom QualifyingAgent: 7�5�Q%w\uwL
Address: 35TWV6WR5ddA34-- ity
office P one 1 -at -- --State—Zip
- W~Contact Number j,2 rY0'y Fax#
State Certification/Registration# r-1 01-1(a-11 QL
Architect Name.Plun.�
Engineer's Name&Phone
Fee Simple Title Holder
Bonding Company Name and Address
Mortgage Lender Name and Address
Application is hereby made to obtain a permit to do the work and maudiatrom,to,indicated lourt6thal aw ka,mal-11-dookeelmonoricedpnorlauh,
issuance a rmit and that all work will be
it dja�oe
r, 65�urnutd 1.meet the standard,ofall laws regulaturgeomitZHo;�in thisjurisdiction. Puspernar,becomes null
an vot 1 wor a not commenced within so(6 no
work is commenced I understand that separate Ooth,, or ifeamaroction or work is surended a,abamdonedjm�Vriod ofsixjol)months at any fim;�afler
Tanks andAir Condolences,an permits most be secaredfw Elecirka Work,Plumbing,Slim, ed1h,Powile, umacs,Boilers,H, tem
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 YOVifi NOTICE OF
COMMENCEMENT.
I he,y,�,ce,16 that I have read and toomameddiss pplicadon andiumne the same to be true andcurrect. All,,ovisterv,oflaws and ordinances governing this
J)W a work will be complied with whether srct sed herein or am The granting of a permit does nor presume to give authority to violate a,camel the
provisions ofmy wherfedital,state,or local in
aw regulating construction or the urybrmame ofcowtoction.
Signature of Ovvner� Signature of Contractor
Print Name A. -.... . ................ Pont N .. P
Swom urand subscribed be ore me Swom 19 and subscribed before me
this -4ayof A 20 /r. is ILSI�`Day of 'A 20
Notary Public OfflarINE OWLEY n'
I,.uiry c-umn; 18
EXPIRES Jarveq 29.2018
Doc # 2016107215, OR RIK 17559 Page 1906, Number Pages; 1, Recorded
05/12/2016 at 11:28 AM, Ronnie Fussell CLERK CIRCUIT COURT DUIAL CO Ty
RECORDING $10.00 ON
PermitNumber 16�btllkl)-1141
Pon.,10 Ninother FILE COPY
NOTICE OF COMMENCEMENT
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