1969 BRISTA DE MAR CIR -GARAGE DOOR -S,_,i' , ,
F_
`s, CITY OF ATLANTIC BEACH
.. 41j 800 SEMINOLE ROAD
.V ,. ____)l ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
\JFilc
WINDOW AND/OR DOOR PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-WIND-1256
Job Type: WINDOW AND/OR DOOR
Description: REPLACE GARAGE DOOR
Estimated Value: $1,859.00
Issue Date: 6/16/2016
Expiration Date: 12/13/2016
PROPERTY ADDRESS:
Address: 1969 BRISTA DE MAR CIR
RE Number: 169506-1670
PROPERTY OWNER:
Name: KANE, PHILIP B
Address: 1969 BRIST DE MAR CIR
GENERAL CONTRACTOR INFORMATION:
Name: PRECISION DOOR SERVICE OF N FL JASON SHEPPARD
Address: 11323 Business Park BLVD
Phone: 904-638-2220
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $29.65
BUILDING PERMIT FEE $59.30
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $92.95
PERMIT IS APPROVED ONLY IN ACCORDANCE NvTTI1 ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
s- City of Atlantic Beach APPLICATION NUMBER
�s r -���- Building Department (To be assigned by the Building Department.)
'fl 800 Seminole Road 1, /
s4 Atlantic Beach, Florida 32233-5445 e—Y/ (l D—I Z5� '
J _r
Phone(904)247-5826 • Fax(904)247-5845
e
0, 19 E-mail: building-dept@coab.us Date routed: 671 !I
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Cc2
Property Address: 1°169 iRstA DE !AA- D ent review required Yes No
Building
Applicant: PRe lSIcN 0:2)012._ E_VtQE;rS an oning
Tree Administrator
Project: C A(ZRC E D00R__ 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: proved. ❑Denied.
(Circle one.) Comments:
UILDING
PLANNING &ZONING '\ /
Reviewed by: Date: 6 ZONING '616
'��
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
BUILDING PERMIT APPLICATION OFFICE COPY
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845 i AA/1 ti Q - 1 Z5 '
Job Address: \NC\ U2-n\-0\ zie_
1` ocz. 1C`� Permit Number:
Legal Description Se\\ o 'MI }\r1\\ �\' ( \-O ` 0\ Parcel # 40-31 - OCI - 2S -2 01 t
lour Area of Sq.Ft. Sq.Ft
Valuation of Work S \� b C •0 roposed Work heated/cooled non-heated/cooled 1\2.
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial identi
If an existing structure,is a fire sprinkler sys em installed? (Circle one): es No NTAD
Florida Product Approval# 15853 .
For multiple products use product approval form \,\
Describe in detail the type of work to be performed: S2-e_V (�_ TRAr � � VV`
Property *___
‘0-tW -
� Owner Information:
t
Name: Y(1\`\\0` -•-0\\*' ... Address: �1DC1`D pjRAS-0\ c t Vikav Ckv.,
City ;T LMv-CC ' \l StateFL-Zip 32233Phone c 24l-554 4
E-Mail or Fax# (Optional)
Contractor Information: A\ M,�� A /�1'
Company Name: P(.t.0\�\�\v IJIJ�E- a,.,(4,\CtNalifyLanA ent: 7�S6iv ��v-� IJ�YA
Address:‘13?,-6-11) City State Cl- ip 3226-le
Y � ti Y 1 Job Sittee,Contact Number " ` Fax Fax#
Office Phone( -'IAA- 'S"h1
State Certification/Registration# •R �
Architect Name& Phone# -\\Ni\ -' 9..n cx,nak1 C
Engineer's Name& Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
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 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. I understand that separate permits must he secured for Electrical Work, Plumbing,Signs, Wells, Pools, Furnaces, Boilers, 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.
I hereby certify that/have read and examined this a,plication 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 herein 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 regulating construction or the performance of construction.
Iorgnature of Owner . ' / /,t_ Signature of Contractor r A
elk Narni4.4 na ,-e1/-7 nc'n Print Name _SA SuE,P'ARD
Sworn to and subs 'bAs •efore me Swop' to and subscr'b•• •efore me
this • I Pay o f UUl 20 (..e this 1 Day of UU t,,4 20
MIC r-" '' . =1/�� Mj 17/7. (1 ( 1''
• Pub "° 1
Notary � i .�...
MY COMMISSION#FF146361; Notary � �c�;.MICHELLE ABRAHAM\Z"?of d''' EXPIRES July 29, 2018 4/ *) MY COMMISSWSFee U76G6 1 0
(407)398.0153 FioridallotaryService.com 1 ",�o,A,d'` EXPIRES July 29. 2018
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