535 Atlantic Blvd Gate Building Application BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
806 Seminole Road,Atlantic Beach, FL 32233
Office (904)247-5826 Fax(904)247-5845 «cr-C ME W -(78
Job Address: 835 ft,R C_ Qw'1'3 Permit Number:
/iG1101`5
9s4- l
Legal Description/0-8 ZI-2S Z4F- ItZ Si9t.Tl11K 71 � 1ot5788779(riParcel# I10(o8t1 -0000
o' ol> rea of Sit.--'Sqr'
Valuation of Work S ( l,000(000 Proposed Work heated/cooled 6LA00 non-heated/cooled
Class of Work(circle one): Ne Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/propused structure(s)(circle one): commercial Residential
If an existing structture,is a fire sprinWer system into e c Pone): Yes No (235
Florida Product Approval# :5% ATMCrb�] GST
For multipleproducts use product approval term yy, �,�,�
Describe in detail the type of work to be performed:S onai UC SeXU IC2 C'ia on w t+ M TI .
Property Owner Information:
Name:&TE— VRVK LF_U✓'1 &M 4N� Address: 95t/0 �I 4 MSF_ si u7
City'SwCKSMIYI«F State�Zip zzx.n Phone 404- 448 -7035 YIQVI
E-Mail or Fax#(Optional) N�X Gh'It?PE"TfZD•G0M Go✓1 acOZ-
8044'
Contractor Information:
Company Name: Qualifying Agent:
Address: City State Zip
Office Phone Job Site/Contact Number Fax#
State Certification/Registration#
Architect Name&Phone# FMN tx AY 5 2 — Q�W l
Engineer's Name&Phone# OS Y. G — b
Fee Simple Title Holder Name and Address Ga ape K Co 61540 Sat+
Bonding Company Name and Address K/01%
Mortgage Lender Name and Address N L A
Application is hereby made to obtain a permit to do the work and installation"as indicated. I certify that no work or Installation has commenced prior to the
issuance ofo permit and that all work will be per(armed to meet the standards ofall laws regulating construction in dus jurisdiction. This permit becomes null
and void fwork is not commenced within sic(6J months,or ifconsimetion or work Is suspended or abandoned for a period of ru(6)months at any time alter
work is commenced. I undersand that separate permits must be secured for EleG ical Work, Plumbing,Signs, la, 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 cert that I have read and examined this plication and know the same to be true and correct All provisions oflaws and ordinances governing this
type o work will be complied with whether sppecs red herein or mt. The granting of a permit does not presume to give authority to violate or cancel the
prwesiow ofany other federal, ate, or local law regulating construction or the performance ofconr"mma.
Signature of Owner / ////__ Signature of Contractor
Print Name . .,_...,,,ci/ Qryii( ...,...._ Print Name .. . .
// ...........
Swom t and subscribed beforey�e Sworn to and subscribed before me
this //� ay f L�27u�t�b� .20 Zli this _Day of .20
c
No P isNotary Public
Revised 01.26.10
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