65 19TH ST - DOOR REPLACE ri r fJrl
CITY OF ATLANTIC BEACH
7-3 r40, 800 800 SEMINOLE ROAD
w , ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
..4 0.r 3 S
WINDOW AND/OR DOOR PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-WIND-1975
Job Type: WINDOW AND/OR DOOR
Description: REPLACE THREE DOORS
Estimated Value: $2,000.00
Issue Date: 9/6/2016
Expiration Date: 3/5/2017
PROPERTY ADDRESS:
Address: 65 19TH ST
RE Number: 169723-1040
PROPERTY OWNER:
Name: SWEENEY,DAVID & PATRICIA, *
Address: 65 19TH ST
GENERAL CONTRACTOR INFORMATION:
Name: RADON PROFESSIONAL SERVICES
, CGC057793
Address: 336 14TH AVE QA WILLIAM TONY DAVENPORT
Phone: - -
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $30.00
BUILDING PERMIT FEE $60.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $94.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
e- l-evpri, City of Atlantic Beach APPLICATION NUMBER
�j Building Department (To be assigned by the Building Department.)
800 Seminole Road
s1 �� 'N
Atlantic Beach, Florida 32233-5445 I lam'— Q - I C� /*`7 f`
Phone(904)247-5826 • Fax(904)247-5845 �
E-mail: building-dept@coab.us Date routed: •
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
cc a -k C
Property Address: (J 1 I — Department review required Ye o
uildin� V
Applicant: �a�Ojv �ZOFF�SIOA�f�( 2�/ Zoning
Tree Administrator
Project: rJ� s (S 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: Approved. I 'Denied.
(Circle one.) Comments:
BUILDING
PLANNING&ZONING Reviewed by: Date:
TREE ADMIN. Second Review:
Approved as revised. ❑Den d.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: (Approved as revised. ['Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
FILE COPY BUILDING PERMIT APPLICATION �,
CITY OF ATLANTIC BEACH F _._.
, -
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845 ) G—WI No. _ I9
Job Address: 605 1 9 c5-tree—f- P rmit Number:
ii IDG
Ftcf3W 40 . Lot- 4
Legal Description U}1-1 I -0q --01-S-aq£. 1 I (.4,4-3 -P-arzeLit
Floor Area elf Sq.Ft. Sq.l~'t
Valuation of Work$ ..t p 60, Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed sfrructure(s) (circle one): Commercial-, Residenti
If an existing structure,is(a fire sprinkler systemi talled? (CirclejMe): es o N /A
Florida Product Approval #, j '35-44/- 1 1 3' 4'/ .- 2_ ,'
For multiple products use Product approval f m
Describe in detail the type of work to-beperformed:-----. 5"Ca1/63) 6e-r b..S 42nn
.0 c f- y One ic d Q�
one O t4 Pflt.s one Fog S*Dr c. !�-�• -s (.�Q
Property Owner Information: 4
Name: Dew i 1- + r Gait. Si e-e_A Address: (0'T I ci.' - st rw
City (',e•-f/t.til,-e- $ ,..... State Zi 32-7-33Phone
E-Mail or Fax# (Optional)
Contractor Information: -�
Company Name: 0,..A.,-„ PtO S vhaQ SO"J t Qualifying Agent: /o s'u.� 8 a d -{0��
• Address: 33c ILP �-e.. City- 1 Sp 6 I State F--, Zip 3
Office Phone G?G • • (, •5ct n a Job Site/Contact Number -1 6 tt• S-61 I • 1 1..-1 d Fax#
State Certification/Registration# (;Cl c.. Os-Os- -7 ' cl I
Architect Name& Phone# — J
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 of a 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 fora period of six(6)months at any time after
work is commenced. I understand that separate permits must be 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 1 have read and examined thisplication 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 federut,\state, or local law re ting construction or the performance of construction.
71- I I'In —_.
Signature of Owner IttA a('j Signature of Contractor m ( 1.,
Print Name far r«-t.,q Sw e-e11Print Name k) T
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SworQ to and subscribed before me Sworn to and subscribed bee;,-e me
t o Day of t. s30 Ii.•. , - 201 -
",, 1 �.' STEPHEN HAFT
�.� r 4y, STEPHEN HAFT
W/I ri.: N$ari PNW-Stote of Florida 4 �. .. _ 1
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