670 Sailfish Dr window permit CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
WINDOW AND/OR DOOR PERMIT
MUST CALL BY 4PM FOR NEXr DAY INSPECrION: 247-5814
JOB INFORMATION:
Job ID: 16-WIND-2123
Job Type: WINDOW AND/OR DOOR
Description: replace 5 windows size for size. NOC turned in 10/03/2016.
Estimated Value: $2,201.00
Issue Date: 10/3/2016
Expiration Date: 4/1/2017
PROPERTY ADDRESS:
Address: 670 SAILFISH DR
RE Number: 171212-0000
PROPERTYOWNER:
Name: WILLIAMS, MARY J
Address: 670 SAILFISH DR
GENERAL CONTRACrOR INFORMATION:
Name: Window World OF Northeast Florida
Brian Albert Wall,CBC1259710
Address: 8110 CYPRESS PLAZA DRAPT405 BRIANWALL
Phone: - -
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $30.50
BUILDING PERMIT FEE $61.01
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $95.51
PERAHT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
City of Atlantic Reach APPLICATION NUMBER- —
Building Department (To be assigned by the Building Department)
800 Seminole Road
Atlantic Beach, Flonda 32233,5445 A)121::-�'-)-
Phone(904)247-5826 Fax(904)247-5845 %
E-mail: building-deptlilicoalb.us Date routed:
Cityweb-ste: http//�coab.us u2
APPLICATION REVIEW AND TRACKING FORM
Property Address: 01-0 !SaAR&h Of Depa Yes 0
W'kn(lot') Mt d I)F lot 'Buidigent review required
Applicant: it F_L Planning&Zoning
Tree Administrator
Project: Q-0ta -t— S'%.1*,nLA0'�_'% Public Woft
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
OtherAgency Reviewor Permit Required Review or Receipt
of Permit Verified By Date
Flonda Dept.of Environmental Protection
Florida Dept.of Transportation
St.Johns RiverWater Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Toba000
Other.
APPLICATION STATUS
Reviewing Department First Review: 24proved. E]Denied.
(Circle one.) Comments:
(!H�
PLANNING&ZONING Revievved by: Date 9_.�?V
TREEADMIN. Second Revim: ElApproved as revised. ElDeniA.'
PUBLICWORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Revim: ElApproved as revised. ElDenied.
Comments:
Reviev�ed by: Date:
Revised 07127/10
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC 13EACII OFFICE COPY
800Scipinole Road.Atlantic Beach. 1�1_ 32233
Office(904)247-5820 Fax(lXI4)247-584.fi
Job Address; Ulu bf- _-PermitNutuber: 119—W1A4— aQ3
-1-1
Floor Allen 01 5",
Valuation of Work S 12 ZO\ Propused Work lucaled/conicd non-hented/cooled—
Clai,i-fw,,,-L Orcic oncy Addifirm Al:-z.nit-, Repai: Moc Dv'atlfilwi; poo!"ip' swr
Use of existing/proposed siruciurets)(circle one): Commercial "si,
Ifan existing structure,is it tire sprodder symeju installed?(Circle uno: as No N /A
Florida product Approval 0
For multiple products use product approval Form
Describe in delail the hpcofoork to he pcillbinnedkeetac-L
Proverly Owner information:
Name:MAY _j
CiIN Vqik�'tLjori 5� state(-,I,Zip 3 Addrvw U ,D SCL s r
111"'na
1.-�lail or rax 4 Optional)-
Contractor Information:
Conilrau� Name: 11 n AOL LIAND&W—wDy Quaid%ilia %golt:_�'Y'N q,-, VQ�X k
Addrcss:qQSZ:��Iqli Hvilxj S+ . t Cit, I e —St--Ic - �L-
. =i�y — -Ar 1-:71)-1-
0 rfice Phone Ssz)IDA� Job Sile. Contao Number 9 0 14,q 14 3-7 66 1 Fax -L'3-_z-7
State Cerlificalion/Registralion it Lm 175g-ILP
I:nj;iuccr's Nuinc& Phone If
1-ceSimple'litictioldcrN:Llll0a,�dAddr.ss_
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WARN]NG TO OWN Ell: YOUR 1,A]LURE -1-0 RECORD A NOTICE OF
COMM ENCEMENTMAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING CONSULT WITH
YOUR UENDER OR AN ATTOR-NEY BEFORE RECORDINC YOUR NOTICE OF
CONIVIEI�CE.VIENT.
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OFFICE COPY
kgnature of Owne 4a�0 Signature of Contractor k��— -it W.4
Print Name me
S� ands b 'bedbolbrew Sworn to and subsc it'd before me
fluou nature,
Day .20 (0 this r 20 t-p
OY
NotarrPu 94 ry r/'
blic Notluf Public
Revised 01.26.10
ANNE S.ML%W
EX'IFIEsod�.M0319 My COMNISSM I FF IM
e 0. EXPIRES,Ofte,21,2018
gd 'M P�
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OFFICE COPY
Of NE Florida
9452 Philips Highway Suite I
Jacksonville,Florida 32256
(352)443-7001 -Fax:(352)961-7587
Limited Power of Attom
Dme: q I U �It U
To: Building Dept.
From:Brian Well
I hereby name and appoint,Gregory Galas,Naomi Mason, Dorom Malv�,Megan Constable,
Phillip Romano,Joshua Galas,Sabrina Sierens a permit service for Window World NE Florida, to
be my lawful attomey in fact to act for me to register my license and apply to:
PA�W�C PYZOn for a�-N�% .perrnit for work to be performed at:
Lot--g-j—Blk: S Sec: 1-1 Twp:-&�LRgeAC(E
Subdivision:g"k ��'nk Parcel or Altky,. D- 0 C'
Address of Job: CP'10 ��A-R!E>Vl 1)
OwnerofProperty; W'kVtor's
and to sign and do all things necessary to this appointment.
Thank you for your assistance.
Sincerely,
—'d 4, * vyso,
Brian Wall
State Qualifier
CBC1259710
State of Florida
Count,of Du�al
The foregoing instrument was acknowledged before me by Brim Wait.who is personally known to me and
who did not coo,an orth.
me no'cure
Sworn to and su beforemethis-10—devef
I: u 2015,
Notary
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re -*'�? CHRISTYMGALAS
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