1890 Beach Ave 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 NE)ff DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-WIND-2804
Job Type: WINDOW AND/OR DOOR
Description: WINDOW REPLACEMENT
Estimated Value: $22,040.00
Issue Date: 12/21/2016
Expiration Date: 6/19/2017
PROPERTY ADDRESS:
Address: 1890 BEACH AVE
RE Number: 169542-0602
PROPERTY OWNER:
Name: SUMNER, WILLIAM D & DEBORAH F,
Address: 1890 BEACH AVE
GENERAL CONTRACTOR INFORMATION:
Name: GREEN MACHINE
GREEN MACHINE REFLRECTIVE JAMES BISHOP, wd-6
L11000144012
Address: 267 SOPHIA TER SUITE 112
Phone: 904-436-5151
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $80.10
BUILDING PERMIT FEE $160.20
STATE DCA SURCHARGE $2.40
STATE DBPR SURCHARGE $2.40
Total Payments: $245.10
PERAM' IS APPROVED ONLY IN ACCORDANCE WFFH ALL CUFF OF ATLANUC 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 �2 4-
Phone(904)247-5826 Fa,r(904)247-5845
E-mail: building-dept@coab.us Daterouted
Cityweb-site: hftp://�.Mab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: -) a ant review required Y 'No
�c ild!
1� Bu=tl
Applicant: G Pro–cl,(N:� Planning&Zoning
RC Tree Administrator
P( Public Works
Project: LQC Public Utilities
Public Safety
Fire Services
N
Other Agency Review or Permit Required Rev.,ew o,'Rec P' Date
of Pe it V nrZ By
Florida Dept.of Environmental Protection
Florida Dept.of 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: 14proved. ElDenied.
(Circle one.) Commen
(Ea)
PLANNING&ZONING Reviewed by:—0104 Date: ir i
TREE ADMIN. Second Review: DApproved as revised. [:]DenieaV
PUBLICWORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date
FIRE SERVICES Third Review: E]Approved as revised. []Denied.
Comments:
Reviewed by: Date:
Ravi.d ON14109
BUILDING PERMIT APPLICATION OFFICE COPY
crry OF ATLANTIC BEACH
goo Seminole Road,Atlantic Reach,FL 32233
office(904)247-5826 Fax(904)247-5845 Im 13 - 2g
Job Address: 3,-,JLH rmit Number.
Legal Description DT- 31 ittL=— ]
Valuation of Work S 2;Q q D Pl"r Area or Sq.Ft. led no.n-heated/cooled
Proposed Work heated/coo —
Class,of Work(eircle one): New Addition Alteration Repair Move Demolition pool/spa window/dwr
s'rocm
8 rm or tem
14 t III
sep pro
t
se of ex,"
"an egnna
F , Prod P
a e p
F 10 r 11' it'id
D sc IT to perform
e nbc detail the type f Horck
Property Owner Information:
7DIftef4A
e: S�ev �Add&rew: e-It
Zip _2Z �
Sta Zip 2Z Phone C1QQ- g-05- 'A 2
E-Mail or Flux#(Optional)
Contiructor Information:
B siln
Company Name: g Age�.
. gent:
_i7h�
'p,
Z
Address: City 0 In Side L Zip
Office Phone Job Site/Conrad Number Fm#—
State Certification/Regismition#
Architect Name&Phone#
Ergineer's Name&Phone N
Fee Simple Title Holder Name end Addres
Bonding Company Name and Address
Mortgage Leader Name and Address
Application is hereby foods to obtain operant to do the work and installations us indicated lanify that w wani of,butaizatine has commencedpridr to the
omes null
issuance a
,faperimt and that all want will be p_r
f"Ined to meet the standards ofall laws regulatull construction in thisjurisdiction. Tharpermitbec
.ndvaidi wonkisnorc000nencedwithinsix(6),nomfis or ifconstriliftlon or work is s:rndedor abandorwidjoraWeriod ofsixg)month,at any date
workiscommenced fundentanddwnp�atepemi6.wsbe.�df�Ekcftic "arkPlumbitilbSigne, edlele-h,
Tisalis andAir Conuffilloners,ela
WARNWG 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 Y6M NOTICE OF
COMMENCEMENT.
lharicerofythat lhans readandexaminedth kajonamilmouthesametobe"eandcornIct. Allprovint h
ar .mong of a permit
III be com c d fun. The gm
plied with whether sfec heres. or
=blzif�W otherfitiend, tau.or local on milulating conanuction or the perfarmancf,of==19es"me
Sigmature of tqjl, 4wy�,6�— Signature of Contractor
Print Name Print Name 0...........---...........
...........-
Swom to=it subsokibed before me Sworn to and subse before
this5' Dayof 11rA "b-tr .20 jtf- this ��-Da3 ein .20 If
-IL-L NA
y
BRffTCHAURY
;�p
MY COMMISSION#FFIfX1933 BRETT C 14ALIRY
MY COMMISSION#FFt 01.26.10
E 'RES Jun.29 20,8
XPIRES June 29.2018 FXPIRESJunfu�, 2oia
NOTICE OF COMMENCEMENT
State of -rt. TuFolioNo. 16,75-92- 6110-21
C
mmyof 1>ULW
To Whom it may Concern:
The Undersigned hereby infinnns you that improvements vvill be m c real and accor ce with Section 713 of
ads to eatain property in dw
the Florida Statutes,the following information is stated N�PCII n?
in this �rCEMENT.
Leo Description of property being improved: Z-QT- 1 9 1�-e—
L,4'7 - 111 -25 - qC
Address of property being unproved:_166% 136,401 Aug- A-MANi+( Re��k-FL
General description of improvemems: ?#tar--e- �izinlDL�)
ovner.—"i't 4x,mm--e Address: lem Oe" Ave- A-tL4Ekt D-&-4
0anaer's interest in site of the improvement: 4ZIA ft, 31-233
Fee Simple Titleholder(if o an owner): 4el ft
Name: —LL
Address:
TeiephoneNo.: !9bq-q3b-5-15-1 Fax No:
Surety(if any) All A
Address: A Amount of Bond
Telephone No:_ �/I A- Faur No:
Name and address of my person making a loan for the construction of the improvements
Name:
Address:
Phone No: Fax No:
Name of Person within the State of Florida,other than himself,designated by ovwter upon whom notices or other documents may be
served: Name: IV
Address:
Telephone No: FuNo:
In addition to himself, mvnerr designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.06(2ft Florida StM=. (Fill in at O"a's option)
Name:
Address:
Fax No:
Telephone No: Vff
Expiraticat data of Notice of Commencement(the expiration date is we(1)year from the data of recording unless a diflepent date is
specified):
TMS SPACE FOR RECORDER'S USE ONLY OWNE It /v
sign 'w �o�— Daac:
Befo"'I MIS Ity of Duval,Sawa:
Dw#201 U91 199.OR BK 17819 Page 1057. Of Flo. ,has Personally appeared V)ejo b i e. Q k n
Nmner Pages:1 Ru
Rec mecIlMIM16402:26PNI, Notary I bfic at Large,State of Florid%, tZygf=Du .
Rwoje Fuseall CLERKCIRCUIT COURT DUVAL My commissi P,
COUNTY Personally=.
RECORDING$10.00 Pd..d Idemjfi%&�
RY
Y
EXPIRES June 29,2ola
21
(401 M41W ft�"Otamae�
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