190 Seminole Rd alteration permit CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
RESIDENTIAL ALT/OTHER
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOBINFORMATION:
Job ID: 17-RAAR-3392
Job Type: RESIDENTIAL ALTERATION
Description: REFIT WITH ADA GRAB BAR
Estimated Value: $900.00
Issue Date: 3/1/2017
Expiration Date: 8/28/2017
PROPERTY ADDRESS:
Address: 190 SEMINOLE RD
RE Number: 170593-0000
PROPERTY OWNER:
Name: LAWHUN ET AL, SHERI L
Address: 190 SEMINOLE RD
GENERAL CONTRACTOR INFORMATION:
Name: RJ ATLANTIC BUILDERS, INC
,CGC 1511900
Address: 115 Florida BLVD
Phone: 904-735-3520
PERMIT INFORMATION:
FEES:
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
BUILDING PERMIT FEE $55.00
Total Payments: $59.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
Building Permit Application
City of Atlantic Beach
800 Seminole Road,Atlantic Beach, FL 32233
-or Phone:(904)247-5826 Fax:(904)247-5845 i 7` RA
Igi0 S i /I;� ae - 9z,
Job Address: aPfnu ! Permit Number:
Legal Description Lg k RE#
Valuation of Work(Replacement Cost)$ Heated/Cooled SF Non-Heated/Cooled
Class of Work(Circle one): New Additio Alteratio Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one: Commercial esidential
• If an existing structure,is afire sprinkler system installed?(Circle one : Yes N/A
Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal
Describe
' in detail the type of/work to bepperform ch ^,
t<-c", Yt.- T!, cn / 9,c.!
&i ,
Florida Product Approval If for multiple products use product approval form
Pro ert Owner Info ma
,on
Name: Le Address: l�0 �1 N` fnr.iL �IOI'
city State A-f zip 22ZJ1 Phone !!4 ?5J
EM IQO !"c.7xao9 .�czfhQ' 1 Corr.
Owner or Agent(R�'�nt,Power df AttorneyorI incy Letter Required)
Contractor Information �t- ,f1 Al
Name of Company: J /f 1 �a� Q Ouall 'n nt: Zk t 'k>-
Address �•rdn rr city State Zip -.
Office Phone /,IL %?jr - i' Job Site/Co au.mber
State Certification/Registration# ! G3 E-Mail arm a —
Architect Name&Phone#
Engineer's Name&Phone If
Workers Compensation wte..4
_Exempt/Insurer/Lease Employees/Expiration Date
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 the laws regulationg
construction in this jurisdiction.I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNS,
WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc.
OWNER'S AFFIDAVIT:I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
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 ('-r
REC'rOORSDIr-NGG YOUR NOTICE OF COMMENCEMENT. RC.-,\-3e t-' (,I t 4c t-6
(Signatureo eror dudl COMrectonature of n[ractor)
Signed and sworn to(or Ira d)b ore this day of Signed and swo�rnntoo a firmed b fore me this_day f
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Wroduced Identification gpdMlkau9n lJWond Ndary otlumdldentifcation \ S GJ7G3--?4 -4
Type of Iden[ifw[ion:
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