340 Camelis St - 16-SFR-2040 Permit Application BUILDING PERMIT APPLICATIO/��Ov
CITY OF ATLANTIC BE v 0�6�
800 Seminole Road,Atlantic Bea 2.
Office(904)2247-15,8,26 Fax(904 45 EQ 1
Job Address:�� ( �]FN1Q �la ;4402-(- I -SFQ- 0e-i
Legal Description & / O C pallmlrjl�r�;"71/) - U
oar Area or bq rt. i
Valuation of Work S l LkL 0 Proposed Work heated/cooled nae-heated/cooled`
r
Class of Work(circle one): .� Addition Alteration Repair Move Demolition pool/spa window/door
Use of exisling/proposed structure(s)(circle one): Commercial /Rest j
If an existing structure,is a fire sprinkler system installed?(Circle one): N/A
Florida Product Approval #
For multiple products use product approval form /1
Describe in detail the type of work to be performed: {'1�(,,1-) CJ✓��P `K/YYL/ Iy ( (,�/D��i'[�-
Pruoerty Owner Information: /� 1 SIP
-
Name: ZZ� ( , - ;'K.l-(/ u-� Address: �� � (.?YI-IU(�/ �L oI SIP jm-,q
City StateZiPP'�y l(/J Phone Cxl _
E-Mail or Fax#(Option,d)��Phlll nP —t-
Contri clor Infornwlinn:
Company Name Ni'✓ _� Quali((ying Agent
Address: L r\ City.YAIG State Zip if
Office Phone SS J b ke/Contact N Fax#
State Certification/Registration#
Architect Name& Phone#
Engineer's Name&Phone# O - -
Fee Simple Title Holder Name and Address ✓) 04
Bonding Company Name and Address
Mortgage Lender Name and Address
Application is hereby made to obtain a permit to do the work and installations our indicated. l crrlifv that amen
Pin work or installation has comced prior to the
issuance ofoperrmit and that all work will beperformed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null
and void� rtrk is not commenced within str(6)months.or if construction or work is susr uded or nbandoned for a r�enod ofslx/6)months at rtm lime aJler
work is commenced. /nndecrrand that separate permits must be secured for E/enrrca!ir'nrk, PlumMng,Sign; WN/s, PmN;Pomace; Bdltis.Healm.
Tanks andAlr Condlllonen,de.
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.
/hereby cerlify thot/have read and esamined this a plication andknaw the came to be tme andcomei. All provision oflows and ardinan es governing this
kvpe of work will be c led with whether srei ard herein or to The granting of a permit does nor presume m give outhorir,to violate or camel the
provision faro oche fe 4state,ar to law regu/alh c heti or theper/ormastcr Icaru'truetion.
Signature of Own Signature of Contractor ,,/ V t
Prim Name '11� I....._...._..... __ Print Name ...T.-._....._�. � _...._..,,
tt 1fn2 C�ypTf � �� Be reme
_Z( J -- .
A thisTDay,
Notary Pu ticl Nota?yfubliq V "
ass- stye MNNRFEN LYNNE CLARK Psns sv°F /ENNIFFER LYNNE CLARK Revised01.26.10
s, MY COMMISSION i FF 072;55e,®��Aj s MYCOMMJSSIONIFF072755
EXPIRES:November 212- ""`i'+o` EXPIRES:November 24,2017
o` em:esmry 9uE+s Ngery Sen•-.s "sa:auT 9on1e0IDw9nadNrAzrY Senhes