1645 SELVA MARINA DR - INTERIOR ALTERATION �`' �S, CITY OF ATLANTIC BEACH
• 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
,V INSPECTION PHONE LINE 247-5814
.s-/-oTh 'r
RESIDENTIAL ALT/OTHER
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 17-RAAR-3859
Job Type: RESIDENTIAL ALTERATION
Description: interior alteration of kitchen & bathrooms
Estimated Value: $50,000.00
Issue Date: 4/28/2017
Expiration Date: 10/25/2017
PROPERTY ADDRESS:
Address: 1645 SELVA MARINA DR
RE Number: 171994-0000
PROPERTY OWNER:
Name: FordPhillips Properties LLC CIO Ford Miller & Wainer PA
Address: 1835 Third ST
GENERAL CONTRACTOR INFORMATION:
Name: PHILLIPS BUILDERS LLC
Barbara Caroline Phillips, CBC1257314
Address: 1250 SELVA MARINA CIR QA BARBARA CAROLINE
PHILLIPS
Phone: - -
PERMIT INFORMATION:
FEES:
BUILDING PERMIT FEE $300.00
STATE DBPR SURCHARGE $4.50
STATE DCA SURCHARGE $4.50
Total Payments: $309.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
i;-il-jbV:je.,p,
BUILDING PERMIT APPLICATION
-. s, CITY OF ATLANTIC BEACH DATE
800 Seminole Road,Atlantic Beach FL 32233
-�o Office: (904)247-5826 • Fax: (904)247-5845
Job Address: /(4S ��l v,A I4 ),v4 De--v Permit Number: It"+KAA C.-31Sci
Legal Description RE#
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Valuation of Work(Replacement Cost)$S )o Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New Addition Altera 'epair Move Demo Pool Window/Door
• Use of existing/proposed structure(s) (Circle one . -ommercial Residential
• If an existing structure, is a fire sprinkler system installed?(Circle one): Yes No N/A
• Submit a Tree Removal Pennit Application if any trees are to be removed or Affidavit of No Tree Removal
Describe in detail the type of work to be performed:
I
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name: M C� ,t Ph� 11,.'P- Address: /(v 4.1 S CI v M �2/w9 e ha.'
City A . /, , StatdC/,Zip 32-2.Z Phone C)6 4 291. 6'22,5'
E-Mail plt.IAA As' I '1'.. c-10' Lt, C--
Owner
Owner or Agent (If Agent,Power of Attorney or Agency Letter Required)
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
RECORDING YOUR NOTICE O�NSULT COMMENCEMENT.WITH OUR LENDER OR AN ATTORNEY BEFORE
Contractor Information:
Name of Company: Pk:i I;r1s go: id ecc LLC Qualifying Agent:
Address: !ZS Q Seuvit MA2W-14G1 a City A. R , 4'-1. State Zip 3 Z
Office Phone q Oi• • 24/ • S 2-zq Job Site/Contact Number •
State Certification/Registration# C.Q,G \25'Z 3 t'- E-Mail Pk;l 1,'086 lies ecom c ar-i. QCT
Architect Name &Phone#
Engineer's Name & Phone#
Worker's Compensation
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 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 for a
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,Fur• ces,Boil s,Heaters nks a Air C• u Yioners,etc.
i � / / ' yll •
Signature of Property c • /i i� ./I Signature of Contractor:
40
Before me �/� ,^ \
thisay of *'P\ t , / DF 1 Before me this a Day of Y l 1 owl 7
Notary Publi/ _AAA/AAL4.4. d. ' 111-411A A Notary Public: 2,WAOUVillik—
•, • 1.. / /414
I hereby certf'that I have read• •• examined this a lication and know the same to be true and correct. All provisions of laws and
ordinances governing this ty.. , .•
,, k wilt with whether specified herein or not. The ,k,• ;:of a tot
presume to give authority to r+ ' ; '1 can �tlE/ll tits of any other federal, state, or local law .;• `-•: co ,f
performance of construction. .. , 17.101$ i a= Noires:Downeer 13.2019
•t; Boded lP v 1 i on Notary Aaron Notary