1855 HICKORY LN - GARAGE DOOR �' %' \s, CITY OF ATLANTIC BEACH
'Q _f 800 SEMINOLE ROAD
j r ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
o.21>1P
WINDOW AND/OR DOOR PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 17-WIND-3766
Job Type: WINDOW AND/OR DOOR
Description: REPLACE GARAGE DOOR
Estimated Value: $1,887.00
Issue Date: 5/1/2017
Expiration Date: 10/28/2017
PROPERTY ADDRESS:
Address: 1855 HICKORY LN
RE Number: 172020-1434
PROPERTY OWNER:
Name: DEWEY MAIN TRUST, EDNA
Address: 1855 HICKORY LN 1855 HICKORY LANE
GENERAL CONTRACTOR INFORMATION:
Name: PRECISION DOOR SERVICE OF N FL JASON
SHEPPARD
Jason Edward Sheppard, CRC1330604
Address: 11323 Business Park BLVD
Phone: 904-638-2220
PERMIT INFORMATION:
FEES:
PLAN CHECK FEES $29.72
BUILDING PERMIT FEE $59.44
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $93.16
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
City of Atlantic Beach APPLICATION NUMBER
/s\\ Building Department (To be assigned by the Building Department.)
• 2
8tla Seminole Road
Atlantic eachFlorida 32233-5445
_\A)
^ l I f Phone(904)247-5826 • Fax(904)247-5845
`,%----7---(y/ E-mail: building-dept@coab.us
Date routed: 4114- ft 7
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 6 '&SS 1,`- 1 C.KOky Lk) Department review required Yes No
Buildin
Applicant: PR cis 10, 0012, Planning &Zoning
Tree Administrator
Project: (RR,1-eE 1- 0(:) 2, Public Works
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
Florida Dept. of Environmental Protection
Florida Dept.of Transportation
St.Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: ( Approved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING
Reviewed by: Date: y'(77 •/
TREE ADMIN. Second Review: A roved as revised.
❑ pp ❑Denies. - - -
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
•
BUILDING PERMIT APPLICATION FILE COPY
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845 r7-\A2 !NO - 37(o C
Job Address: i 955 5 \ ' �v\c Permit Number:
Legal Description 9 \�C\ �'\O1 \ n..-- qsParcel# T-2-a 00\-- 2 .- 2-0,
oorArea of q.t. Sq.Ft
Valuation of Work$ V? Q •°\C Proposed Work heated/cooled non-heated/cooled 1 k2
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa indow/door
Use of existing/pro osed structure(s)(circle one): Commercial esidenti
If an existing structure,is a fire sprinkler s stem installed?(Circle one): es No N
Florida Product Approval# 52, \
For multiple products use product approval form FC9t
(�' 1,�\ A lDescribe in detail the type of work to be performed:rep1O\C� �W� V�1 C1evv
Property Owner Information:
CityOfl\Name: ��\ \(655 ��
O r StateFL Zip'n.22i3 Phone q0'3 c ,45%J
E-Mail or Fax# (Optional)
Contractor Information: a
Company Name:Pref\S\On or 9,e`r\\,Ct, Qualifying Agent: Zo\5 pp�(`l
Address: "'of
City �i1M\ State h Zip
d 11?�2�, �u�,ness �vd 3_22sie
Office Phone • tit- • _:- 1 Job Site Contact Number )' I\ Fax# COA-2\1-} B 5
State Certification/Registration# .' \' 4 `- _
I Z�
Architect Name&Phone# hcc1() rm�\C ,� l L- ;� j.::
Engineer's Name& Phone# H ""
Fee Simple Title Holder Name and Address
Bonding Company Name and Address jI APR 1 3 2017
Mortgage Lender Name and Address I
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 abandonedfor 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, Furnaces, Boilers, Heaters,
Tanks and Air Conditioners,etc.
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.
I herebycertify that I have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this
type of ork will be complied with whether specified herein or not. The granting of a permit does not presume to give authority t. iolat . cancel the
provisions of any other federal,state, or local law regulating construction or the performance of construction.
mitiawa lar 9,t� AL ef---6-1U Signature of Contractor dilk
Print Name c l a— �/L,a-t t.4 Print Name jt►etR ,
Sworn to and subscribed before me Sworn to and subscribed before me
this t cmDayo J �✓`c (/(y • :20 this \1 D.y of i • ' ,20 11
i�,t,G,/ �.> 71.7' - - II .� 414. 1414. 1Notary P MICHELLE ABRAHAM N• a••"'.0li
,. „,k, „..cMICHELLE ABRAHAM:
MY COMMISSION#FF146360 4 MY COMMISSION#FFRe7iEIsed 01.26.1 O
',N,„V EXPIRES July 29, 2018 •••.,e•ortid!'.: EXPIRES July 29, 2018
(407)398-0133 FloridallotaryService.com (407)398.0153 FloridallotaryService.com