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2075 Vela Norte Cir - Exterior Repair .1 1 r0-01:00 City of Atlantic Beach APPLICATION NUMBER J= -. t 111 Building Department (To be assigned by the Building Department.) •i,• :% 800 Seminole Road AA Atlantic Beach, Florida 32233-5445 I�0-CLA 7A a-- i- I g 1J� Phone(904)247-5826 • Fax(904)247-5845 P o E-mail: building-dept@coab.us Date routed: 0 4 1 a I City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: a O�s V L)jj NO(t L e.:1( .i Dep tm_ent review required Ye No �uilding ,� Applicant: S MD1-( 4V Q,,�A ,(1kS (i�j(t , Planning &Zoning Tree Administrator Project: (1?ctt( s '-&c(.J , p\y W o°d i 1!),6% 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: loved. ODenied. (Circle one.) Comments: NBUIL ING need PLANNING &ZONING Reviewed by: /21 Date: / t�glG TREE ADMIN. Second Review: A roved as revised. ❑ pp ❑Denied. 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 OFFICE COPY 1- riii...�v' BUILDING PERMIT APPLICATION r �t\ - r l CITY OF ATLANTIC BEACH 800 Seminole Road,Atlantic Beach FL 32233 '�Zci'tr�''' Office: (904)247-5826 • Fax: (904)247-5845 322"1'x' Job Address: 1.0-Ac \j e\. hoc Ck,CC.,,2. -��\-}cam L I Permit Number: ` ' i,Ogg IPt 141-1 Legal Description '50,-°14 Oi LS-2-SF SC\vz I\Igf}e.U,,:ik-ZIJ(, RE# AVI Ob"•io 1 Valuation of Work(Replacement Cost)$ 1 o00 Heated/Cooled SF Non-Heated/Cooled ■ Class of Work(Circle one): New Addition Alteration e epai Move Demo Pool Window/Door • Use of existing/proposed structure(s) (Circle one): Commercial • If an existing structure, is a fire sprinkler system installed?(Circle one): Yes c 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 be performed: OsennoUe. ,44ccO i-. J n die 2 feroy. gt iv X 10'H +o r pL2 role." pi ysia00A. ar-il sts'ter ca,►s4.1,1 2''x 6'". Refi% L sh.cg•- t J�,por r114rtsdv-Go rr .4h (31.10 �,�-vC-(,O• py►A - V;$c y,),to N �,1 p,' /if 1 A S;,--U of.-f tit 4r - Refit I i\Aiv lil-, , �f 0ec..86d Florida Product Approval#_ for multiple products use product approval form Property Owner Information /n Name: (p c�A" Vke. .t Address: 2J1 VC I, 61 ( PCik City R4-� 6e4-0,,-,� State R. Zip 32.22 Phone E-Mail Owner or Agent (If Agent,Power of Attorney or Agency Letter Required) WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. Contractor Information: Name of Company: 4„ma ri-Gr' 1j4- UOrgQualif ing Agent: S�, V ice.rd Address: 6\21 S 6-rC3,�,, City s i i1.eState(-eip 1,22..541 Office Phone ' d y' •2I,4Q Job Site/Contact Number State Certification/Registration# C G t✓ i Sp 51 g E-Mail t . C vi QmtmS h e t3,M Architect Name & Phone # Engineer's Name & Phone# Worker's Compensation sSo(A,,--i;Q &)u a 1.i J,QI 3 20Jxempt / nsurer Lease mloyees / Expiration Date Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null and void if work s not commenced within six(6)months, or if construction or work is suspended or abandoned for a period of six(6)months at any time after i . is commenced. 1 understand that separate permits must be secured for Electrical Work,Plumbing, Signs, Wells,Pools,Furnaces,Boilers, ers, Tanks'nd Air tditioners,etc. 4 Signature of Property Owner: Q,..,, Ad Signature of Contractor ,�_# , /fQ�J Before me 1 --. this ZZ © Day of u Fy D,D 1 Co 4 Before me this `1.7 Day of _$i , _ .P 14, I a - i I Notary Public: 0I Q _ ' 3 Notary Public: ��, . • SERE �� Mpg\0\p #�F�Sz1aB Ag1OI 10 - 5��63 I hereby cert that I have re , Rap l �y, 7iq� A.t? km .w the same to be true and co• I py,Q}A3fshts 1�43H l�r�ic1 20AB ordinances got erning this t, xie: v Jk.'i 4�i?�ccQm irtvithi, dt r specified herein or not. 'ie.v?tiittn . o pgpNl dytemze5t 4 presume to give authorityto .e.la am.a old- ro�taTio A any other_fedemal, state, or local k v-Peg ttfrtg'to 6 n o•gteeOOm performance of construction. I: r� oodat4 EX allotaN A�s� . 3 S'-r4 --x 4' ' ATLANTIC BEACH +, --z: PERMIT RECEIPT /-74 JiilJr PERMIT DESCRIPTION: NOC REQUIRED - remove stucco & rotton plywood, replace & repair interior drywall PERMIT NUMBER: 16-RAAR-1718 ADDRESS: 2075 VELA NORTE CIR o5 ,20 OWNER. Pk\ ��PN(�CBEp,GN DATE ISSUED: CVO °V P 1 FEES DUE: PLAN CHECK FEES $60.00 BUILDING PERMIT FEE $120.00 STATE DCA SURCHARGE $2.00 STATE DBPR SURCHARGE $2.00 CITY OF ATLANTIC BEACH 800 SEMINOLE RD ATLANTIC BEAC,FL 32233 08 OS 2016 14:40:32 Totals: CREDIT CARD $184.00 VISA SALE CARD» XXXXXXXXXXXX0683 INVOICE 0008 SEQ;r: 0008 Batch;r: 000373 Approval Code: 00969G Entry Method: Manual Mode: Online Tax Amount: ;0.00 Card Code: M SALE AMOUNT 5184.00 I CUSTOMER COPY