1238 Beach Ave stucco repair permit .IS CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
RESIDENTIAL - ALTERATION RESIDENTIAL
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RES17-0174
Description: stucco demo & repair
Estimated Value: 5000
Issue Date: 9/27/2017
Expiration Date: 3/26/2018
PROPERTY ADDRESS:
Address: 1238 BEACH AVE
RE Number: 1718270000
PROPERTY OWNER:
Name: MOYER RICK ANTHONY
Address: 1238 BEACH AVE
ATLANTIC BEACH, FL 32233-5730
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: PHILLIPS BUILDERS, LLC
Address: 1250 SELVA MARINA CIR
ATLANTIC BEACH, FL 32233
Phone:
PERMIT INFORMATION:
Please see attached conditions of approval.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOU PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB
SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
* A notice of Commencement is only required for work exceeding an estimated value of
$2,500. For HVAC work, a Notice of Commencement is only required when HVAC work
exceeds and estimated value of$7,500.
—' V] City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach, Florida 32233-5445 0
9
Phone(904)247-5826 - Fax(904)247-5845
E-mail: building-dept@coab.us Date routed: Q
717 City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: Department review required Yesz,No
CLZuirdi-n-
Applicant: Wk wt vs &'Ck I kws LLL- Planning &Zoning
Tree Administrator
Project: 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: PA/poproved. OlDenied. [:]Not applicable
(Circle one.) Comments: 0
CU I L:D;1D
PLANNING &ZONING Reviewed by: Date:_C�'/
TREE ADMIN. Second Review: FlApproved as revised. F]Denied. ONot applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: F]Approved as revised. FIDenied. ONot applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
Building Permit Application
City of Atlantic Beach
800 Seminole Road, Atlantic Beach, FIL 32233
SEP 1 9 2017
Phone: (904) 247-5826 Fax: (904) 247-5845 U, 1
Job Address: 1,23 9" Z3�4_=,A� Permit Number: 0 1
Legal Description RE#
Valuation of Work(Replacement COSL,
0 06 Heated/Cooled SIF !�_�Non-Heated/Cooled
• Class of Work(Circle one): New Addition Alteration eepair?Move Demo Pool Window/
• Use of existi ng/p ro posed structure(s)(Circle one): Commercial qE��? OFFICE COPY
• If an existing structure, is a fire sprinkler system installed?(Circle one): Yes No 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: 41,j
Lwor,�,Pwj 1--ifivion CAW�-� se,,Ay�_
732ow,,Ki ,E +3 5c,� ey4�-t ;4*-D ge, j7u-sw) 0(7 r.JeJ
Florida Product Approval# for multiple products use product approval form
Property-pwner Information
r
Acldress:—Z _:eh JAtfovv-e
Name 0 ;?
City- XYZA,�&_ qOMC� State��Zip
E-Mail T 6;0!A1,g - cm!4—
Owner or Agent(If Agent, ��er of Attorney or Agency Letter Required)
Contractor Information
Name of Company: Vw'vL"'DS I'Sokff Luc, Qualifying Agent:
Address q02, OC-C" ) Igtvo' A city P" State i-It zir) 37-2-43
Office Phone 4 0 + 34 9 lag O� Job Site/Contact Number
State Certification/Registration# CII3 C I IS � '5 '14 E-Mail 171A�. 60r��-(,Q
Architect Name& Phone#
Engineer's Name& Phone#
Workers Compensation esea��I sc!� xempt Insure /Lease Employees/Expiration Date
Application is hereby made to obtain a permit to do 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
RECORDING :)UR NOTICE OF COMMENCEMENT.
�,, ;,Y( > 0 d
(Signa tu�K2f Owner or Agent) (Signature of ContraAor)
OrTclu ing contractor)
Signed and sworn to(or affirmed) before me this AIL day of Signed and sworn to affi med) before me this day of
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