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455 IREX RD - REMODEL .j YLy �� i CITY OF ATLANTIC BEACH �v) 800 SEMINOLE ROAD ,r : �i+.:�,��;ie, City of Atlantic Beach APPLICATION NUMBER J1i Building Department (To be assigned by the Building Department.) H.. :_ 800 Seminole Road S ( t! — 000(0 Atlantic Beach, Florida 32233-5445 0 Phone(904)247-5826 • Fax(904)247-5845 f el 1 (o;tt�•r/ E-mail: building-dept@coab.us Date routed: t l City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: LI.c -\--c 1\f,_ r Department review required Yxeylo Cunaing -. Applicant: 6( lV ,\L(i -3 m ViAirf\Li')'5 Planning &Zoning Tree Administrator Project: a \Q -.= ("CO ISS ‘-t-A-( (N ` GtTh Public Works Public Utilities c 1 tIv\G 6,0 Public Safety Fire Services Review fee $ Dept Signature t—Ea Q_ Review or Receipt l (_pis c Other Agency Review or Permit Required of Permit Verified By Date W L Florida Dept. of Environmental Protection G1 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. ❑Not applicable (Circle one.) Comments: /vow BUILD! PLANNING &ZONING9 Reviewed by: ",/V� _ Date: / - c7d TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. ['Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 n cr.:4 n OFFICE COF Building Permit ApplicationJAN Updated 12/8/1/t' City of Atlantic Beach Q 2018 ja a.•1:11S, 800 Seminole Road,Atlantic Beach,FL 32233 -e i 1 Phone:(904)247-5826 Fax:(904)247-5845 'i 0- Job Address: krot N"' /+l"^�'` L? J , FL 322-33 Permit Number: Legal Description 71'/6 17-AS-2- E I ./f7 0( IP1 of 41„/ Pkl ks /0r 14 ! RE# i7(Lilo—woo Valuation of Work(Replacement Cost)$ V, ©G Heated/Cooled SF in, Non-Heated/Cooled 24 O • Class of Work(Circle one): New AdditionAlterati.i Repair Move Demo Pool WindowfDoor. • Use of existing/proposed structure(s)(Circle one): Commercial Residen • 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 1"-q4 Describe in detail the type of work to be performed: 1-ot A a,�l ht l� ren,u r 2_ a &4e-0 jovrs Florida Product Approval# •2S(-' C% - L ems^«' for multiple products use product approval form Property Owner Information Name: Tr~co+v`" clnoeAA,es LLC Address: 3721 1)..y.,41' City la(.'It5onvllc State r Zip 327-17 Phone gal/-Sv q-ft 7ti E-Mail vio+eul�lQLac ,;l.r�r Owner or Agent(If Agent,Power of Attorney or Agency Letter Required) ©✓ Contractor Information Name of Company: (t1 Qualifying Agent: h -sI;i (3 J1 Address 41015 oIi"c ad. City -4cI(-s6,,..-1ts- State Zip ? -2iQ Office Phone 'o`I - 6 f to Job Site/Contact Number TIFF 4[2--SOPo State Certification/Registration# e --(331'f07 E-Mail c(wsF.'@ 19BIW h (d ter.com Architect Name&Phone# .''/ i Engineer's Name&Phone# Workers Compensation t; 't/m//Q' 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 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. NOTICE: In addition to the requirements of this permit,there may be additional restrictions applicable to this property that may be found in the public records of this county,and there may be additional permits required from other governmental entities such as water management districts,state agencies,or federal agencies. 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 ATTO• ' ' =EFORE RECORDING Y NOTICE OF COMMENCEMENT. (Signature of Owner or Agent) (Signature of Contractor) (including contractor) Signed and sworn to(or affirmed)before me this-6 ' day of Signed and sworn to(or affirmed)before me this 4S day of ,-?b1 `6 ,by \tp Q4SSYL.,_..- by b .,. 8rcl.cx (Signature of Notary) (Signature of Notary) NilBu® CARRIE JAMES "',""�i ersonally Known OR { ,,� °�c Versonall Known OR • ' CARRIE JAMES MY COMMISSION#FF 115059 y MY COMMISSION#FF 115059 [ ]Produced Identification ; EXPIRES:April 22,2018 [ ]Produced Identification � ,* EXPIRES:April 22,2018 Type of Identifications . ,g�gatNotaryS°n Type of Identification: a-A4 a dThd tNotary Soni<.ea