1885 SEA OATS REPLACE DOOR AND WINDOWS (2) BUILDING PERMIT APPLICATION
OFFICE C0PY CITY OF ATLANTIC BEACH Cau*nm,0r P1ck UPW-837-&W
800 Seminole Road, Atlantic Beach, FL 32233
Office (904)247-5826 Fax (904)247-5845
Job Address: 'Dr Permit Number:
Legal Description .3�'-7v 09--Z-41,0 �1 vf, No-n*-. 0-_1j'9 Parcel# I?�oa o~ OS3`1
Floor ea o q. t. Sq.Ft
Valuation of Work$ 1a YOO Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial Resid
If an existing structure,is a fire sprinkler system installed?(Circle one): es NoN/
Florida Product Approval #
For multiple products use product approval form
Describe in detail the type of work to be performed: (E P l o.w � tv,A 1> w s 41 1 b•o r J r7c -lot s r z.s
Property Owner Information:
Name: �� P! (T i Address: 1 k e.5 ,S& Ou.t y �
City, Ia�Z•� �t•ye1+ StateG'1 Zip -U-751 Phone
E-Mail or Fax#(Optional)
Contractor Information:
Company Name: 1Ntn�0ft.4 +Da-40 Quali ing Agent: TkmeS
Address:-1.50 s X3 w, City wt�! State 3-77Y,0t Zip 3-77�
Office Phone 227-4 97- kyov Job Site/Contact Number Fax#
State Certification/Registration# G_ 8G OY67Ia
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address !
Bonding Company Name and Address
Mortgage Lender Name and Address
Application is hereby pde 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 o a permit athat all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null
and void gwork is nommenced within six(6)months, or if construction or work is suspended or abandoned for a eriod of six(6)months at any time after
work is commenced. 1 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 YOVfi NOTICE OF
COMMENCEMENT.
1 hereb certify that I have read and examined thisplication and know the same to be true and correct. All provisions of laws and ordinances governing this
type ojYwork will be compliedi te
with whether specd herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other federal tate,or local law regulating construction or the performance of construction.
Signature of Owners Signature of Contractor
Print Name ..........� 1..QY.._S�............... t .. ....................................... Print Name �Tw.r*+ ...... !!..1....,I
Sworn IqLmd subscribed before me Sworn tD and subscribed before me
this�� Day of��_ ,201k this 13 Day of 1 sxy4 .20 46f
Notary PublicoP tPublic
Revised 01.26.10
TIMOTHY R.O'MALLEY
(=�? MY COMMISSION#GG 117135
ji"• c EXPIRES:August 7,2021 a:::B; TIMOTHY R.O'MALLEY
13c^led Thru Notary Public Undorv'riters _,. .�_ MY COMMISSION#GG 117135
`— — -- EXPIRES:August 7,2021
�_J:,° Bonded Thru Notary Public Underwriters