Unit 4 DEMO18-0017 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
DEMO - INTERIOR ONLY
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: DEM018-0017
Description: Interior Demo
Estimated Value: 56850
Issue Date: 6/21/2018
Expiration Date: 12/18/2018
PROPERTY ADDRESS:
Address: 725 ATLANTIC BLVD UNIT 4
RE Number: 171363 0000
PROPERTY OWNER:
Name: ATLANTIC-PENMAN LLC
Address: 500 S 3RD ST
JACKSONVILLE BEACH, FL 32250
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: K.C. Services of North Florida, Inc.
Address: 12851 Southern Hill CIR
JACKSONVILLE, FL 32225
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.
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.
* 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.
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road ^�
j Atlantic Beach,Florida 322335 p445 t TCYL O ' O— 0017
Phone(904)2475826 Fax(904)247-5845
1 E-mail: building-dept@coab.us Date routed: G 13
Jig-
City web-site: http://w .wab.us
APPLICATION RnE�V/IEW1 AND TRACKING FORM
Property Address: I�St�` f7'T l Il C De ment review required Ye No
Applicant: Kc . SPI V[ CeS Planning &Zoning
Tree Administrator
Project: Public Works
tic Utilities
u is Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified B
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. . ❑Not applicable
(Circle on Comments:
vrt WnS'�Yvofibn 1/'iC'� � IZeCvsl� by (3vilot in�+
BUILDING �rar- m.4+.
PLANNING&ZONING Reviewed by: Date:
TREE ADMIN. Second Review: ❑Approved as revised. ❑Deni . . ❑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
OFFICE GUF�jilcling Permit Application Updated 12/8/17
City of Atlantic Beach
800 Seminole Road,Atlantic Beach,FL 32233
Phone:(904)247-5828 Fax:(904)247- JUN 1 3 2018
Job Address: �/ �f_ 1j &ZZ nn e/3-�'.Z�3 -601
Permit Number.
Legal Descriptio n%/ tA=1T-19E 7 4S 7�e / 4 /
✓/fd�— 77
REi 1�/763-O�nL
Valuation of Work(Replacement Cost)$ . sa. em, 14eated/filed SF Non-Heated/Cooled
AA Class of Work(Circle one): New Addition Alteration Repair Move em Pool Window/Door
• Use of existing/proposed stmcture(s)(ancle one): Commercial Residential
AA If an existing structure,is a fire sprinkler system installed?(Circle one): yes No N/A
• Submit a Tree Removal Permit Application H any trees are to be removed or Affidavit of No Tree Removal
Describe In detail the tyof work o be pertormed:
Pa/�ovd�D f ax�sli v, Lr/d�e�Lo'/s fo e A,f ese Case sfrurfures
Florida Product Approval a
ProRerty
for multiple products use product approval form
lhvnerlMorma ion 1
Name: .4zA/J./i i!• - PpAI/NR.0 /�.i• gddress: '� O C h'lS 7
City Ts X t✓ //p K&,ii StateC_zip 71_ Z a// phone D
E-Mall
Owner or Agent(R Agent,Power of Attorney or Agenry Letter Required)
Contractor Information L
Name of Company: d/r IBY/L/CIS D/ W, Quali I� �c;P`
Address /1 SS/ 6D f k'y >�//c C r fy Agent. �_-�----
Office Phone �.>"/— yp/ on State ZIP j1.Z.ZS
.Z. lob Site/Contact Number
State Certification/gegistrationk(°GC%T/O/1D E-Mall, h0�/.rJiG 3.7550 ops Loo/y
Architect Name&Phone i
Engineers Name&Phone
Workers Compensation E vv 77 L I l,+c,74
Exempt7lnwrer/Lease Emp "ery on thee
Application is hereby made to obtain a permit to do the work and Installations as indicate . cortify 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 n all the laws rellation h
construction in this jurisdiction.I understand that a separate permit must b r secured for ELECTRICAL WORK,PLUMBING,SIGNS,
gulationg
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 entitles 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 AN ATTORNEY BEFORE
RECORD) YOUR NOTICE OF COMMENCEMENT.
gnature of Owner or Agent)
(including contactor)
(5lgnatureof ntnimr)
SIBjI i sworn»I ryirm.A before a this /J day of Signed and sworn to(or affirmed)be(orq rr this�day of
••l b YZ(r1 1'i Jr�.L ,by n4e1 'FtA.n
(SignaNr Notary) (S nature of Notary)
Personally Known OR I )Personally Known OR
I 1 Produced Identiriwtion P
Type of Identwcatlon: JESSICA A CLARK t
•^K1Y COfaM138gNi N pefro
eNnmiwll rPba .. ..•,.Q \a Q,
EXPIRES Mary 07,2021 OZat'2Z+awUO's381dx3
pggt'MAANOISSIRNOOM }' ,yi
N0I1N11rd3AMN3r
�/ RlOgICE OF COAgMNCEdIENr
state nr-CLOP
To Whom it Ma County of._�.��/
y Coacwn; --�,Tax Polio No.
The mderaig¢ed hereby into
We Florida Statutes,the foilowi You that 1mprovements will be made m cadrdo reel
u�Desanptlon ofproperty being o Pro�is stated ja+his NOTICE OP CO p1°POrtY.and in accordance with
7e IMMSNC�T Section 713 of
Addrew ofproparty being improved: X,7177
"aa,description ofimpm amams
el,
Owner:L2'.r�,JnJfiF CC.
wear tercet
in site ofth Address �Ov S Fo 5
y Fee Srnpl Ttlholder(ifoth tban owner), / F` I `�
Name:
j Address: p�
i Talepho�No Q'O!/
Snooty(if any) '�F�� Fax No
Address:
Telephone NO:No: Amount ofBond$---
Nemeandaddress otanyperson maung a tom for Pax No:
Name: constriction ofthe —improvements
i
i Address:
Phone No:
within the State - Fax No:
Name of Person
ofPloridet, ntber than htmself,'designated b
saved: Name:
Y owner upon whom Will or other documents
my 6e
Address:
. Telephone No:
In addition to himself, owner des' ales Pax No: _
713.g6(2xb),Florida Statues. in the following Parson fo
Name. (Pill in et Owner's option) receive a "Py of the lienor's Nones as
Provided in Sesdoa
Address;
Telephone No:
BaPinuion date of It of Fax No:
speaifmd): Commencement(tbe expimtlon data is one
(1)Year Som the data of
rewrdiag aeleas a different date is
TIM SPACE FOB RECORDER'S OSE ONLY O{yN
ER
S*.d:
x 120181390ti2,OR 8K 18419 Page 1935. Beforeme D. �3�j
+mbar Rages:l OfP/orid; Peyonapyap asrecl inw Coantyof-- D— oral.State
xorded 08/13r201810:34AM, Penona11Y own;
JNNIE FUSSELL CLERK CIRCUIT COURT DUVAL prodlr«dldrnc8 on:
)LINTY Notary public:
[CORDING $10,0 Myrgmmiadoa ray; ,CLARK
MISSION k GG9e92aa
yt,,, eY 07.2021