88 W.4th St. ACRS18-0282 Cash Register Receipt Receipt Number
0 City of Atlantic Beach R5527
DESCRIPTION ACCOUNT CITY PAID
PermitTRAK j$24.00
ACRS18-0282 Address: 88 W 4TH ST APN: 170827 0000
MECHANICAL
MECHANICAL BASE FEE 455-0000.322-1000 0
AC AND REFRIGERATION 455-0000-322-1000 1
FURNACES AND HEATING 455-0000.322-1000 1STATE SURCHARGES
STATE DBPR SURCHARGE 455-0000.208-0600 0 $2.00
STATE DCA SURCHARGE 45500002080700 0 52.00
TOTALPAID BY ••
Date Paid: Friday,June 29, 2018
Paid By: INVENT AC AND HEAT
Cashier:CB
Pay Method:CREDIT CARD 094422
Printed: Friday,June 29,201812:43 PM 1 of 1
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CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814
MECHANICAL RESIDENTIAL HVAC -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: ACRSIB-0282
Description: Install 3 Ton 36K BTU HVAC System
Estimated Value: 3155
Issue Date: 6/29/2018
Expiration Date: 12/26/2018
PROPERTY ADDRESS:
Address: 88 W 4TH ST
RE Number: 170827 0000
PROPERTY OW NER:
Name: KEYS JENNIFER L
Address: 88 W 4TH ST
JACKSONVILLE, FL 32206
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: INVENT AC AND HEAT
Address: 2201 EDISON AVE
JACKSONVILLE, FL 32204
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$7,500.
Building Permit Application Updated 12X17
City of Atlantic Beach
BW Seminole Road,Atlantic Beach,FL 32233
one:(906)26]-5826 Fax:(904)247 MATS
cel ,C�Iy ' 1l �a
Job Address: OO v' �`^' Permit Numberpl�st0C/UrA
Legal Description ee��DD RER
Valuation of Work(Replacement Cost)$ Heated/Cooled SF Non-Neatad/Cooled
• Class of Work(Circle one): New Addition Alteration Repair Move mo Pool Window/Door
• Use of existing/proposed structures)(Circle one): Commercial Residential
• If an existing structure,is afire sprinkler system installed?(Circle one): Yes No N/A j
• 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:
�havlc� oJ�t� Hu(�c S�,stk�FY. 3 -bn 3l0l00� `�(1-�
Florida Product Approval If for multiple products use product approval form
Property Owner Information /� � 1/!,' C�•,.\
Name: Jehill;& f" Address: J W
City State Zip�ol t6Phone
E-Mail
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contract"Informati n Pf2S�Di'1
Name of Company: Qu r,iiyn�$�ge,�n.��t, 11 r
Address V� Gty�tALFf}t 1ULUk State 2'p
Office Phone 9134- - 7I Job SRe/Conrad Number
State CertiRwtion/Registration R I X1 10631 E-MailKN rra rrtoatS E IIIJP Dr_IC
Architect Name&Phone a
Engineer's Name&Phone If
Workers Compensation CVL$(A/VL• L 2 I $' �,,
Exempt/Imurer/Lm a Emploxes/Fxpimtion Gate ',,
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 AN ATTORNEY BEFORE
RECORDIN YOUR A OIn E OF COMMENCEMENT.
S natureof Camractor)
(ggnature of caner or Agent) ( g
(Including contractor) ��pp
Signed and swomto1(or affirmed)before me this_(day of Signed and swum to(or affirmed)before me this day of
tld]-Es•=I8r,by / by �
diva ,Jnf '_
""''�� (Signature of Notary)ary)� (Syratureof Notary)
ttyrersonalHKnown OR �'"::"4M NJORDLEYAK [ I Personally Known OR
MY cow�ISSIBN IFF20Q'i� Produced Identification i
I J Produced Identification on �• I 1
Type of identification: x I • Flattery y5N18 Type of Identification:
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