494 SELVA LAKES CIR RES19-0001 WINDOW PERMIT s
rSr��f RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH RES19-0001
8
ISSUED: 1/11/2019
00 SEMINOLE ROAD
'7- 9r ATLANTIC BEACH. FL 32233 EXPIRES: 7/10/2019
MUST CALL INSPECTION • i . i i i PM FORDAY • •
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
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.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
RESIDENTIAL ALTERATION
494 SELVA LAKES CIR RESIDENTIAL replace 2 windows $1926.00
TYPE OF BUILDING
CONSTRUCTION: NUMBER: GROUP:
172027 5054 SELVA LAKES
COMPANY: + ! ! • STATE:
LOWES HOME CENTERS 4948 TELSON PL ORLANDO FL 32812
INC
• ADDRESS: STATE:
ABDULLAH ANITA L 494 SELVA LAKES CIR ATLANTIC BEACH FL 32233-4358
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT
IN YOUR 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.
LIST OF
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $60.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $30.00
STATE DBPR SURCHARGE 45S-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 4SS-0000-208-0600 0 $2.00
TOTAL:$94.00
Issued Date: 1/11/2019 1 of 2
City of Atlantic Beach APPLICATION NUMBER
ys Building Department (To be assigned by the Building Department.)
800 Seminole Road _oo o j
r� Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 • Fax(904)247-5845 ` 3 I
E-mail: building-dept@coab.us Date routed:
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: LA q LJSp-lU ��-� ` t i D ment review required Ye No
Applicant: L-Owt'-S *Z(Y � k_aU4S Planning & Zoning
r! Tree Administrator
Project: C' a �^' �� "` Public Works
It Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt
of Permit Verified B Date
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: M KpProved. ❑Denied. ❑Not applicable
(Circle one.) Comments:
GEDIN)
PLANNING &ZONING Reviewed by: Date:
TREE ADMIN. Second Review: []Approved as revised. ❑Denie . []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
Building Permit Application
City of Atlantic Beach
800 Seminole Road,Atlantic Beach, FL 32233
Phone: (904) 247-5826 Fax:(904)247-5845 r`I; 3 2019
Job Address:_ /z,, c / � Permit Number:_ �� i `
Legal Description 41-55 17-2S-29E SELVA LAKES LOT 26 RE# 172027-5054
Valuation of work(Replacement Cost)$ 1926.00 Heated/Cooled SF Non-Pleated/Cooled
• Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool inclo� %boor
• Use afexisting/proposed structure(s)(Cirtleone): Commercial esident� OFFICE COPY
• If an existing structure, is a fire sprinkler system installed?(Circle one): Yes No /A r T
• 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:
Florida Product App w�a!# 16809.1 16809.14 for multiple products use product approval form
PropenV Owner lnfdrmation W
Name: eqa�4L 1. G/ s V
Address: ,.,/�< f" tom
City 14-- State�L- Zip.?��?; Phone F—��r� z
E-Mail (
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required) NIA
ti
Contractor Information 0-"z
Name of Company: Lowes Home Centers LLC Qualifying Agent: Pete Cafaro
UaU o
Address PO BOX 781993 —�-��_
Office Phone 0)535.3793 Ciry Orlando State FL Zip 32� t:
Job Site/Contact Number Dan Smith(904)535-3793 `a Q �' Q
State Certification/Registration# CGC1508417 E-Mail dspeMvtingChFm11.com U)
Architect Name&Phone# NIA
Engineer's Name& Phone# NA LLQ
Workers Compensation YVCO23102416 EXP:04MU2018 U j-
Exempt/Insurer/Lease Employees/Expiration Date LJ Q
Application is hereby made to obtain a permit to do the work and installations as indicated.I certify that no work or in?51 o 1 w
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws tgulationg w
construction in this Jurisdiction.I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBIN SIGNS, W
WE LLS,POOLS, FURNACES,BOILERS, HEATERS,TANKS,and AIR CONDITIONERS,etc. Q cc
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 ATTO NEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
(Signature of Owner or Agent including Contractor) (Signature of Contractor)
St ned and sworn to (or affirmed)before me this - / day of Signed and sworn to or armed)before me this—L day of
by ��� 2C 1� .affirmed)
PES CIF
gnature of Notary}' J11ME3 5.RMEN
My COMMSSION#GG135259 (Signature of Notary)
EXPM:AUG 16,2021
�'t �k;Yt1d11fY134�lI 1st 571M tltwrance �'� .,; NATHAN BROOKS RYDER
_�, �,•: Notary Pubk-State of Fiorlda
I J Personally Known OR ;•. Commiss'an.GG 094838 Personally Known OR My Comm.Ezpirei bat 16.2021
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