473 STURDIVANT AVE RES ALT PERM RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH RES19-0038
V~ 800 SEMINOLE ROAD ISSUED:
ATLANTIC BEACH. FL 32233 EXPIRES:
MUST CALL INSPECTION • • • 1 BY 4 PM FORDAY INSPECTION.
ALL WORK MUST CONFORMTO THE CURRENT 6TH EDITION1 OF • '
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: PERMITTYPE: DESCRIPTION: VALUE OF WORK:
473 STURDIVANT AVE RESIDENTIAL ALTERATION T1-11 SIDING AND HOUSE $14600.00
RESIDENTIAL WRAP
TYPE OF •
ZONING: : • •
• • GROUP:
1706510020 SALTAIR SEC 03
COMPANY: ADDRESS:
SUPER SIDERS AND TRIM,
INC 65 W. 9th Street Atlantic Beach FL 32233
• ADDRESS:
WILHITE CAROLE C ET AL 199 SYLVAN DR ATLANTIC BEACH FL 32233
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 $125.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $62.50
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.81
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $192.31
Issued Date: 1 of 2
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road RC)C)J
G
Atlantic Beach, Florida 32233-5445 �� 1
Phone(904)247-5826 - Fax(904)247-5845 ^�
-J;3 qY E-mail: building-dept@coab.us Date routed: G—
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: L U �� V fl� p-arrtmr t review required Yes Mo
Applicant: -S L) ��(L � Planning nin
9
Tree Administrator
1 ���
Project: l ublic Works
t ti C'� - [,�USS
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
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
I�
Reviewing Department First Review: proved. []Denied. ❑Not applicable
(Circle one.) Comments: ,/i �O�
BUILDING ���/
PLANNING &ZONING Reviewed by: Dater o �aUlg
07
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
OFFICE COPY
R Esvz� - (D o:5
- Building Permit Applicat:oii Updoted10/9/18
_ City of Atlantic Beach Building Department "*ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL.32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building--Dept@coab.us IS REQUIRED.
Job Address: 5y"GL12 ` Permit Number:
r�
Legal Description - y '� -Z ctc r �'/'" l S' ' 1�%�# Z3 —
Valuation of Work(Replacement Cost)$�y G�� Heated/Fooled SF Non-Heated/Cooled
• Classof Work: ❑New ❑Addition UAlteration ❑Repair ClMove ❑Demo ❑Pool ❑Winnow/Dcor
• Use of existing/proposed structure(s): ❑Commercial pesidential
• If xisting stru s afire sprinkler system installed?: Dyes ONo
Will trees be removed in as anon with aroposed project? [-]Yes(mustsubmit separate Tree Removal Permit ❑No
D tribe in detail the type of work to be pe �ed:
S ,� t
CI�✓I (%�'CT ��
Flora Pro uct Approval#� f L i�5!1�� for multiple products use product approval form
Pro a Owner Information / �
Name i Address �� 1.,_,,W, ✓l.c /�� _
City Slate Zip Phone , c
E-Mail r 11/r.,
_
Owner or Agent(If Ag nt,Power of Attorney or Agency Letter Required)
Contractor Information // _
Name of Company ,ie-r c-,d f-j 4^& �lrtualifyingAgent ✓Z ��_ �r �, /��� ` s
Address y' [1� ` s City ,4'/ ��.,t 4��, tate_Ft zip
Office Phone tlZz Job Site Contact Number
State Certification/Registration# 455 7 q E-Mail
Architect Name&Phone# _ _
Engineer's Name&Phone# Q
Workers Compensation Insurer ;)U it.7 OR Exempt o Expiration Date / W ( a
Application is hereby made to obtain a permit to do the work and installations as indicated.I certify that no work o instal lata cyhas I
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulatic
construction in this jurisdiction.I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNM ( Q 0
WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS,and AIR CONDMONERS,etc. NOTICE:In addition to the requirements tl14 0 F
permit,there may be additional restrictions applicable to this property :hat may be found in the public records of this county, —
there may be additional permits required from other governmental ent ties such as water management districts,state agenci p Z F-
O
federal agencies. U d U p
OWNER'S AFFIDAVIT:I certify that all the foregoing information is accurate and that all work will be done in compliance with Z X Z
applicable laws regulating construction and zoning. 0 Q
WARNING TO OWNER: YOUR FAILURE TO RECORE A NOTICE OF COMMENCEMENT MAIX � z
oa
RESULT IN YOUR PAYING TWICE FOR IMPROVEMEN P OUR OPERTY- IF YOU INT9&0- ¢ Z'
ww
TO OBTAIN FINANCING, CONSULT WITH YOUR IDER OR ORNEY BEFORE W }. ll
REC0,3DING YO R NOTICE OF C MMENCEM T.
w5uwwi tp W
(Signature of Owner or Agent) (Signature of Contractor) W
,cc ccW
Sign_eq and sworn to(or affirmed)before me this day of Signed and sworn to(or affirmed)before me this of
C. L_P0tlby'
State of Florida-Notary Public ", C. LEIGH WILHITE
3 Commission # GG 210812 ji��y State of Floride-Notary Public
Personally n My Commission Expires Personal Kna�ron Commission #GG 210612
' Pers • /�r AAril 24, 2022 i;Perso Personally
%� My Commission Expires