654 OCEAN BLVD KITCHEN REMOD PERM RESIDENTIAL PERMIT PERMITNUMBER
CITY OF ATLANTIC BEACH RES19-0035
800 SEMINOLE ROAD ISSUED: 2/15/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 8/14/2019
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODEA. 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:
654 OCEAN BLVD RESIDENTIAL ALTERATION INTERIOR KITCHEN $42000.00
RESIDENTIAL REMODEL
TYPE OF REALESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
1701350010 ATLANTIC BEACH
COMPANY: ADDRESS: CITY: STATE: ZIP: E
HOM SPACE 116 13TH AVE N ATLANTIC BEACH I'L 32233
a T -ADDRESS: CITY: STATE: ZIP:
SAUNDERS ROBERT L 111 654 OCEAN BLVD ATLANTIC BEACH FIL 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 CONDITIONS
,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 4S5-0000-322-1000 0 $26S.00
BUILDING PLAN CHECK 4SS-0000-322-1001 0 $13230
STATE DBPR SURCHARGE 455-0000-208-0700 0 $S.96
STATE DCA SURCHARGE 4SS-0000-208-0600 0 $3.98
TOTAL: $407.44
Issued Date: 2/15/2019 1 of 2
RESIDENTIAL PERMIT PERMIT NUMBER
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-0035
CITY OF ATLANTIC BEACH RES19
800 SEMINOLE ROAD ISSUED: 2/15/2019
ATLANTIC BEACH. FIL 32233 EXPIRES: 8/14/2019
Issued Date:2/15/2019 2 of 2
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
v 800 Seminole Road C7
Atlantic Beach, Florida 32233-5445 0
Phone(904)247-5826 - Fax(904)247-5845 2/4 ji[9
E-mail: building-dept@coab.us L Date routed:
City web-site: hftp://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: Department review required Y No
Q7 <:�in g
Applicant: — Hor" (D 1p�C, r\.) Pla-nning'-&Zoning
Tree Administrator
P r oj e c t: 1< 'T C C-_yy-v c> Public Works
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
Reviewing Department First Review: EYA-pproved. ElDenied. El Not applicable
(Circle one.) Comments: jv 0
(9;1-
PLANNING &ZONING Reviewed by: Date:
TREE ADMIN. Second Review: ElApproved as revised. F]Denied. F]Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: FlApproved as revised. []Denied. E]Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
Building Permit Application Up da te d 10/9/18
OFFICE COPY
City of Atlantic Beach Building Department "ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
MW Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: (054 &_-EAM 9QJP ATLIW-TI, 04F�4Z441 FJ_ ��Z_3,3 -Permit Number: Rese
Legal Description 5-L91 1/, -- 2,5-2-'1-e- ,02 ATIMXPI_P,6�6CH Lt)-T-Iqw-17 RE# i7o 13$
Valuation of Work(Replacement Cost)$ 42 K Heated/Cooled SIF Non-Heated/Cooled Z
J Z C'b
• ClassofWork: ONew DAddition Y'Alteration E]Repair DMove ODemo []Pool OWinclow/Door 0
CL 0, E
• Use of existing/pro posed structure(s): OCommercial gKesidential 2 UJI — a
Z
0 Ed t:
00
• If an existing structure,is a fire sprinkler system installed?: OYes ;<01' CJ C.) a 0 C3
• Will tree(s)be removed in association with proposed proiect?DYes(must submit separate Tree Removal PermW ENa< in
Describe iYe7tl the type of wo k to be performl:
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Florida Product Approval# for multiple products use product a Cal ff r1fl
PropertV Owner Information UJ M
N a m e�R00 E-R-T L- 5ALA�-AD 6(2-5 Address (,,t3_4 oc_JFAt_�, 9L_QV UU1J C 3 W
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City_.^_rLA111 C— F6A,(-H� State P�- zip 322-33 Phone 4o-7- 95, 2-o-ES"' 4X- UJ
E-Mail C 5 0,LA,r-,Cte-r S Ln�-� h'i 6—.5 Y-" >
Owner or Agent(if Agent,Power of Attorney or Agency Letter Required)
Contractor information
Name of Company 14ait !;ip,&e-Q- I fie-, QualifyingAgent 62atujo$ IJ, it at.- t4l 1.0
Address .116 1144 0411g, - City,7&k!g5 gi State__E
!f6&471 Job Site Contact Number
Office Phone , _?j1_
State Certification/Registration#a6 E-Mail
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt/ Expiration Date It 71 C7 7_0 V0
Application is hereby made to obtain a permit to do the work and installations as indicated.I certify that no work or ins(allation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulating
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 IMPROVEMEN�S TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LEN �N EY E RE
REZMZM _'E=OFMENCEMEN
(Signature of Owner or Agent) i natur actor)
'ed ffir _'�before me this d y of
Signed and sworn to(o ff before me this ;2- day of ned d sworn to Lor a ea . 1AC-�
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Notary Public-State of Florida To I
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Produced Identification My Comm.Expires Jun 9,2019 produced Identification
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Type of Identificatio pe of Identification: 24r6- 4S9-6