1783 E Park Terrace RES19-0095 Install Windows RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH RES19-0095
800 SEMINOLE ROAD ISSUED:4/3/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 9/30/2019
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 BUILDINI
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANC
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
NOTICE: In addition to the requirements of this permit,there may be additional restrictions applica
that may befound in the public records of this county,and there may be additional permits requirE
governmental entities such aswater management districts,state agencies,or federal agencies.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
1783 E PARK TER RESIDENTIAL ALTERATION install single-hung windows $1260.00
RESIDENTIAL
TYPE OF REALESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
1720200416 SELVA MARINA UNIT08
COMPANY: ADDRESS: CITY: STATE: ZIP:
LOWES HOME CENTERS 4948 TELSON PL ORLANDO FL 32812
INC
OWNER: ADDRESS: CITY: STATE: ZIP:
RICCI DAVID 1 1783 PARK TER E 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 CONDITIONS
Roll off container company must beon Cityapproved list. Containercannot be placed on Cityright-of way 7
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDINGPERMIT 4SS WOO 322 1000 0 $6000
BUILDING PLAN CHECK 455 0000 322 1001 0 $3000
STATE DBPR SURCHARGE 45C 0000 208 0700 $200
STATE DCA SURCHARGE 455-0000-208 0600 0 $2,00
TOTAL:$94.00
Issued Date:4/3/2019 lof2
RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH RES19-0095
800 SEMINOLE ROAD ISSUED:4/3/2019
ATLANTIC BEACH. FL 32233 EXPIRES:913012019
Issued Date:4/3/2019 2 of 2
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach, Flonda 32233-5445 Est Cl
Phone(904)247-5826 Fax(904)247-5845
E-mail: building-dept@wab.us Date routed
Cii http:/A�.coabus
APPLICATION REVIEW AND TRACKING FORM
Property Address: t review required y No
jftu,eld,.Vo� Y-01
Applicant: L D'u-L �s Planning &Zoning
Tres Administrator
Project: L f) Ska 9—\A JA1,3 Public Works
Public Utilities
Public Safety
Fire Services
RPM 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
Any Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other
APPLICATION STATUS
Reviewing Department First Review: gKproi []Denied. [:]Not applicable
Cincle one.) Comments:
Qg��5G
PLANNING &ZONING Reviewed by: Date:
TREEADMIN. Second Review: DApproved as revised. E]Deme V d. E]Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Datec—
FIRE SERVICES Third Review: E]Approved as revised. E]Denied. E]Not applicable
Comments:
Reviewed by: Date:—
Revised Mi
Building Permit Application OFFICE COPY
City of Atlantic [teach
800 Seminole Road,Atlantic Beach,FL 32233
Phone:(904)247-5826 Fax; (904)247-5845
JobAdthess Permit Number: 9—&,s 19 —C)09T
Legal Description 34-85 09-2S-29E SELVA MARINA UNIT 8 I-OrIC) BLK 14 —
Reff 172020-0416
Valuation of work(Replacement Cost)� 1260-00 Helitted/Cooted SF_Non-Heared/c..led
Class of Work(Circle me): New Addition Alteration Repair Mow Damn pool
Use of existing/proposed structure(s)(circle me): Commercf�as=ldenlpll
Y. --r—I
if an existing structure,Is afirespTinkler system installed?(cirdeme): Yes NoFNA
Suboat a Tree Removal'Permit Application if any trees am to be removed or Affidavit of No Tree Removal
Dalwnbe in detall the type of work to be performed: vxoem&�
A 5%b7 /b�) ;W, MAR
2 0 U19
Florida Product Approval 20100.1 for multiple products use product app*al fnr. of
Proixertv Owneir Informatisp —1 Z
:3 4 0
Z
Name 4A—A I Address: I T4?f'P-A 1E Q. elf
city
Stat; Zip Phone Q 1—p"IF
E-M.,l iE�4 03 Ez
Owner Or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Informartion
Z Z
Name of Company: Qualifying Agent: Fam,Calm 0
Address PO BOX 78V Monte Centans LLC 11 ti; wo
City 711—
Ortardo State Fl- Zip Z
O,ffice Phone Job Site/corlact Number Den Skase,(90,11 5s.5-3793 ri � III
State Certification/Registrath-a F-Mall dseennakraftorsell.. LL. M
Architect Namea,Phone# WA 9
Ellelnelar's Name&Phone 0 WA 0
Workers Compensation us
su 3:
Applecatnon Is hereby made to obtain a permit to d"he work and installations as indicated.I certify that no work or lnstal&n has i�u
commenced Prior to the issuance Of A Permit and that all woA will be performed to meet the standards of all the laws regggtitrng IC
cownuccon 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.
OVMEWS AFFIDAVIT:I certify that all the foregoing information is accurate and the all work will be done in compliance with all
appilcabe fzvv�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
RECORDING YOUR NOTICE OF COMMENCEMENT.
�S�—Rlltl�a —2d
(Sisnoture of Owner or All Indudine Con" -19rennefcomrscunt
Signed and morn to(or affirmed)before me this /Tlday Of Signed am sworn to*affirmed)before me this
291/7? 'b M01-* 2116— l(K day of
Scgrature of Notary)
isignature Of Notary)
Mute a am,
W 001AUSS""n"'s .OF
EXPIRES AW IS, ,02,
ano,
Personally"own OR H-PZ.rell,M.OR Myciom.UrmiAF042021
ralwo,
Isnrduced Identification
lype Of Iftntifi,ation. L- Type of Identifit.—i.,
Florida Buildi,g Cja 0rjj,g
hftPs'./Ifloridab,ilding-org/pr)pr-app_dtluPx?Pa��GEVXQ,,D.,.
Cate Subadmad
Date Validated 05/2312017 OFFICE COPY
Cuba reading FBBC AppMVal 0610812017
Cate APP..d
06/09/2017
SUMA14g,Of prouluria
FL# Model,Number Or Name
- - Case0pulon
20100.1 Srr, 1201130 Single Hung Single Hun ---
,[.Its.1 tuse i 9 window
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Created By Incalwadert Thind Party.
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20100.3 Sarlas 1501160 Single Hung Single,Turn,and TrIple ,dr,s
Limits of Use
Approve,for Use to HVHUl NO ciartifiestion ftem,C.Ou,to'.
Appag,as,far Use Outside NVHZ.Yes H�ZQLQQ_B4_-C-f.6C-N101 29511 L5Q Big 5H IlM7.01,0`
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Cash Register Receipt Receipt Number
City of Atlantic Beach R8972
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $55.00
RE519-0095 Address: 1783 E PARK TER APN: 172020 0416 $55.00
BUIWING WINDOW DOOR FINAL--N13012019 RBE $55.00
BU MING WINDOW DOOR FINAL— 45500003221002 0 $S5,00
04/3012019 RBE
TOTAL FEES PAID BY RECEIPT: R8972 $S5.00
Date Paid:Tuesday, May 07, 2019
Paid By: LOWES HOME CENTERS INC
Cashier: CT
Pay Method: CREDIT CARD 309127
Printed:Tuesday,May 07,2019 2:38 PM I Of 1