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122 6th St RES19-0109 Repair Fireplace RESIDENTIAL PERMIT PERMIT NUMBER CITY OF ATLANTIC BEACH RES19-0109 800 SEMINOLE ROAD ISSUED:4/17/2019 ATLANTIC BEACH. FIL 32233 EXPIRES: 10/14/2019 MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION. ALL WORK MUST CONFORM TO THE CURRENT ISTH EDITION (2017) OF THE FLORIDA BUILDING CODE, NEC, IPIMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES . ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY. the requirements of this permit,there may be additional restrictions applicable to this property the public records of this county,and there may be additional permits required I i such as water management districts,state agencies,orfecleral agencies. JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK: 122 STH ST RESIDENTIAL ALTERATION REPAIR WOOD ON $5000.00 RESIDENTIAL FIREPLACE TYPE OF REALESTATE BUILDING USE CONSTRUCTION: NUMBER: ZONING: GROUP: SUBDIVISION: 1701490000 ATLANTIC BEACH COMPANY: ADDRESS: CITY: STATE: ZIP: STYLES CONSTRUCTION 1537 PENMAN RD SUITE A JACKSONVILLE FL 32250 BEACH OWNER: ADDRESS: CITY: STATE: ZIP: HITE JEFFREY A 122 6TH ST ATLANTIC BEACH FL 32233-5316 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 DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT RU IDINC IHMI kw02!H 1�22.2 2 $80co $4000 STATE DBPR SURCHARGE 455 0000 208 07W 0 $2,00 STATE QCA SURCHARGE 455 0003 208 06W 0 $2.00 TOTAL:$124.GO Issued Date:4/1712019 1 of 2 City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road Atlantic Beach, Flonda 32233-5445 to Phone(904)247-5826 Fax(904)247-5845 E-mail: building-dept@coalb.us Daterouted. 41SJi !� City"b-sfte h"I/�.coab,us APPLICATION REVIEW AND TRACKING FORM Property Addresd: -T D! ment review required Y No Buddl, 15 Applicant: -T 4.-/L-!E�4 Ci 0 M_�' _T Plannihg&Zoning Tree Administrator Project: cpn V\ ewn (N=&C— Public Works p L_p,C�C Public Utilities Public Safety Fire Services Review or Recei Other Agency Review or Permit Required ofPem!tVerifiedpB'y Date Florida Dept.of EmAronmental Protecbon Florida Dept.of Transportation St.Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division ot Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: g?Approved. E313enied. E]Not applicable (Circle one.) Comments: — 7'N eT�v PLANNING&ZONING Reviewed by: Date TREE ADMIN. Second Review: E]Approved as revised. Denied. E]Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: DApproved as revised. ElDenied. E]Nct applicable Comments; Reviewed by: Date:— ReAsed 051IW2017 Building Permit Application OFFICE COPY uPd.wdj019118 City of Atlantic Beach Building Department "ALLINrORMATION 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY Phone: (904) 247-5826 Email: Build ing-DeptCcDcoab.us IS REQUIRED. Job Address: PermitNumber: —otoq Legal Description RE# Valuation of Work(Replacement Cost)$ Heated/Cooled SF—Non-Heatedi­ • ClassofWork: []New OAddition DAlteration gill Ovinve C]Demo 0Po.I 1JWirdmv/DOO • Use of existing/proposed structure(s): C]Commerdal Ar4sidential `4 2M, • If an existing structure,is a Fire sprinkler system installed?: Dyes 01i • Will treelsi be removed in association with maosed pro ect?Dyes(must submit separate Tree Removal Pernritl ONo Describe in detail the type of work to be performed: Florida Product Approval# for multiple products use product approval form Property Owner Information 7 N J� Addrei,�,9 CJ7 Phone 9— State Pe-- Zip_ Phone L M I � �Q Owner or Agent(if Agent,Power of Attorney or Agency Letter Required) Contractor Information Name of Company Z�c, Qualifying Agent 15'13'7— State /5.7;. Zip Address Office Phone f,14' Job Site Contact Number State Certfflc n/Registration# E-M a I 1 .0 Architect Name&Phone# Engineerps Name&Phone If sation Insurer /do-2-k OR Exempt o Expiration Dabe Application is hereby made to obtain a perm t to do the work and instalfations as indicated.I certify that no work orinstaWion has commenced priorto the issuance of a permit and that all work will be performed to meet the standards of all the laws rem3ating 0 construction in this jurisdiction.I understand that a separate permit must be secured for ELECTRICALWORK,PLUMBING,QII3X J, OZ WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc. NOTICE:In addition to the 0"Ltsq to sp permit,there may be additional restrictions applicable to this property that may be found in the public records or this codit� there may be additional permits req uired from other governmental entities such as water management districts,state ago CIA,ff 0Z federal agencies. 0 C3 0 0 LU I CI OWNER'S AFFIDAVIT:I certify that all the foregoing information is accurate and that all work will be done in compliance­QhZ W Z 'a 0 < r1tx applicable laws regulating construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT folgt: Z S yu 12 RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU legbi W � Le TO OBTAIN FINANCING, CONSULT WITH YOUR LENDE RAN ATTORNEY BEFORE LJLI � wm wo REC=DI YO!UTRTIOE OF COMMENCEMENT 0 , -fijam) (Signature of Contrador) ttl (Signature of Owner or cc cc Signed and sworn to for affirmed fore me this_�[_day of Si ed and sworn to(or affirmed)before me this dayof JL -3,ck" by CA 0,A JBN ER JOHNS" Wcom Z-Mt�re of Nct.ry) __j%irwatunzofNotnry) M'S=,l El EXPIR A20 11NNI`R"` N M,co q 'co"'ago�,=M " ­,�,F rs �r,u1kAarPi,bkU,&vvnars 111P 7. - in By'now -E:&�py EXPIRES;Oxi N20 I Personally Known OR .cL ,iovy,,,.U= (ij�"uced Identification I Ptdo dinrliBirtRi o Type of Identification: F� �, ., Ll I-% k-,LJI­nSe- Type of Identifflication:—