351 11th St RES19-0138 Replace Windows RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH RES19-0138
ISSUED: 5/15/2019
800 SEMINOLE ROAD EXPIRES: 11/1112019
ATLANTIC BEACH. FL 32233
ALL WORK M I X 1%yAV'dyA'e!1MtII
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
' t or on Y It"
tt is "and teh.r ma be ad
OT' I to ot e q or m t of s P rm
that may be found In the publ record of h county,and there may be additional permits required from other
P c - c my -a y o.s'
governmental S't't es t on g RE m ricts,state agencies,orfecleral agencies.
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governmental entities suchaswater m.n.gementd.,t e
351 11TH ST RESIDENTIALAILTERATION replace windows $12735.00
RESIDENTIAL
TYPE OF REALESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP: ATLANTIC BEACH
1701070100
COMPANY: ADDRESS: CITY: STATE: ZIP:
KOEHLER HOMES INC 5538SCOASTALLN' JACKSONVILLE FL 32258
OWNER: ADDRESS: CITY: STATE: ZIP:
HOWELLJOHNC 351 11TH ST ATLANTIC BEACH FIL 32233-5531
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.
FEES
DESCRIPTION �"MMP" �--"' '
BUILDING PERMIT 455 0000 322 1" 0 $115.00
BUiUDING PI-AN CHECK 455 00(�-322 1001 0 $57,50
STATE DERR SURCHARGE 455-0000 208 07M 0 $2.59
STATE DCA SURCHARGE 455-�n np.rRno 0
TOTAL:$177.09
is5ued Date:5/15/2019 1 of 2
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the B,,Id,n,D rhment
800 Seminole Road �e!,t
Atlantic Beach,Florida 32233-5445
Phone(904)247�5826 Fax(904)247-5845
E-mail: building-dept@wab.us Daterouted:
City mb-site: http://�.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: S� De ant review required jY,7-No
13 1�
Applicant: Kof l' ading
oln`VS _XVV Planning&Zoning
Tree�Adnrdinistrator
Project: wtR&" Public Works
Public Utilities
Public Safety
Fire Services
Dept Signature ...
Other Agency Review or Permit Required Rev iew=lBy Data
of Permit
Florida Dept.of Environmental Protection
Florida Dept.of Transportation
St.Johns River Water Management District
Any Corps of Engineen;
Division of Hotels and Restaurants
Division ofAlcoholiC Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: Ba<P—Prowd. E]Denied. E]Notapplicable
(Circle one.) Comments:
(E��
PLANNING&ZONING Reviewed by:—/)-I Date:
TREE ADMIN. Second Review: []AppRoved as revised. E]DenlecY E]Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date
FIRESERVICES Third Review: E]Approved as revised, E]Demed. E]Not applicable
Comments:
Reviewed by: Date:—
Revised 05/19/2017
OFFICE COPY
Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department -*ALL INFORMATION
800 Seminole Road,Atlantic Beach,FL 32233 HIGHLIGHTED IN GRAY
Phone;(9D4)247-5826 Fax:(904)247-5845 Email:Building-Dept@coab.us IS REQUIRED.
Job Address: 1337&M IF/ Permit Number: 0 1 V!1
W
Legal Description RE# _i Z
< 0
Valuation ofWork(Replacement Cost)$ 1k, XIS- H..t.d/C.oled SF_Non-Heated/Cooled IL Z e-
Elpool 0a3 _ Z
ClassofWork: ONew [JAddition DAlteration LJRepaIr []Move CIDerro 14ndow/Door 0 0
L) CJ 0 (,)
• Use of existlng/proposed structure(s): jjCDmmercIaI [R(Residential LEI F_ < 0 C
� 0 Z Ic Z
• If an existing structure,is afire sprinkler system installed?: WYes EdNo C"I 0 4
• Will tree removed in association with proposed pro ect-MYes[must submit separate Tr
Describe in detail the type of work to be performed: WAY YOAUI�J
All A0111'W'(V5 C13 e hi;- do
III —
Florida Product Approval# for multiple proclud s use product approy :D C
CY Lu
Property Owner Information U) ...
N Address 3SI "M
CJZ]A���
State
Zip _47233-S331 Phone
E-Mail
Owner or Agent(if Agent,Power of Attorney or Agency Letter Required) n1a
Contractor Information
Name ofCompany QualITLIngAgent
0 City.14fj;YW4,Ca State ci� P-3
Address 53� d??Z4r4'3 *Z 3&/& 4
Office Phone-9W-;'?/- ��3 Job Site Contaq Number '.Wc/-
State Certiflution/Registration#eBebS&ISS
Architect Name&Phore#
Engineer's Name&Phone#
Workers compensation Insurer OR Exempt Jim Date
Application is hereby made to obtain a permit to do the work and Installations as lndlcate�l�cepdfyiZt no W04 or i4stallation 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 CONDMONERS,etc. NOTICE:In addition to the requirements of this
permit,there maybe additional restrictions applicableto this property that maybe found in the public records of this county,and
there maybe 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 IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOU OMMENCEMENT��
'��Ww 2_� -
(51iinawre of Owner or Agent) - (SIgnWrii ofContructor)
Signed and flfirmedj�;.fDris me th0a day of Signed and sworn to(or affirmed)b fo t"is_jjdayof
swo=by )01i"I by
otary)
now NMqPt�gsxeefFkxxIii I emonally Kn OR
own Nalairy'ftlilk,SUMv d Fkcx1a
I Personally K nOR .40 rodumd Idendfl, don !!f
W Produced J& ofication Krefin L Buillie Msfin L Burke
Type of Identificatlor: My Ciinx 253515 a of Identification:.
NOTIft OF COMMBNCEPIENT OFFICE COPY
(PREPARE IN DUPLICATE)
Permit No Tax Folio No. 107&0-7-&W
Ends of— L a—&T&A County of r2 tj%PAI
To whom It may concern:
The undersigned hereby Informs you that Improvements will be made a certain real pioperty,and In
accordance with Section 713 of the Florida Statutes,the following Informat Inat Is stated In this NOTICE OF
COMMENCEMENT.
Legal desorption of pjop ad:
4-t/d.42nm e� 449r
Address of property being Improved: 'W/ // M
R— 3ZZ33
General description of improvements
QY--
Owns,
voi�4�5bejVi ey
Address35/ HIM Ao4&4oI "jm�E-AR—' CZ2-u
Owners interest in site of thehinproverment A-YLYJ�
Fee Simple Titleholder(if other than owner) OLI'I
Name
Address
!Contractor X&O-VI
Address 5'*7/ cSW, 1.
Ph.neNo.fflLW--'5,"-137?7 —FQxNo.
Surety tif any) /Ut-
Address maul it of bond$
Phone No. Fax No —
Name and address of any person making a loan for the construction at the Impir avements.
Name
Address
Phone No Fa.No
!Name of person within the State of Florida.other than himself.designated by V. nor upon whorn notices or other
documents may be served:
Name A.A
Address
Phone No Fax No.
]I,addition to Wrinself.owner designates the following person to receive a copy f the Lienor's Notice a in
Section 71 3.OB(2)(b).Florida Statutes.(Fill in at Owner a option).
Norms AA�
Address �7
Phone No. Fax No.
Expiration data of Notice of Commencement(the expiration date Is r from the date of recording unhai
different date Is specified):_ 2,
—ifif ISNLY
THIS SPACE FOR RECORTHER'S I �WNER DATE ;v
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Recorded OWIM19 08:20 AM. no tax ran 'c 'Y:,"", . �
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RONNIE FUSSELL JUERK CIRCUIT COURT DUVAL Kristin L.Sake
COUNTY My Conarrusaxon GO 268615
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