15-RAAR-2807 750 AQUATIC DR CITY OF ATLANTIC BEACH
f 800 SEMINOLE ROAD
J - X ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
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RESIDENTIAL ALT/OTHER
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-RAAR-2807
Job Type: RESIDENTIAL ALTERATION
Description: FLOOD DAMAGE - FIRE WALL
Estimated Value:
Issue Date: 12/3/2015
Expiration Date: 5/31/2016
PROPERTY ADDRESS:
Address: 750 AQUATIC DR
RE Number: 171818-5250
PROPERTY OWNER:
Name: KIELLEY,
Address: 750 AQUATIC DR
PERMIT INFORMATION:
FEES:
Total Payments: $0.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
(, N L L_ //V�� C✓//1
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904)247-5845
Job Address: s _F Permit Number: --
Legal Description "r A 1GRD ` Ma8rcel#
Valuation of Work$ Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Repa' Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commerci
Han existing structure,is a fire sprinkler system installed? (Circle one): Yes No N/A
Florida Product Approval#
For multiple products use product approva orm
Describe in detail the type of work to be performed:___ _6/,e t 00911 _44V4745
244 1 7',q F/ate
Property Owner Information: -7 -o /1 6jvATi C L)R I M
Name•Srz1r;+tA/ C 1 E LEV Address: Art 1 G �E G H F 3 i.2 �3
City m! G C H State Zip 3223 jphone _ _
E-Mail or Fax#(Optional)
Contractor Information: CONTRACTOR EMAIL ADDRESS:
Company Name: dying Agent:
Address: 1'y State Zip _
Office Phone Job Site/Contact N er Fax#
State Certification/Registration# —
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address — —
tlpplication is hereby made to obtain a permit to do the work and installations as indicated. I cert6 that no work or installation has commenced prior to the
issuance ,fa permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null
and void f work is not commenced within six(6)months, or if construction or work is suspended or Tibandoned fora���pperiod of six 6)months at any time after
work is commenced. I understand that separate permits must be secured for Electrical-Work,Plumbing,Signs, Wells,Pools,PiIrnaces,Boilers,Herders,
Tanks and Air Conditioner;,eta
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 YOUi NOTICE OF
COMMENCEMENT.
I herebycertify that I have read and examined this plication and know the same to be true and correct. All provisions of laws and ordinances governing this
type ofwork will be complied with whether sppecs Ted herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other federal,st te, or local w-regulating construction or the performance of construction.
Signature of Owner /
Signature of Contractor
Print Natne ! .v r�/
...............................C................._............ Print Name
......................................................................................................................................
Before me Before me
his Day of_- 20 this Day
Jotary Public Notary Public ---
Revised 01.26.10