1104 Stocks St FOUN19-0004 foundation only permitFOUNDATION ONLY PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
PERMIT NUMBER
FOUN19-0004
ISSUED: 8/27/2019
EXPIRES: 2/23/2020
I
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
;overnmental entities such as water management districts, state agencies, or federal agencies.
FOUNDATION ONLY SINGLE OR
TWO FAMILY FOUNDATION FOUNDATION ONLY - 1104 $0.00
ONLY STOCKS ST
ASM Riverside Holdings
2000 Florida Blvd Neptune Beach FL 32266
dba Mederos Homes
ADDRESS, - CITY: STATE: ZIP:
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.
TOTAL: $59.00
Issued Date: 8/27/2019 1 of 2
DESCRIPTION
ACCOUNT
QUANTITY PAID AMOUNT
BUILDING PERMIT
455-0000-322-1000
0 $55.00
STATE DBPR SURCHARGE
455-0000-208-0700
0 $2.00
STATE DCA SURCHARGE
455-0000-208-0600
0 $2.00
TOTAL: $59.00
Issued Date: 8/27/2019 1 of 2
FOUNDATION ONLY PERMIT
J+ i1
l r,
CITY OF ATLANTIC BEACH
J
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
Issued Date: 8/27/2019 2 of 2
PERMIT NUMBER
FOUN19-0004
ISSUED: 8/27/2019
EXPIRES: 2/23/2020
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
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PyLho'T
Phone:
, : (904) 247-5826 Email: Building-Dept@coab.us i (� IS REQUIRED.
Job Address: 1 0 9+cGLy � t` Permit Number: rC13 to 1'"1 - C)DO_+
Legal Description
Valuation of Work (Replacement Cost) $
RE#
Heated/Cooled SF Non- Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial ❑Residential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes ❑No
• Will trees be removed in association with proposed ro'ect? ❑Yes must submit separate Tree Removal Permit El No
Describe in detail the type of work to be performed: C� AcllnS GZ /.
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-For
F "1 + ft 1Ze S t `" 0 Z W C�2r�i (S froV :01L4;4
Florida Product Approval #
Property.Owner Information Q -
Name 1 VRIS •1( « Address
City S44 Zip
E -Mail
Owner or Agent (If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company
Address
Office Phone
State Certification/Registration #
Architect Name & Phone #
Engineer's Name & Phone #
Workers Compensation Insurer
for multiple products use product approval form
Phone
Qualifying Agent
City State Zip
Job Site Contact Number
E -Mai
OR Exempt ❑ Expiration Date
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation 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 IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR N OF COMMENCEMENT.
(S' ture wner or Agent) Siature of Contractor)
Signed and sworn to (or affirmed) before me this day of ' ned and sworn t�l�r a fi me )abeor;Ce this yof
by : _ t
n
(Signature of Notary)
[ ] Personally Known OR
[ ] Produced Identification
Type of Identification:
Personal) Know#."`.,"kg; TONIGINDLESPERGER
y MY COMMISSION # FF 924951
[ ] Produced Identification '•�' �,
EX: RES: October 6, 2019
Type of Identification: e: osd ihruAlota P&T,Underwriters