522 Aquatic Dr RES20-0030 Interior Reno , �r'y,,).„ RESIDENTIAL PERMIT PERMIT NUMBER
`- CITY OF ATLANTIC BEACH RES20-0030
JV ISSUED: 1/31/2020
800 SEMINOLE ROAD
,. ;i��; EXPIRES: 7/29/2020
ATLANTIC BEACH. FL 32233
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 BUILDING
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
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.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
522 AQUATIC DR RESIDENTIAL ALTERATION INTERIOR RENO $2500.00
RESIDENTIAL
TYPE OF I REAL ESTATE ! ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
171818 5174 AQUATIC GARDENS
COMPANY: ADDRESS: CITY: STATE: ZIP:
BRACEY BUILDING 10513 Atlantic Boulevard JACKSONVILLE FL 32225
CONTRACTORS
OWNER: ADDRESS: CITY: ' STATE: ZIP:
REBECCA BURCHELL REAL PONTE VEDRA
8192 SEVEN MILE DR FL 32082
ESTATE LLC BEACH
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.
— z
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $65.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $32.50
STATE DBPR SURCHARGE 455-0000-208-0700 0 $4.09
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.73
Issued Date: 1/31/2020 1 of 2
'^JS 0_,A4-N RESIDENTIAL PERMIT PERMIT NUMBER 3,
s, CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD RES20-0030
ISSUED: 1/31/2020
'`u;t �r ATLANTIC BEACH. FL 32233 EXPIRES: 7/29/2020
WORK WITHOUT PERMIT 455-0000-322-1000 0 $175.00
TOTAL: $279.32
Issued Date: 1/31/2020 2 of 2
Building Permit Application — l�, C) Updated 10/9/18
City of Atlantic Beach Building Department �V_ **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: 5z /16a4-1;c Pr. W /04,11,&11-6 Permit Number: R E z o'-003 0
Legal Description .3 5-1( I 9 _-_07. 7 �l4r,/_ (III/2 1/S AO'/0-71 RE# 17 ( /(J -- 5, I /
I .
Valuation of Work(Replacement Cost $ "/.4,frge_• Heated/Cooled SF 6/d, Non-Heated/Cooled -
• Class of Work: ❑New ❑Addition ❑Alteration Repair ❑Move ❑Demo ❑Pool ❑Window/Door f
• Use of existing/proposed structure(s): ❑Commercial j$jtesidential l'444p(/41
• If an existing structure,is a fire sprinkler system installed?: ❑Yes £[Vo JAN 3 0 2020
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) JRI.No
Describe in detail the type of work to be performed: Fta C. rep/ ce,,est :• a
ms*Fl . h-t'er'or PPno(xr-ooS S0 1't•.-icJ r f .*I-4 rOOM- Ui,e l"(et- rep ce-‘44 e-1,11—
Florida
orida Product Approval# for multiple products use product approval form
Property Owner Information
Name l e61?CCe7 l)W/' t,( /( Address Il9S 3e1Jerl fit Pr•
City Pont& ()ed rbi' tSv44-4 U1 State 'FL Zip 32Of2 Phone
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information y /
Name of Company aer e. 8144 /d Li �j/IGGfa7s Qualifyin Agent 5(Y// c,e57
Address /05/-1 t/( L 5/V(L City 9/!(/x//1 State (''(� /Zip 37225
Office Phone 90 lQ4'(p Job Site C ntact Number 9dy 23 q 3 . 5
State Certification/Registration# r C /2 5.i 0O E-Mail 4 t c4Ge Oa,1 d'iv 0.2.4-1
A,•chitect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt k Expiration Date y-z -"2/
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
RE C 1 DING YOUR NOTICE OF COMMENCEMENT.
(Signature of Owner or Agent) _ (Signatu e of Contractor)
iSi ned and sworn to(or affirmed)before me this d I day of _ d and sworn to(or affirm-d)bef e j-this day of
an&ory , a�0 Rea .c4 6drC/W( , ,moo ,byi YY(
4111111
. . . a ::nature of Notary)
'� `otary Public State of Florida 7
_° , John Musser .•:►e":.(4, RYAN E JOWERS
.0.. . My Commission GG 184351 :i.vie,
?
[ j Personally Known OR 'na,ap' Expires 11/30/2021 [ j•personally Known OR �� •� MY COMMISSION#GG002600
[ Produced Identification, 'roduced Identificati. Q� ••fid° EXPIRES June.15,2020
ype of Identification: L P Type of Identification: iti-a._.:F .,o.u...,. ..