1410 Beach Ave RESO20-0007 deck permit submittal 1 of 5Building Permit Application
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City of Atlantic Beach Building Department
all
800 Seminole Road, Atlantic Beach, FL 32233
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Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: 1410 BEACH AVE ATLANTIC BEACH, FL 32233-5734
Legal Description 10-11 16 -2S -29E MANDALAY E 65FT LOT 5 BLK 60
Permit Number:
Updated 10/9/18
"ALL INFORMATION
HIGHLIGHTED IN GRAY
IS REQUIRED.
RE# 171860-0010
Valuation of Work (Replacement Cost) $ 30000 Heated/Cooled SF Non- Heated/Cooled
• ClassofWork: ❑New ❑Addition RIAlteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial L&Residential
• If an existing structure, is a fire sprinkler system installed?: Dyes 1XNo
• Will trees be removed in association with proposed roiect? ❑Yes must submit separate Tree Removal Permit IKNo
Describe in detail the type of work to be performed: Repair deck and add stairs
Florida Product Approval # for multiple products use product approval form
PropertV Owner Information
Name COOK ROBERT BF Address 1410 BEACH AVE
City ATli.Awnc RF.AcH, State FL Zip 37733-5734 Phone
E -Mail
Owner or Agent (If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company Southern Concepts Contracting Qualifying Agent Ezekiel Stewart
Address 2328 Shipwreck Cir W City Jacksonville State FL Zip 32224
Office Phone 9044700282 Job Site Contact Number 9044700282
State Certification/Registration # CBC1259345 E -Mail 7ekeasouthemcnnce; tccom
Architect Name & Phone #
Engineer's Name & Phone # Chris Sabo 904-625-2823
Workers Compensation Insurer OR Exempt N Expiration Date 09/21
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 FINA , CONSULT WITH YOUR LENDER OR AN TTORNEY BEFORE
RECORDI TICE OF OMMENCEMENT.
(Signature of Owner or Agent) (Signature of Contractor)
Signed and sworn to (or affirm before me this 1 day of fined d sworn to (or affirmed) before me thisl� day of
by �L\
O "� CM\v_ aQ90 by ff�ze.IGLZA
Si nature of -Notary) (Signature o
^'w PATRICIA B FRANZ
MY COMMISSION # GG024176 SHANEL R. CHALWELL
PersonallyKnow [ PersonallyKnown OR '� ' ��•; �! Notary Public - State of Florida
o: • , EXPIRES October 1S, 2020 ':e`,' Commission q GG 757166
[ ] Produced Identif atidtr • ] Produced Identificatio ?or oo- 5
Type of Identification: Type of Identification: �.." �'.'` "�Exse fiu� " --