Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
49 Dudley St RES20-0172 1 of 17 permit application_1
Building Permit Application Updated 10/9/18 City of Atlantic Beach Building Department , "ALL INFORMATION r 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED 1N GRAY -_Jitltaf I$ REQUIRED. Phone: (904) 247-5826 Email: Building-Dept@coab.us Job Address:42 D Permit Number: Legal Description `74- '17-,2 nmm- �y 6_ �i'G/%1'�1V�C�A� 44:YT -3 RE## 1712 M'7- DO!& Valuation of Work (Replacement Cost) $ Heated/Cooled 5F Non- Heated/Cooled Ira • Class of Work: VNew ❑Addition l]Alteration ©Repair ❑Move []Demo ❑Pool ❑Window/Door Use of existing proposed structure(s): ❑Commercial 'esidentiXJN al o • If an existing structure, is a fire sprinkler system installed?: ©Yes • Will trees be removed in association with 2r000sed ro`ect? ❑Yes must submit separate Tree Removal Permit ®No Describe in detail the type of work to be performed:tv � f e, —"' N�L � APS �Q Florida Product Approval #. for multiple products use product approval form Address5to QST- Luilw mglr.d PCS. Zip __3 _2.2.5_2 Phone CLOLA 'LLLk t\t Owner or Agent (If Agent, Power of Attorney or Agency Letter Required) t.va�«tsa.iveausv4iurq ,�. tt `` �� Name of Company Qualifying Agent —m w4kty l�f� Address !s !! City State . Zip 3zZ Office Phone Q a Job Site Contact Number State Certification/Registration # -Mail_ IV & !Q,/r11/Vad e-h&hL0r, 4L+�'!r—_ Architect Name & Phone# e e Engineer's Name & Phone # Workers Compensation Insurer 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 applicableIs regulating construction and zoning, 11__ 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 OT CE OF COMMENCEMENT. — - -= - (Signature of Owner or Agent) (Signature of Contractor) Signed and sworn to (or affirmed) before me this 2 0 day of spf i t 29 2-0 , by _u5 3 t k %produced ersonally Known ( Identifici Type of Identification: nature,bf Notary) BETFf,A,NY SALcAN ABY COMMISSION # GG 317919 EXPIRES, tel' 11, 2023 onded T}vu Notary PuW U mft% a Si d and sworn to (or affirmed) before me this-d"U dayof (Si ature of Notary) 03° I&& Notary Public State of Ronda 2ersonally Known t7 = t: Ava J Butler ,4{ My Cammms an GG 209143 ]produced Identificat' n,**,,.. Expires 09/11/2020 Type of Identification: