Pittman permit appBuilding Permit Application Updated 10/9/18
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City of Atlantic Beach Building Department "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: �O 0 l S -Til . Permit Number:
Legal Description 1,0 - 5 I(.— a► S al E SCC a I -6 r (7t c)�C1 I RE# 1-1 11
Valuation of Work (Replacement Cost) $ i ,> 3 a Heated/Cooled SF b_ Non- Heated/Cooled
• Class of Work: V/VeW ❑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 WIN
• Will trees be removed in association with proposed ro'ect? Dyes must submit separate Tree Removal Permit ❑No
Describe in detail the type of wor to be p rformed-
1 U x 1 LP oda C7 - P c�' S-�u _4;iL c , No an C oy1C
Florida Product Approval # for multiple products use product approval form
Property Owner Information
Name Address OL b • 'Z�sr
City StateL Zip 3ac�•� Phone q 6 4
E -Mail S . C d rv-1
Owner gent If A nt, Power of Attorney or Agency Letter Required) t
Contractor Information
Name of Company Tuff Shed, Inc. Qualifying Agent Tom Saurey
Address 1777 S. Harrison St, Ste 600 City Denver State CO Zip 80210
Office Phone 303-474-5524 Job Site Contact Number 904-272-9586
State Certification/Registration # CBC1253645 E -Mail licenses@tuffshed.com
Architect Name & Phone #
Engineer's Name & Phone # Richard Wills/76835
Workers Compensation Insurer Old Liberty Insurance Company OR Exempt ❑ Expiration Date 3/1/2020
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 O /I
ORNEY BEFORE
RECORDING (OUR NOTICE OF COMMENCEMENT.
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(Signature of Owner or Agent) P VSignature of ontr r)
Signed and sworn to (or affirmedl before me this!j�day of
vica r , -k� la�-ttn A2r4 Mg C=am
Commission # GG 356025
Expires July 17, 2023
[ ] Personally Known ',y Fa ��' Bonded Thru Troy Fain Insurance 800-385-7019
Produced Identific
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Type of Identification: .fl Lf
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Signed and sworn to (or affirmed) before me this 16ay of
February 2020b04
om Saurey
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JOHN H MAXWELL
NOTARY PUBLIC - STATE OF COLORADO
j� Personally Known OR NOTARY ID 20204004181
[ ] Produced Identification MY COMMISSION EXPIRES JAN 30, 2024
Type of Identification: N/A