1660 BEACH AVE #2 RES20-0291 .`S'''-' Building Permit Application
()poured 20/9/18
V IV }) City of Atlantic Beach Building Department **ALL INFORMATION
/ 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
4 b"-t+/ IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept(Wcoab.us (�
Job Address: t (� 0 i3„..,-__ 11 {File LA,A,1 }" `
Z— Permit Number:+ Es ac")- c7 zC-]
Legal Description tT nti(I r.4- t_..)4,, `'i c..-G1' l 0 .l3 i 0� {t (C, s RE# 1(a et `5-7S - U v i L..;,
Valuation of Work(Replacement Cost)$ _OC Heated/Cooled SF 20 7 Non-Heated/Cooled //,.5"--
•
,S
• Class of Work: ❑New ❑Addition ❑Alteration ®Repaylove ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial ential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes N� o
• Will tree(s)be removed in association with proposed prosect? ❑Yes(must submi_ t separate Tree Removal Permit) C3fQo
Describe in detail the type of work to be performed:
/
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Namec,rr 1.3e-r,l, ,...t.-1Address 14.4,,J iSec ji Ave.- 1t— L.—
City ,/�6 _State et.- Zip , 2-1 5 J Pnone
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information/ // ' /
Name of Company ) V kl-i-, [:� 5
^ f.tc—f4 c»') 'Qualifying Agent__ /• ,L.LtL-r� V t Kms/ _
Address 2-Z t7 L�'•-a1�. (T � t`*/ City State �L Zip ' i2 ?
Office.ghone Job Site Contact Number
State Certification/Registration# C 6(.- 1s-(6 k 3', E-Mail Richarciv i r ( s 0 j'Y1 COI , C f')')
Architect Name&Phone#
Engineer's Name&Phone# i. 2
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 foi ELECTRICAL WORK, PLUMBING,SIGNS,
WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc. NO i ICE: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 nay be additional permits required from other governmental entities such as wattrr 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 NOTICE OF COMMENCEMENT. / /'
(Signature of Owner or Agent) (Signature ••Contractor)
Signed and sworn to(or affirmed)before me this day of a nd sworn to o_r affir bef•r e : f day of
ili: by (COL.),,by 0 16 t n u.
(Signature of Notary) Signature• 'o1 ry)
I ]Personally Known OR [ ]Personally Known OR
•2o`"F ° �; TONT GINDLESPERGER
[ I Produced Identification [ ]Produced Identification ib '' •= M EXPIRES:OON#GG 353178
�`���: EXPIRES:October 6,2023
Type of Identification: Type of Identification: , .•• ,oc; •
.• -•': Underwriters
• .
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, .
Building Permit Application
city of Atlantic Beach Building Department
••ALL INF ORMATtON
\- ..../, SOO Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
4b_lil,k> Home
Phone: (904) 247-5826 Email: BuilciinerDeotPcoab.us IS REQUIRED. .
Job Address: 1 f' 6 0 .. 4, ,,A-V e Lc.111- V''. 2.•-• Permit Number +
ar
legal Description ( f' ,..at- 1........4,i, i ci c.,-,1 0 ..(3 I ri.,_Isc- ..-., tiErr
. =
Valuation of Work(Replacement Cost)$ 2-..C"C"1„..? ___Heated/Cooled SF 20 c/,, Non-Heated/Cooted,,j_ __ __
• Class of Work: ONew DAddition LIAlteratiou lafCtr 9Nlove 1.:Demo riPool flWindow/Door (
• Use of existing/proposed structure(s). liCommercial "serResidential .....--- I
_,.".-
• d e,an existing structuris a fire sprinkle( system installed?. 0Yes YiNt)
• Villt tree(s1 be removed In„,Y,OCUiti0,1 WIth proposed prow:,, f.,,,i ,i • •,di,,,cellar at C'Tr.:,Pe,v,,,,;;;Pf,,,,tl
IOescrioe in detail the type of work to be performed:
izce,,, ..„),;-r,,)e.... ut,c,„..
Florida Product Approval4 for multiple products use product approval!c°,
_
Property Owner Information
Name ell Cc r-le 1 %-(”. ,-1/-1. Address 1 L.)
°Sy //-:',/; State f'-i-- Zip ,2-1. 52 Pnone
E-Mail i
- -
Owner or Agent Of Agent,Power of Attorney or Agency tette: Required) _
Contractor Information n J „/
k
k
Name of Company je...) V.-i I., (.x.. ,_sh^i--Le..-ibr...iva ._Qualifying Agent
Ifia,..kc-tv, i i,e;-
...-i--
Address a/i iT Cri-i‘i.43,---7.3 _62_,Le fr.:•r•-•:_l_C,, (.2.1.- ___ cit,i A411.7, .- State r--t. Zip_
OfficeiphoneJob Site Contact Number
State Certification/Registration 4 6.L.-,I.:- I S/6 ,'- i'-''',. E-Mail
Architect Name&Phone# ii 4- :
Engineer's Name&Phone 4 _ li -"› .
Workers Compensation Insurer OR Exempt a Expiration Date
Application is hereby made to obtain a pernat 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 foi 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
RECORD! - YOUR N,9 '10E QF CO MENCEMENT.
of Owner or Agenti - . (Signature of Contractor)
','..1`. A' %WC,.r t to(or affirmed before me this 1 r day of Signed and sworn to(or affirmed)before me this day of
• ---------- ,4 ar s ch. , by
rnr-— _
h4gnature uf Notary) (Signature of Notary)
•• 4, , _ ,.
,CitKet . ,
"Tit"444.a4rtto - --i.iii;
i ;Personally Known OR
, .. . i i Produced Identification
1.)ftsier tS LI ai&N.SC,. .
Type of IrfentiliCatiCM:
, -