220 12th St GSRS20-0082 App Mechanical Permit Application **ALL INFORMATION
HIGHLIGHTED IN
,:.` City of Atlantic Beach Building Department GRAY IS REQUIRED.
%Mr 800 Seminole Rd, Atlantic Beach, FL 32233 G 12s`Z-C)-00E)z-
-on o•
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: `-v 0 d 070
JOB ADDRESS: c2, 2�/ f /-k_ cS-V- PROJECT VALUE$ ��50o. 00
I I NEW AIR CONDITIONING & HEATING SYSTEM INSTALLATION ARI#(REQUIRED)
❑ Air Handling Equipment Only ❑ Condenser Only ❑ Air Handling Unit& Condenser
Air Conditioning: Unit Quantity Tons per Unit
Heat: Unit Quantity BTUs per Unit Seer Rating (REQUIRED)
Duct Systems: Total CFM
REPLACEMENT AIR CONDITIONING & HEATING SYSTEM INSTALLATION ARI#(REQUIRED)
❑ Air Handling Equipment Only ❑ Condenser Only ❑ Air Handling Unit& Condenser
Air Conditioning: Unit Quantity Tons per Unit
Heat: Unit Quantity BTU's Per Unit Seer Rating (REQUIRED)
Duct Systems: Total CFM
❑FIRE PREVENTION
Fire Sprinkler System Quantity (Requires 3 sets of plans)
Fire Standpipe Quantity (Requires 3 sets of plans)
Underground Fire Main Value (Requires 3 sets of plans)
Fire Hose Cabinets Quantity (Requires 3 sets of plans)
Commercial Hoods Quantity (Requires 3 sets of plans)
Fire Suppression Systems Quantity (Requires 3 sets of plans)
I I FIRE PLACES MISCELLANEOUS:
Prefabricated Fireplace (Qty) Automobile Lifts
Gas Piping Outlets Boilers BTUs
Elevators/Escalators
ALL OTHER GAS PIPING Heat Exchanger
Quantity of Outlets Pumps
#Vented Wall Furnaces Refrigerator Condenser BTUs
#Water Heaters Solar Collection Systems
Tanks (gallons)
Wells
pi OTHER: �r I r U dc, �I U P /
Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for six months. I hereby
certify that I have read this application and know the same to be true and correct. All provisions of laws and ordinances governing this
work will be complied with whether specified or not. The permit does not give authority to violate the provisions of any other state or
local law regulation construction
or
rrrtthe performanceJof construction. •I ,
Owner Name: 6Oa) 4 , " l c/95 46 /")4 Phone Number:
Mechanical Company: �(Jb (�c'LLs At/1r? Office Phone: Fax
Co.Address: /', 0 , 'O>C �3/ -7 8,2 City: tf 4- . State: I/ Zip: 2-.2.22
License Holder: Z !Ei
nC -, C_/ State Certification/Registration# d�‘(/Y
logif ,I
Notarized Si•nature of License Holder _, .0 r Its
The forego rtt -nt w:s acknowledged before me this day , �� , 20Z he State of Florida,
County of .
Signature of Notary Public
os Ye'6;;: TONI GINDLESPERGER [ rsonally Known OR [ ] Produced Identification
`r' 'c,- MY COMMISSION#GG 353178 Type of Identification:
-;. `ra ' - EXPIRES:October 6,2023 Updated 10/9/18
'-5:p; `;.• Bonded Thru Notary Public Underwriters