328 2nd ST -RES20-0339 Building Permit Application Updated 10/9/18
.. 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: "2 U 2...4aS! }9T/L,n,7i 1.36.-ch 33 Permit Number: I\ �.O 1��33
Legal Description J4-pi .0 C $Ta,.Cco 0,i iP/yr we( y,,' A iZ 7- 3 kg.RE#
Valuation of Work (Replacement Cost)$2U 08 c/ Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ElNew EAddition ❑Alteration ARepair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial *Residential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes DNo
• Will tree(s) be removed in association with proposed project? EYes(must submit separate Tree Removal Permit) VNo
Describe/' in detail the type of work to be performed: //c iC 5cv.J� .-/ Ccrf`''✓y ScT e o/e(./•, 'fig, /ire.+/c
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Florida Product Approval# .yC'.�e- F'f rii'/% rex.. ;•-e' e.e t,' - C for multiple products use product approval form
Property Owner Information! 'did
Name YY',�i,, (Z. 2:+✓ Address 32`' Z ~ 5 1ce1 T/6:0%4 A-6,44 f :72.2.73
City OTIA.44-,i 6re,. , State fi-i, Zip 3�,Z J3 Phone 9'OV ' ,c32.— `I V '3
E-Mail C+Rdc't2 C tn,,i/• cot-,
Owner or Agent(It Age i{, Power of Attorney or Agency Letter Required)
Contractor Information n n / > /
Name of Company (�v>>✓ !d / 4/2v��sy C vST Qualifying Agent tec,tifsy/ P b..,v'•,�r
Address J)6o 5�,eIe//y CT ,� / City <TGLc-kse,v i /c State ft Zip 3ZZZ/
Office Phone WV 7* - (UO3. Job Site Conta9t- - Number 7e1 $(✓7 `c 4,�
State Certification/Registration# CUC '(iSb bG;� E-Mail a,Cu1 -yL G( J.-we-T./; r/ ty�C
Architect Name& Phone# J
Engineer's Name& Phone#
Workers Compensation Insurer £ i-r,`Ji 61.'.if f'vvycii_y1;.c'C OR Exempt%_Expiration Date %1/?Zl_/
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 OR AN ATTORNEY BEFORE
RE�� y'R TICE OF COMMENCEMENT. 4_,410
/ ��T
(Signature of Owner or Agent) (Signature of Contractor)
igned and sworn to(or affi m:d1b- •re ' e this day of Sign d and sworn to(or a• it ed)befor- me this 7day of
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_�. N. "i_ MY COMMISSION#GG 333178 1.:' ,rn °% MY COMMISSIONGG 353178
[ I Personally Known OR uf. 7mW EXPIRES:October 6,2023 [ Personally Known OR u :* �.
./ •:.` .•.r l.:a: EXPIRES:. .,.ber 6,2023
Produced Identification '':FpFF qQ` Produced Identification '.7::f?)."61:•''': EcndedThruNot.1 f__uh!icUnderTters
[ ] Bonded Thru Notary Public Un�envrite 9. •
Type of Identification: Type of Identification: LJ �