1671 Francis Ave RESO20-0037 Application JOB COPY REVIEWED FOR CODE COMPLIANCE 12.8.2020
4'';''?-1,-4, Building Permit Application Updated 10/9/18
yXV',`,l City of Atlantic Beach Building Department **ALL INFORMATION
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800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
urs w- IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us JJ �'v-�
Job Address: /6 2 ii
/ '41 J5 41, Permit Number: 1R L 0 ZC)- 00 37
Legal Description /V f? !"td ,R/ j (-7‘.sl14 SY12)rf.;v., RE# i 7225_7 ^/1/!_8----Valuation of Work(Replacement Cost)$ 4,061 -. Heated/Cooled SF —0— Non-Heated/Cooled
• Class of Work: L'' ew ❑Addition [Alteration DRepair LiMove DDemo OPool DWindow/Door
• Use of existing/proposed structure(s): [ 'Commercial ❑Residential
• If an existing structure,is a fire sprinkler system installed?: L]Yes L:7No
• Will tree(s)be removed in association with proposed_project? I}Yes(must submit separate Tree Removal Permit) kilo
Describec! in detail�� the type of work to be performed: ,...-1—.41/44,,,,, _n .. -. ,o r, /�
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Florida Product Approval# J v for multiple products use product approval form
Property Owner Information
Name CoA Ti _ Address
City State Zip Phone
E-Mail
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information //��
Name of Company ? 61. f�i.,4,4 igua/J.ly Qualifying Agent (i(,,/iy Di a,
Address '717 /Y) ,ii City ,}f1,#,4 State Zip `3?233
Office Phone e7�� ‘ 57Q/ Job Site Contact Number
State Certification/Registration# L L /}t/2-39d E-Mail O.Ai ;+,e. _ -- • _ IC{�
Architect Name&Phone# Ney-
Engineer's Name&Phone#_ SAGO CpQfac 'at )
Workers Compensation Insurer �JJ OR Exempt❑ Expiration Date V
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 A RNEY FORE
R CORDING 0 R NO CE OF C MMENCEMENT. s----
t • --
.. X91 — C�
Arai , (Signatur r Owner, nt) , (Signature of Contractor) �
e`nd sworn to(or of dl before me this e•laay of Signed and sworn to(or affirmed)before me Zs 111—day of
-s t! N .Jhsr,�. y Oa{r:nUr' , 2c) ,by G kS' L .'1s.crl
F_,--•
(t. atur ( Signa.ro , . r
il ';J`aw KYLE MATTHEW MURRAY 1
,•,: �'• TONI GINDLESPERG :