128 Pine St RES20-0333 Int Door, Drywall, etc S� f RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH RES20-0333
ISSUED: 12/3/2020
800 SEMINOLE ROAD
nrEXPIRES: 6/1/2021
ATLANTIC BEACH, FL 32233
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
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.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
RESIDENTIAL ALTERATION interior doors, drywall,
128 PINE ST $4500.00
RESIDENTIAL flooring, porch repair
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170633 0000 SALTAIR SEC 03
COMPANY: ADDRESS: CITY: STATE: ZIP:
JLS BUILDERS LLC 13974 S. Shipwreck Cir Jacksonville FL 32224
OWNER: ADDRESS: CITY: I STATE: ZIP:
Jennifer Hower 128 PINE ST ATLANTIC BEACH FL 32233
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT II\
YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT
MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU
INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
r
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $75.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $3.90
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.60
WORK WITHOUT PERMIT 455-0000-322-1000 0 $185.00
TOTAL:$266.50
Issued Date: 12/3/2020 1 of 2
RESIDENTIAL PERMIT PERMIT NUMBER
- CITY OF ATLANTIC BEACH
RES20-0333
800 SEMINOLE ROAD ISSUED: 12/3/2020
ATLANTIC BEACH. FL 32233 EXPIRES: 6/1/2021
Issued Date: 12/3/2020 2 of 2
j' 1, Building Permit Application updated 10/9/18
,. City of Atlantic Beach Building Department **ALL INFORMATION
, 800 Seminole Road, Atlantic Beach,
FL 32233 HIGHLIGHTED IN GRAY
\,_ I ,?�' IS REQUIRED.
Phone: (904 247-5826 Email: Building-Dept @coallus
Job Address: /28 /A/6 457 1 Permit Number; e_ecV—o - .33
_— __
liz'
Legal Description l / i i- I5-'age •051 .,`At(Alf c."- 3 F1' 'Eli)f 70 6 33 rl lei
Valuation of Work(Replacement Cost)$ 7f Heated/Cooled SF Non-Heated/Cooled___
• Class of Work: ONew DAddition JVAlteration DRepair DMove DDemo DPool DWindow/Door
• Use of existing/proposed structure(s): ❑Commercial %Residential
• if an existing structure,is a fire sprinkler system installed?: DYes XNo
• Will tree(s)be removed in association with proposed oroiect? ❑Yes imust submit separate Tree Removal Permit) ❑No
Describe in detail the type of work to be performed: JJfIu- Ni*-) fol-olio IC Dooms` Tom"ley cJI4u. 1 e-1‘)Aig-t Viv y L
TIL frLOQ1ki46.0 rafeietoA (.4iwr,j New 3Ateewilt, s, cad,,rr f z,t' ilc A414.
Florida Product Approval# for multiple products use product approval form
Property Owner information
Name d�11+`Il1=e'e ooseK Address /28 Prole s-rizee
1---
city Airc.4 1Th c $.cAcri State Ft- Zip 312-33 Phone 3t° — y?/- 4, 7 96,
E-Mail ,-ie✓es/t *terelH005'C 4 e�O1#tLE,C..d.4"--
Owner or Agent(if Agent, Power of Attorney or Agency Letter Required)
Contractor Information ,—.-
Name of Company tLS .gUit-.CR I c- Qualifying Agent ;,/E..rtE_o l 6c_ ItoZZ�/
Address/. 9?Y SH'/Pimeec_c-_too. S. City TA-h. State w ZP
Office Phone 6,'05/ - gel- 89.5-- - Job Site Contact Number el!,‘-iel- 8 --
State Certification/Registration#Cr6 4457 86 2.3 E-Mail 31—S Booz- S1:NL t' ' O ) �"k. '`s
Architect Name& Phone#
Engineer's Name&Phone# f-� .�y
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 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 FINANCIpp,CONSULT WITH YOUR LENDER OR AN ATTiCIRNEY BEFORE
RECORD! YOUR ONCE OF COMMENCEMENT. f j
iou, kcjA, tiA0:1),P" ---
,tsignature of Owner or Agent) (Signe/tt,re of Contractor)
tt Signed and swocnto(or affirmed)before me th',a day of
Signed and sworro q�affirmed)before me his day of - � t�i��tWY " 'C�by ' 'rt't 't t•VI s �C
L Ci:rtli?(f .by__ till '
r
fleiry Put!,c State of Florid .,,er !�OaE;y PLi#=Staai of FIO ea
fr Ni, Amanda Danielle Potty a� AmanOa Daraeilie Potty
: : < 4t Co�;saich GG E3`riZa i Uy Cxrtz+siact GG flJ5t24
Y 0-Personally Known OR % # ' EXE s2/o+.ro21
DiOersonally Known OR ;"� ' Ezo�ras a2ro�rzaza �a�
4 ]Produced Identification .„ i ]Produced Identification , 1
Type of identification: Type of Identification: