1478 MARSH VIEW CT RES20-0347 ,L'A�w :, 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
�' 'r IS REQUIRED.
Phone:i (904), 247-5826 Email:il' Building-Dept@coab.us
Job Address: )LJ 7!> ' ” ct_i S ht)t e I-0 ( 1 , Permit Number: R Es LO - 7
SyJd7 3& -L,5 -Z9-4 . 21 Z ; /Ci O'/ n// S--
Legal Description (-},c est , .�G .'5 G ��- RE# j
Valuation of Work(Replacement Cost)$ / ,i5O • Heated/Cooled SF Non-Heated/Cooled
•
• Class of Work: ❑New ❑Addition Plteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial IFesidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes ❑No
• Will tree(s)be removed in association with pro osed project? ❑Yes(must submit separate Tree Removal Permit) ❑No
Describe in detail the type of work to be performed: ';X i,,,LeUr-f-e . — ,3}Gcc,uv ^,/ 1c<'`,tek" d,',
p zye-Lb it/ pet r4 --
Florida Product Approval# for multiple products use product approval form
Property Owner Information r,/ �/]� p
Name r�2 t4-in !At;��e `L Lc , Address /1-7� J4 a tSJ ✓i t'll 6-1�
City ice* lull!4-t`G k5c4e _ State CL, Zip 3 Z3�'j Phone ?/e g72-t/2)��
E-Mail iter #'L. . J?ru-etc
'e t Z , ,44<, l_ c't�,r-1
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information ,(J Illi �- j/��
Name of Company �j�. 0 -- S ,i d't S Ci iv !f/ qualifying Agent ,..le"‘�t'wt / "(C ,Lt'c
Address 2 7 6-a:-✓ti Oma',n '� l i City `j ma y- , State �1-L Zip .?Z 7 7-S
Office Phone C `?Gil/ . t/2 g ,VAC— Job Site Contact Number State Certification/Registration# 44 45'-,7e/ E-Mail J(yiA ;`KCS 17 C✓ 9/Y1ci'J, CC,'-i
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer 5 Le. i 1 7 OR Exempt o Expiration Date //j,1
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 N ATTORNEY BEFORE
RECORDI, YOUR NOTICE OF COMMENCEMENT.
.4
(Signature of Owner or Agent) ignature ractor)
t"V /
Signed and sworn to(or affirmed)before me this Ili day of ( . giedp and sworn to(or affirmed)before me this !day of
C. O�.V,by '_ �� y I1.0 _%*, a.4
Signat re of1/0r/144'
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�a"PL. REBEKAH STEVENS Personal) Know -. Expires Fe sruary 14,2023
[ Personally Known OR i�. '��; Y ���:�.,�,:;� p
{�1 ,: Notary Public-State of Florida [ Produced IdentifratiofY.f`V' Flnnded?h u Troy Fain Insurance 800-385-7019.
[ ]Produced Identification `1" y Commission#HH 25265 .;:
Y.'..', My C Type of Identificatiori.' '
Type of Identification: Comm YP
3onded through National Notary Assn.