549 Vikings Ln DEMO20-0039 App � Building Permit Application Updated 10/9/18
X' 's City of Atlantic Beach Building Department **ALL INFORMATION
M800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us � z
Job Address: 54/1' V"I V-4.1 CA. at4e— Permit Number:D E- /v
\ZO 03 C?
Legal Description 35-(0'1 IT-2S-Z'IE SEA SpKAy WT ZS 8i K- 1. RE# 1"70103 -OZSO
Valuation of Work(Replacement Cost)$ � ad 0 Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New XAddition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial (Residential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes �'Jo
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) IgNo
Describe in detail the type of work to be performed:
tEMb rola ENCrtlt'�EEfL
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name 3Ay mor.--to to Address 51-4c1 J4-4N4-N.S LN
City A State F I Zip 3Z-Z33 Phone 9o-/- (Q/y-1••13a c>
E-Mail 5p.' p' c. to w CL C-trt41i . LO"
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company ? \'t\\'tPS '�Ut tbEft.S Qualifying Agent '?ARBtA ' tIVtPS
Address 99 Z OCEA1 '\V D City A i-e)• State C.\ Zip•3ZZ33
Office Phone cloy-3491 - 29010, Job Site Contact Number 5 0 y-753- `/(VI F1
State Certification/Registration# ESC tZS731- E-Mail 1?AAt11.PSe;kit tPE S @coro.CAST •Kier
Architect Name&Phone#
Engineer's Name&Phone#
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 FIN NG, CONSULT WITH YOUR LENDER OR ATTORNEY BEFORE
RECORDIG YOUR N i l- E OF COMMENCEMENT.-'
(Signatu''of Ow'- o t) - (S• ature of Contractor)
Si ned and sworn to(or affirmed fore me thi gday of Si n and sworn to(or of•r.••-d)b-fore me . iAt
day of
c Cntx.— Z- 2 , Y Oat J E Vl^t�✓ -1e LC_, ?CLQ, olk t f►:4.r�, •.1
_
ISMER
ofNottate 1 -n. ,~nor�/
MADISON G.HARVEY
— Notary) Cf�
:.. ,. MY COMMISSION#HH 006249 ••�
{ 4Prally L99une 3,2024 t P rsonally Pk—, TONI GINDLESPERGER
w ugbildkcifilik ,tic Und•matters [ ]Produced I r��fi; titfi MY COMMISSION#GG 353178
-; , • . jig/SUM 1', - Type of Identi dxi• " r ExptgFS•nrtaber 6,2023
f.?!.r;° Bonded" u Notary Public Underwriters