122 S OCEANWALK DR RES21-0015 Building Permit Application updt,ted10/9/18
f-... ._ City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: R!!ilding:Dept@coab.us IS REQUIRED.
Job Address: j Z L C FANS'.\L P i vc 10 Jr
K I H Permit Number. � �� � I - �� _�
Legal Description 'SC'1 ,Z -L:,'-Zgf .;y .L.l 11 3) -23-211 c• SAA U ';r f RE# • ' '-
Valuation of Work(Replacement Cost)$ 19 c,- , - Heated/Cooled SF !1/,/,i Non-Heated/Cooled /1'/1
• Class of Work: ❑New ❑Addition ❑Alteration Li'(Repair pMove ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ECommercial e7/Residential//
• If an existing structure,is a fire sprinkler system installed?: ❑Yes 3No
• Will tree s be removed in association with •ro.osed •ro ect? ❑Yes must submit se•arate Tree Removal Permit " o
Describe in detail the type of work to be performed: ,t 1 n+.' r-v.vf/Z pc.4'r,n,td F s N.rfc ,,L .•/:.0,f17.7,Ad /7
Tv /'. AA (6 f�,5r/.✓ (- c.4Jc.fo 5 II .,t- p v. ,•:!,..e,,•,,,,...,
I !Lk Lo w.1/; P-'o,:rru^i ;:F )n,,...447..
Florida Product Approval# /`iin for multiple products use product approval form
Property Owner Information
Name rL):.EP. 6362
"• Address 1Z2 (,).: 01,v:"'1 l.K n,r:I✓F Sc..-,//
City /fi'•-114/zi C 13t4,ra State ,4 k,.. Zip 'y z 7; Phone Li L;-f . qt.!y. 2 cl3
E-Mail r'- a 4/I'ybc.irh1,1,14., , ler y
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) ,) v,vP:
Contractor Information
Name of Company S V/"7/f/.v - cy,, 1>1 c..J '; 1 '-r,c'r' Qualifying Agent J c,.f ril Al ,V/' 4 ('c',c
Address 573 V,!</,v„J LAuf City A 13 State fL Zip j 7. 3 i
Office Phonec-) ' G•
1 Z c /G a � Job Site Contact Number •f � -/ Z,%, /C' L 'f
State Certification/Registration# e,.,./.,C /LSE S y; E-Mail J`` r S✓•1,J•h,•I C C c,•s S i l rl c C-,;.•1
Architect Name& Phone# ,"�/Q
Engineer's Name& Phone# ityq
Workers Compensation Insurer [,,,,v veA(:. 111,-6 OR Exempt ❑ Expiration Date / On i /2 c.,"
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 YOU: PROPERTY. IF YOU INTEND
TO OBTAIN FINAN G, ONSULT WITH YOUR LENDER OR • ' '.'•r EY BEFORE
RECORDING YOU re i ,C F COMMENCEMENT.
7 7
ig . 'r=oi Owner or Agent)
ly
(Signature of Contractor)
Signed and sworn to(or affirme before me this 7 day of Signed and sworn to ( ' affirmed)before m- his/ day of
._ ��, U�l�bv��n�Ce� ��i� el� � + -.1/�Nc�a:� , L�Z1 ysJob �=,t.c _.
(Signature of Notary) J _ Sign .ure . J�otary)
Personally Known OR f .•>�......... LINDSAY FRANQUI
personally Known ORVls. """°°"
[ ] Produced Identification I l '1,7 ,'_ Notary Publi<-State of Florida
[ ]Produced Identification �`.•:-..c TO-NI GINDLESPERGER
Commission a GG 185831 7 `„•'1%'• MY coMMISSION#GG 353178
Type of Identification: t .,SFA -1e' Myrnmm FvptrPsApr 18 2021 Type of Identification: •::
1
Bonded through National Notary Assn. d `; EXPIRES:October6,2023
i ——� — —— —__—__ L Bonded Th No'
ii , .,,;x _ Notary Public Underwriters