325 ROYAL PALM DR RES21-0022 -- " Building Permit Application \ �) Updated 10/9/18
f-
%,,, -., /,ri City of Atlantic Beach Building Department !,—w **ALL INFORMATION
;; ._/ 800 Seminole Road, Atlantic Beach, FL 32233 / HIGHLIGHTED IN GRAY
`,,''- IS REQUIRED.
P�►hoone::: (904) 247-5826 Email: Building-Dept@coab.us �\�
Job Address: �,2 korl fexl••v>ts Dr,Lie y Permit Number: R Es z ( - W z Z
Legal Description,3/—/ /7--.25.—.2,F ►/ Pct/i'L$ [J,v,T .2 4 Lot //RE#
' QK y
Valuation of Work(Replacement Cost)$ //,Q 1 ao Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition ❑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 )fNo
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) ❑No
Describe in detail the type of work to be performed:
ReirtOue Sl crier am/ Idose %I., a1 e,,,g
Florida Product Approval# FL / /90- IQ 6 for multiple products use product approval form
Property Owner Information d
Names 6✓NiheiNd N ( SI'aCy 4eZ Address 9/9 en" /gad Nor#
City re•- /State /O/ Zip 322.fo Phone 901'-If y- X386
E-Mail SfGe.I'!v/s h14441%,Gp�.
Owner or Agent?f Agent, Power of Attorney or Agency Letter Required)
Contractor Information _
/� /
Name of Company Rkk CN /, c O/c sseJ rsC• Qualifying Agent 01 L✓ Lot/ IR
/2d
Address e40+ 5 re g/� City O//►.o✓ bC�.
. g . State ft Zip3Z./74
Office Phone 0.G-�yy/-7989 Job Site Contact Number . - — —7S
State Certification/Registration# CgcOS8l// E-Mail ck coterts of/rcG - OA
Ala; , G
Architect Name& Phone# s
Engineer's Name& Phone#
Workers Compensation Insurer OR Exempt X Expiration Date ‘,44)/2402/
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 ATTORNEY BEFORE
REC`ORDINj YOUR NOT OF COMMENCEMENTyn I / C.), t
i).
(Signature Owner ent)
(Signature of Contractor)
Signed and sworn to(or affirmed)before me this,,Zb� day of Signed and sworn to(or affirmed)before me this L{�day of
1C.r uccy „,a)2.I ,by cifne.1 D Ci—v2__ 11,nol y , .,2Z�.2J , b tkeJ Lori,-
' DACODAH PARRISH "."�j �'' -,r •
�° Si nature of Notary) s." DACODAH PARRISH (Signatu of Notary)
- Commission#HH 024083 g = ,,
' =4417 = Expires 27,2024 I Commission#HH 024083
='�F• =` d July `; ��� ExpirerrsnnJJ�ulrry 272024
R!,!.• Bonded Thru Troy Fain Insurance 800-385-7019
•Fos F final "I�Qowrr ain Insurance 800.385.7019
(,}Produced Identification [- Produced Identi [cation
Type of Identification: KN._ - L20-)90-73- 3-U Type of Identification: FL.Di"- 0:3D "7 7 CI-6/-c25 3-t
Home Repairs Made Easy
Licensed and Insured
o
H'D ryr
RKR Enterprises Inc.
1285 Ocean Shore Blvd.
Ormond Beach, Florida 32176
CBC-058911
Robert W. Lort Sr. 0- (386)441-7989
Email:rkrenterprisesinc@gmal.corn F- (386)441-2288
32.x` 1ya1 Pa415 L2 e.
A *1 , Q F/, 32233
l APPLICABLE CODES:
Le9o•l Desci.P1 .) .3/-/ 17- 15-•25 E , FLORIDA BUILDING CODE 6TH EDITION - RESIDENTIAL
Leri
yaI Pas (),,,,1(),,,,1, . A FLORIDA BUILDING CODE 6TH EDITION - ACCESSIBILITY
FLORIDA BUILDING CODE 6TH EDITION - ENERGY CONSERVATION
Lot i t 8/1< /4/ FLORIDA BUILDING CODE 6TH EDITION - FUEL GAS
FLORIDA BUILDING CODE 6TH EDITION - MECHANICAL
FLORIDA BUILDING CODE 6TH EDITION - PLUMBING
FLORIDA FIRE PREVENTION CODE 6TH EDITION
2014 NATIONAL ELECTRICAL CODE
..
_ . - ._______,
/,'dap II'(' J0,,>>/x7
a411d as'qi ,cx' 'L'd r!!
•,•0„41 ewe, io t
O [,gyp �nv.� }f°�S^'.l
a S T
P"fs ' ��
r15.1^1.9 1,15,d2 -gypfft.4"
obi 1;14;11 o 4,.,'do NI aSQ) 2 P"!
1 A
1 J n:J'4742 \ �!'
�7 OJt''ys' / �� ' h
I
, 0.11. i
1 �l
p fs a.�' o� Sl N . ,444 ilii
a e la Axr 4,y5;$.14 .
tlistAq
.ray Bxh
ml t, 'AC'.a
l