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Permit Siding 1155 East Coast Dr 2012 � 3 , CITY OF ATLANTIC BEACH j 800 SEMINOLE ROAD '" ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5814 Application Number 12- 00000238 Date 3/01/12 Property Address 1155 EAST COAST DR Application type description SIDING PERMIT Property Zoning TO BE UPDATED Application valuation . . . 6000 Application desc hardi board siding Owner Contractor BRYSON JONATHAN & CHARLENE OWNER 1155 EAST COAST DRIVE ATLANTIC BEACH FL 32233 Permit SIDING PERMIT Additional desc . Permit Fee . . . 80.00 Plan Check Fee . . .00 Issue Date . . . Valuation . . . . 6000 Expiration Date . 8/28/12 Other Fees STATE DCA SURCHARGE 2.00 STATE DBPR SURCHARGE 2.00 Fee summary Charged Paid Credited Due Permit Fee Total 80.00 80.00 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.00 4.00 .00 .00 Grand Total 84.00 84.00 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247 -5826 Fax (904) 247 -5845 • Job Address: j 1 0131 c tet p t y r Permit Number: Legal Description Parcel # Floor Area of Sq.Ft. Sq.Ft Valuation of Work $ Z. too Proposed Work heated/cooled non- heated /cooled Class of Work (circle one): New Addition Alteration epair Move Demolition pool /spa window /door Use of existing /proposed structure(s) (circle one): Commercial i esidential j If an existing structure, is a fire sprinkler system installed? (Circle one): es No Florida Product Approval # For multiple products use product approval form Describe in detail the type of work to be performed: ,ivy (Atik• zt sim c f ifrhteie ti Property Owner Information: Name: Onr rito..t +,,,. gM004/ Address: 11 ST r)13 w j - k City /Cn t B.mc# State n.Zip 3t2 Phone 90.( -22 -7764, E -Mail or Fax # (Optional) Contractor Information: Company Name: Qualifying Agent: Address: City State Zip Office Phone Job Site/ Contact Number Fax # State Certification/Registration # Architect Name & Phone # Engineer's Name & Phone # - Fee Simple Title Holder Name and Address Bonding Company Name and Address Mortgage Lender Name and Address 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 laws regulating construction in this jurisdiction. This permit becomes null and void if work is not commenced within six (6) months, or if construction or work is sus ended or abandoned for aperiod of six (6) months at any time after work is commenced . I understand that separate permits must be secured for Electrica Plumbing, Signs, Wells, Pools, F urnaces, Bo Heaters, Tanks and Air Conditioners, etc. 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 RECORDING YOUR NOTICE OF COMMENCEMENT. 1 hereby certify that I have read and examined this a plication and know the sane to be true and correct. All provisions of laws and ordinances governing this type of work will be con:plied with whether specified herein or not. The granting of a permit does not presunze to give authority to violate or cancel the provisions of any other federal, state, or lo al law regulating construction or the performance of construction. Signature of Owner Signature of Contractor Print Name ;j L-' : . Print Name Swor e e , b- '1- e b- Sworn to and subscribed before me this ►ay o , ; ' �', 20' - this Day of 20 Notary ' ub , ;,z; .� Bonded EXPIRES: ru Notary Public Underwriters ers Notary Public ``�-` Revised 01.26.10 CITY OF ATLANTIC BEACH - �' ' ®WNER / BUILDER AFFIDAVIT I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION CONTRACTING" REQUIRES OWNER / BUILDER TO ACKNOWLEDGE THE LAW: DISCLOSURE STATEMENT FOR SECTION 489.103(7), FLORIDA STATUTES: STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT LAW. THE EXEMPTION ALLOWS YOU, AS THE OWNER OF YOUR PROPERTY, TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE — OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR IMPROVE A COMMERCIAL BUILDING AT A COST OF $25,000.00 OR LESS. THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE. IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES. II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING TAX AND /OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES. IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY. UNDER FLORIDA STATUTE NO. 455 - 228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE BUILDING DEPARTMENT (247 -5826) IF IN DOUBT. V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER- BUILDER PERMIT. I tvt i Cv13r Dr4V( 9JY -u 7544 ADDRESS PHONE NUMBER jt v.. kurr.4., PRINT NAME 1= el 'Oteit wit DATE S�PP1+4�f7R1�"' // �j� p 0 Before me this / day o 1 / ? ? Q G (. , 21 the county of Duval, State of Florida, has personally appeared herin by himself / herself and affirms that all statements l and accurate. , Notary Public at Large dec State arations of are true County of V a' rsonally Known ❑ Produced Ident �. �� .� � LEy G MY ' .�. �' � XP OMMISSIO # p S�j�6 Notary Sion > °� _ �' 1 ' *,P {fie Bonded I RNS. Febr public Unde uary 14, 2 014 Notary NOP -., nvriters F: BLDG /Owner - Builder Affadavit REVISED: 4 16/2009