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665 SAILFISH DR E RES21-0116 ,,,•;'4,..'ri,-,\,, Building Permit Application Updated 10/9/18 a City of Atlantic Beach Building Department **ALL INFORMATION ~ 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY It 0' IS REQUIRED. Phone: (904) 247-5826` Email: Building-Dept@coab.us Job Address:. C4) SQ% 1-V 1 `)k. E G\S-4. Permit Number: � Z 1 Cp' t VJ Legal Description Ne_w 0/4 Door RE# t (. 1 O Valuation of Work(Replacement Cost)$ (3K Heated/Cooled SF 1 100 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?: IL]Yes ❑No • Will tree(s)be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) AN() Describe in detail the type of work to be performed: 3o - (p 0 -- .i ._• ,,s -a . E 1`©yal c)cll M3 _.. r , 7 moi* ,i •' U rk‘i 1— \ L o -7 N I O Ckt C Florida Product Approval# c\ag b-71 1 for multiple products use product approval form Property Owner Information 9��`-' Name `.5(-1(..0 l�(-Duo lc Address (o6S Sok 1It-15n D`'`✓� t'� City AA 10/\;. �jpOGS4' State F-L.- Zip 3 f.. „a3- Phone (.A(7 y 1� 7 fat\b I y E-Mail /LPt' k,./()t' t� ())C "q:A,_; , . ( M Owner or Agent(If Agent, Power o Attorney or Agency Letter Required) D Lin e r Contractor Information t Name of Company N-e.,4 key c' L©(}S1Ul4 &\ Qualifying Agent Address pc, V...::, CO i City .`-k o 1AC, State L Zip '5:),O Office Phone Job Site Contact Number CI Dy GC,A. -) i S State Certification/Registration# CeIC 1St 01815 E-Mail 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 FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECO¢AIN 'YOUR NOTICE _vi QF COMMENCEMENT. (Signat iii0 anyv er or Agent) (Signature of Contractor) (, • ed akhd sworn to .r affrd)befor• me thi day of ned and worn to(or of ed before m- this day of �t � , _'Oi' , . 1. 111. a / Ptc /, b e 4. 4110 InIMILIKSW .41,-y.-.-:„'' TONT GINDLESP'Ilf TONI GINDLESPERGER ' ':, MY COMMISSION#GG 353178 fiiia ;��C RRrOGG 353178 [ 1 PersonallyKnown OR +;.`'�S7. EXPIRES:October 6,2023 ; Itlll ]d�2r d F•....OP: r. :' rQdulrt5�,202 F. Bonded Thru Nota FbF [ ]Produced Identification �.,_ ryPublicUnderwriters BprtdednhhIatfhgublic Undry rtt Type of Identification: