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1651 COQUINA PL DEMO21-0016 r:t'ri - Building Permit Application Updated 10/9/18 i--, City of Atlantic Beach Building Department **ALL INFORMATION \ ,,, 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY '1�� IS REQUIRED. Phone: (904) 247-5826 Email: Building-Dept@coab.us Job Address: 0 \ \fo5`3 Cc c tiv(10. 'PL , A,% .a Permit Number: E-IVIO Z 1 — C C= I Legal Description \S-8a. ©S—o1S —c7, \ 1 w . earLX Cscove 1 Sjt V`R# \fQ k (o(rr -©oc�c -i 1 Cs.-e' S 1of-i of W 10F'C WU to Valuation of Work(Replacement Cost) $ 5o 0 0 , Heated/Cooled SF Non-Heated/Cooled • Class of Work: DNew ❑Addition ❑Alteration DRepair ❑Move XDemo ❑Pool ❑Window/Door • Use of existing/proposed structure(s): DCommercial .•Residential • If an existing structure, is a fire sprinkler system installed?: ❑Yes RNo • Will tree(s) be removed in association with proposed proiect? UYes(must submit separate Tree Removal Permit) ENo Describe in detail the type of work to be performed: De ✓n.o tfarI,J V\�Sf r►-e.11,(7C--- Florida Product Approval# for multiple products use product approval form Property Owner Information Name KO1Zumt S& t' Ta1(e►yt.06 Address \CA01SeV\\\a \ & . W•City �st\oh}Cc C3e.aC1r, State FL_ Zip '3•A?: '3 Phone (-ib aa- V -\ E-Mail SCp-N-ICotlue\1 2rc&wL.\ .cor Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information Name of Company ya k Q:f.„\ce4E-S Qualifying Agent ()LAS-WIN SCcL$(f'\ Address ?)2. Cl4' `j\. City ilt,FS State FL Zip `3'3x.3'3 Office Phone Spy • 913.366\ Job Site Contact Number State Certification/Registration# CAjc/25 7 5 IrG E-Mail Au.sltiv, ct Toc4.4c-W\ectkc,u?Ke Ts.cow Architect Name&Phone# AJE} Engineer's Name& Phone# AJ 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 RECD SING YOUR NOTICE OF COMMENCEMENT. • \\\`�,�� lllllll (Signature of ne gent) Signature of Contractor) yp0..• 0: ii4 1or.Nlill/I/� y-.PS��� �# (or affirmed) before me this 7�hday of Signed and sworn to(or affirmed)before rr �*ir�� `•: �F� ' ��ni., % UY ( or'Luwtii a Z1DZ( , byii:044S �tCy: AO • • ,884323 4. ` (Signa e of Notary) (Signat is _*fTlotary)4,• S si �fj ' '••C� .r ' h1I�Pn OR �`) Personally Known OR �43e UMW.• 0 � 0` iation Produced �; � Identification:Type� Type oIdentification: , I� -C-Mo 2_ l - 00 I& 34.00 x 22.00 • n • •3 GSC - LGs WCZ CsG as. p(et 1 C. CC Q t o MA t 'f%• A.-3 _J Mir SCHEMATIC SITE wv _ COQUINA PLACE NeauNrnt Type:<not eodpned> , 1, 5 / ( /SGL K k �-, p&-14-q,1D Aced eek ane. � o W 7, c( k dpi 3 co 4.n . st.(rte K P G c� Li , 6ti5-.4e. wL 4.I-tr a 11A � Lr J (Z-(C. �tie-4 r1.5 C(E4lD