487 ROYAL PALMS DR RES21-0205 ;. : Building Permit Application Updated 10/9/18
r . , ,,., „ r City of Atlantic Beach Building Department **ALLINFORMATION
!, 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
!�- IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: - b 01 V9Pó(AWR Dove.,1)vi\' Permit Number: R ESZ l U aO 5
Legal Description k' '71 ""1 I`." 11-2c'2'i Lar IS 131-14- �-t�13 RE# ("7 `f�f4 -Ooc
Valuation of Work(Replacement Cost)$ °It006 Heated/Cooled SF 2c Non-
Heated/Cooled
• Class of Work: OENew DAddition -Alteration ❑Repair ��DMove ❑Demo DPool i lindow/Door
• Use of existing/proposed structure(s): DCommercial Il esidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes (
• Will trees) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) o
Describe in detail the type of work to be performed:
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Florida Product Approval## _ _ - C L ,• __for multiple products use product approval form
Property Owner Information
t
Name . A 1L6T*Y Address -7 1041 . .'11--rOot"
City Add. 'Wilt ,�,/ Ft_ Zip 32 37 Phone - ���
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E-Mail � y'' ;r 1 14.4174 I )
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required) DiArrve-✓
Contractor Information (� ��, l /�
Name of Company t YV .Y I?riGC,Y`vtt i4j 60 414^ua (tying Agent Il.` .�.-=t-�'" -1 ''f'"
Address ' � 1 C. f- '' Cit
�`��y y�'f�M.t1G � State Zip-3223-5
Office Phone t�{ .--I '9 113 Job Site Contact Number 4ft't-('-13A---;- 1-2,
State Certification/Registration# CI<C t 32_q 2_( E-Mail Olt ai'►la le Ale 1-CIO- , )m
Architect Name&Phone#
Engineer's Name&Phone##
Workers Compensation Insurer OR Exempt 0<piration 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 a :TAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RElI .. DING YOUR N /TICE OF COMMENCEMENT.
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(Signature of Owner or Agent) 7 (Si_ ature of Contracto,
ed and sw to or ffir,I before me thi ,Zelay of S ned and sworn to(or a' •d)before met of
-' �i by i:.►..w. /,(�4�I . . 0 n�-��2CZ. . �� <4. 44 4 .1
11.11111641:401. 1#1.1
„0:1*::., TONI G!NDLEttPE >.,,y, .-,
.; t!� :, MY COMMISSION#GGICP
:z�>?y,.', TONI GINDLESPERGER
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Personally Known OR ';;,.��.Q,� EXPIRES:October 6,2023 ( ' sonally Known OR ;
FBF F Produced Identification :1MY COMMISSION#GG 353178
[ J Produced Identificatio ..... Bonded Thru Notary Public Underwriters F
*fY,:'�' EXPIRES:October 6,2023
Type of Identification: Type of Identification: •,,,,i k FY d'
•` u•rc underwdters
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Category/Subcategor Product Limitation
y Manufacturer Description of Use State# Local#
EXTERIOR DOORS
2. Sliding Renaissance Sliding glass door FL-31130.4
B. WINDOWS
1. Single Hung Renaissance Twin FL-31137.2
Renaissance Single FL-31137.1
Vinyl Horizontal
2. Horizontal Slider Renaissance Sliding Window FL-31114.1 HS