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700 Amberjack Ln RES20-0140 SidingOWNER:ADDRESS:CITY:STATE:ZIP: JONES ELLIOT 700 AMBERJACK LN ATLANTIC BEACH FL 32233 COMPANY:ADDRESS:CITY:STATE:ZIP: TYPE OF CONSTRUCTION: REAL ESTATE NUMBER:ZONING:BUILDING USE GROUP:SUBDIVISION: 171125 0000 ROYAL PALMS UNIT 01 JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK: 700 AMBERJACK LN RESIDENTIAL SIDING SIDING $600.00 FEES DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT BUILDING PERMIT 455-0000-322-1000 0 $55.00 BUILDING PLAN CHECK 455-0000-322-1001 0 $27.50 STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00 STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00 TOTAL: $86.50 LIST OF CONDITIONS Roll off container company must be on City approved list . Container cannot be placed on City right-of-way. 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. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION. ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES . ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY. 1 of 1Issued Date: 6/25/2021 PERMIT NUMBER RES20-0140 ISSUED: 6/25/2021 EXPIRES: 12/22/2021 RESIDENTIAL PERMIT CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 DESCRIPTION ACCOUNT QTY PAID PermitTRAK $90.50 RES20-0140 Address: 700 AMBERJACK LN APN: 171125 0000 $90.50 BUILDING $55.00 BUILDING PERMIT 455-0000-322-1000 0 $55.00 BUILDING PLAN REVIEW $27.50 BUILDING PLAN CHECK 455-0000-322-1001 0 $27.50 STATE SURCHARGES $8.00 STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00 STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00 STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00 STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00 TOTAL FEES PAID BY RECEIPT: R16178 $90.50 Printed: Friday, June 25, 2021 1:06 PM Date Paid: Friday, June 25, 2021 Paid By: JONES ELLIOT Pay Method: CREDIT CARD 472906605 1 of 1 Cashier: CG Cash Register Receipt City of Atlantic Beach Receipt Number R16178 Building Permit Application Updated 10/9/18 City of Atlantic Beach Building Department 800 Seminole Road, Atlantic Beach, FL 32233 Phone: (904) 247-5826 Email: Building-Dept@coab.us Job Address: _______________________________________________________ Permit Number: ____________________________ Legal Description ________________________________________________________________ RE# _________________________ Valuation of Work (Replacement Cost) $_________________ 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 □No  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: Florida Product Approval #______________________________________________ for multiple products use product approval form Property Owner Information Name ______________________________________________ Address _________________________________________________ City ____________________________________ State _______ Zip _______________ Phone ________________________________ E-Mail ______________________________________________________________________________________________________ Owner or Agent (If Agent, Power of Attorney or Agency Letter Required) _________________________________________________ Contractor Information Name of Company _______________________________________ Qualifying Agent _______________________________________ Address________________________________________________ City___________________ State ________ Zip_______________ Office Phone ____________________________________ Job Site Contact Number _______________________________________ State Certification/Registration # ____________________ 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 RECORDING YOUR NOTICE OF COMMENCEMENT. ___________________________________________________ (Signature of Owner or Agent) Signed and sworn to (or affirmed) before me this ____ day of ___________, ________, by ____________________________ ________________________________ (Signature of Notary) [ ] Personally Known OR [ ] Produced Identification Type of Identification: ______________________________________ ___________________________________________________ (Signature of Contractor) Signed and sworn to (or affirmed) before me this ____ day of ___________, ________, by ____________________________ ________________________________ (Signature of Notary) [ ] Personally Known OR [ ] Produced Identification Type of Identification: ______________________________________ **ALL INFORMATION HIGHLIGHTED IN GRAY IS REQUIRED.