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2265 Beachcomber Tr Submittal '-' ',., Building Permit Application Updated 10/9/18 ,; City of Atlantic Beach Building Department **ALL INFORMATION 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY 1 )r IS REQUIRED. Phone:o (904) 247-58'2p6 Email: Building-Dept@coab.us Job Address: , 7 ` ,L4 ,4/%,M(2e- �/�Aii Permit Number: Legal Description X;?-1 ©g J a5-ane /��Ef.daylL•4✓UA)i I < Gar 77 RE# /69V(3-0/5 g Valuation of Work(Replacement Cost)$ %7,g3g 6 Heated/Cooled SF 3o/72 Non-H t Coled 'V ED • Class of Work: DNew DAddition ['Alteration ❑Repair ❑Move ❑Demo DPool ❑Wi w/Door • Use of existing/proposed structure(s): ❑Commercial E0fAesidential JUL 1 4 2021 • If an existing structure,is a fire sprinkler system installed?: DYes iilo BY' • Will tree(s) be removed in association with proposed project? ❑Yes"(must submit spa ate Tree Removal Permit) o Describe in detail the type of work to be performed: /fil-r/ K r k,(/ UIQ bt f I CL iUf}r(1-�7. e�Lc stke,C,CA Et.�,'r©R5, PLoiil er FS,�/ P firg.r, -5' -k- /k) At rEPsz� �CEr "f Florida Product Approval# / for multiple products use product approval form Property Owner Informati,o�n� /� / �r Name (3 AOGe K6,06a Y TK- Address O�v Jr �CFhCK�/4 - r,C f�.Z City fifat)f L C// State F6_ Zip 3333 Phone (%v to -/670 E-Mail K►3Kin LL ' /9OL• •Wfn Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information Name of Compan � L'�. e ,,L1_ ♦ LCL' I / Quali ing Agent I GQr 00- Address O�]5 • i ? ov T on City i r i�tr�G A •tate Zip 01 % iffice Phone 9G A '/-6)3,.A.0 Job Site Contact Number NY c7'31"5-52=0 tate Certification/Registration# 446 050011a E-Mail BRAD ejf5a5e.oet3c. = coM Architect Name& Phone# Engineer's Name& Phone# / Workers Compensation Insurer V�641 011LJ VfA-�G'OR Exempt n Expiration Date 12 ©/ O1O: Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work r in tallation 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 Nom) E OF COMMENCEMENT. .. / ,.44- - (Signature ./Owner or Agent) (Signature of Contractor) Signed and sworn to(or affirmed)before me thi/ 3 ..I of Signed and sworn to(or affirmed) before me this 13 day . _vL.Y ,20Z-( , by - i K �v� -- J✓LY , ZoZ4 , by -i O 4 ir �t . �.IF: 4.11 :24`• ..`�.'•.;: • bel_ r-17 IV t•ry) V 0 41 / .. -.. pF .._ MYCOMMISSION# F7 .at. ,L <�"°�'' WILLIAM L.POPE ',�►�'a EXPIRES;October19,2023 . _ MY COMMISSION#GG 348645 O`•F`q,".•'_Bonded Thru Notary Public Underwriters Personally Known OR ,-kms `,; EXPIRES:October 19,2023 i Q•rV' BondedProduced Identification [ ]Produced Identification I ��''•••••••••' Notary { ] Type of Identification: /C4 r ` C") v� -type of Identification: �n�y y �/ 5�(,%