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333 Plaza RESO21-0054 Revision Submittal 7.26.2021 .,:t1-Li-r,`,, Revision Request/Correction to Comments **ALL INFORMATION _ 9 j City of Atlantic Beach GRAY HIGHSIRHTEDEQUI E Building DepartmentIS REQUIRED. 800 Seminole Rd, Atlantic Beach, FL 32233 Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: t- U -b(--' — ' :// c?L--, / L--- ( ri Revision to Issued Permit OR ©Corrections to Comments Date: -11 1 1, `l Project Address: 533 P1cczc:�- A--{-t�-,t,i -t c, BC'cIG PL 3 3.73 Contractor/Contact Name: rle..1 I LJ Pd e , Contact Phone: 110 ° 27)1 [) ° 4-1°62.......' Email: ,,K cul-Fz "e.)00 9 I-flat, ( C Description of Proposed Revision/Corrections: L_0- ( (.r, t �Ji cC,k. M P i + ti C0 , i 5 LL o 61► 1 D 00 1A A l 1 iii +�i 'L affirm the revision/correction to comments is inclusive of the proposed changes. (pfinted name) Ilitt W' proposed revision/corrections add additional square foota e to original submittal? @EN No 0 Yes (additional s.f.to be added: ) ` Nil I proposed revision/corrections add additional increase in buil ing value to original submittal? o E*Yes (additional increase in building value: $ ) (Contractor must sign if increase in valuation) *Signature of Contractor/Agent: , ,�� CHn \, r' (Office Use Only) ❑ Approved ❑ Denied — Not Applicable to Department Permit Fee Due$ Revision/Plan Review Comments Department Review Required: Building Planning&Zoning Reviewed By Tree Administrator Public Works Public Utilities Public Safety Date Fire Services Updated 10/17/18 r;'''',,,,, Building Permit Application Updated 10/9/18 .-.i.,- = City of Atlantic Beach Building Department **ALL INFORMATION - �v 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUI�R-EyD.�� Job Address: b`J t PIC.CZCL. Permit Numbe�rr:c EDa t -w 1- Legal Description LD-I" t l.t� y ?IOC K— 11 1 PICZ+ No• ( SL xi%v•sl'On `n.# �L� A q dot I --co C.) Valuation of Work lacement ReZ.0 C'�' Work(Replacement Cost)$ I Heated/Cooled SF Non-Heated/Cooled • Class of Work: Flew 1=IAddition ❑Alteration ❑Repair. ❑Move ❑Demo ❑Pool ❑Window/Door • Use of existing/proposed structure(s): ❑Commercial Vd,Residential • If an existing structure,is a fire sprinkler system installed?: ❑Yes lhlo • Will tree(s)be removed in association with proposed proiect? ❑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 �1t Pki•C'cLY" Address !)1 ?) ?LCiZc� City � •I-t C. AaciA State FL Zip 3;,2,7133 1"' Phone K, • •5117 • c 5j2— E-Mail 'ti:; VGrfVw A1.C®v'+,1 Owner or Agent(If Agent, Power of gttorney or Agency Letter Required) Contractor Information Name of Company Qualifying Agent Address City j/ 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 o 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 wo wwill 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. r 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 NOTIC F OMI�ENcEMENT. -rpt'"(4-- _, / nature of Owner o gent) (Signature of Contractor) igned and sworn to(or a' irm-d)before met is r".. of Signed and sworn to(or affirmed)before me this day of ZO7 (, • _ .�, . III �• (-c by AIRIINIIIIMIL I:•: a !!. 77:T • (Signature of Notary) [ ]Personally Known OR . sem•= ----:•-.•.'own OR [ I Produced Identification •.;.76G �9�br3 TONI GINDLEF &ed Id:' tification Type of Identification: �- tz?•• -. , •MMWSIOt it }ifi F tion: ' -*' EXPIRES:October 6,2023 --" OF;i-k,' Bonded Thru Notary Public Undetxfilers