45 Simmons Rd CIV21-0003 Revised App with Contractor l''''''-- Building Permit Application Updoted10;9/18
City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: 45 Simmons Road Atlantic Beach. FL 32233 Permit Number: CIV21-0003
Legal Description LOT 5 BLOCK 9 RE# 1742164-0000
IZ--
Valuation of Work(Replacement Cost)$ 6 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 ONo
• Will tree(s)be removed in association with proposed project? EYes(must submit separate Tree Removal Permit) i21No
Describe in detail the type of work to be performed:
Proposed new build of 1900 SQ FT warehouse
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name American Landscape and Lawn care Inc. Address 1352 Pinewood Road
City Jacksonville Beach State F j Zip 32250 Phone
E-Mail 1TimmyThompson@gmail.com 1
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information I
Name of o pany D - �J - rJ ';di1 Qualifying Agent �� Z
Address,0 0 • f c*t Glji City,--\t,..4 I�jC* State Z Zip �j
Office Phone �/a�(eon- �.5 �/ Job Sit Contact Num r , c
State Certification/Registration I.
7-i VO 3 [ E-Mail 5-rte."! (7 tic t/gN W NS f t chrj• Cs,/41
Architect Name&Phone# TBD
Engineer's Name&Phone# Reynold t'Peterson P.E.904-551-4945
Workers Compensation Insurer OR Exempt 0 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 ICE OF COMMENCEMENT.
(Signature of _ er or Agent) < (Signature of Contractor)
SiIroiLed and rn to(or affir ed)beforethis/C) day of Signed and sworn to(or affir ed)before met is f 0 day of
t.� swome 2021 �r 4,i 1\16�Scn I ,NV6U5T, 202 ,by IAN)
(Signature of Notary)
\l',"" 7 JENNIFER L.BENDETTI
'� �' Notary Public-State of Florida
O Personally Known L •.,:71.6-,,,,e,. Commission#GG 367988 I I ppesonally Known OR
produced Identific. My Comm.Expires Aug 20,2023 •
1✓f Y ( roduced Identification -4- .'"i;':"-• CHRISTIAN Ci1LES
Type of Identification: ' ,. d Fe ' sMY COMMISSION#HH 117153
./�y��r Type of Identification: ��:
'-.;:;e'7.,::17,1 EXPIRES:April 13,2025
''f°',,,,°P Bonded Nu Notary Public Undensriiera I