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980 MANDALAY AVEBRIGHT ANI) BEAUTIFUL• BAY 10 BEACH Planning & Development Department 100 S. Myrtle Avenue, Suite 210 Clearwater, FL 33756 Telephone: (727) 562-4567 www.myclearwater.com APPLICATION FOR NON -SUBSTANTIAL DAMAGE / IMPROVEMENT REVIEW Parcel Number: Property Address: Owner's Name: Co -Owner's Name: Owner's Mailing Address: Owner Phone Number: pc a4 /5 S¢bbb o+ a pogo q $6 P1 Ar4fri,Aci /GLE Gte i”.17 NAbn1 TnA'i\l /g67 AblvELAIGE Leh /Z4) 77tio Yb SA'Ss* 3 3 5-q 8!3a Ston FIRM Flood Zone: BFE: Panel: Lowest Floor Elevation (excluding garage): I am attaching an appraisal report of my property, or I am not submitting an appraisal report of my property I accept the County's Estimated Market Value. (©3 4ag Initials Initials Initials ') f I accept the attached estimated cost of construction as a fair cost of repair or improvement for my home Initialsl� SIGNATURES: Owner: Co -Owner: Contractor: RECEIVED BY: V.J.K MAY 0 4 201 PLANNING & DEVELOPMENT CITY OF CLEARWATER 3f Date: 980 MANDALAY AVE BCP2018-05152 0 REMODEL Zoning: Low Medium Density Atlas #: 238A RIGHT ANIJ BLAUriFUL • BAY TO BEACH Planning & Development Department 100 S. Myrtle Avenue, Suite 210 Clearwater, FL 33756 Telephone: (727) 562-4567 www.myclearwater.com OWNER RECONSTRUCTION/IMPROVEMENT AFFIDAVIT Parcel#: 0s / a1 / (S / 51446 / 069- / oO�� Property Address: 9?b pkaAtieeti fklie (.. 6-x-RW,1LR. 35747 Contractor Name: /n, 1 A1-_, //at) 65,5y License #: G 0 0 4 3/ 9 Address: c3 1 l cff-13(26 6 i?C gto ISS V(1.4,6 34494one: 731 744 o/7 I attest that I, or a member of my staff, personally inspected the above-mentioned property and produced the attached itemized list of repairs, reconstruction and/or remodeling. This list is submitted for a Substantial Damage or Improvement Review. These damages/improvements are ALL OF THE DAMAGES / IMPROVEMENTS sustained by this structure, and that all additions, improvements or repairs proposed on the subject building are included in this estimate. I understand that I am subject to enforcement and penalties if an inspection of the property reveals that I have made repairs or improvements NOT INCLUDED ON THE ATTACHED LIST. This includes any non- conforming or illegal structures/additions, or repairs made to the existing structure without having presented plans for such work. I understand that any permit issued by the City of Clearwater pursuant to this affidavit does not authorize the reconstruction, repair or maintenance of any illegal additions, fences, sheds, or non- conforming uses or structures on the subject property. (See Attached Itemized List) Total Labor and Materials $ b o Overhead & Profit $ 41 a 0 0 Total $ 44- 0'00 AFFIDAVIT STATE OF FLORIDA COUNTY OF PINELLAS Before me this day personally appeared I V�►�" who, being duly sworn, deposes and says that he/she has read, understands, and agrees to comply with all of the aforementioned conditions. X Owner's Signature Co -Owner's Signature SWORN TO AND SUBSCRIBED before me this e- day of '*'14' fig`: JASON MICHAEL AVERY NotaryPublic - State of cs Florida 0 Commission # GG 189362 My Comm. Expires Feb 25, 2022 I APIIIPMPleprsorraymprorm REVISED 05.03.2016 Date: t -'z I ( 6 44 RECEIVED BY: i!.J.K of Florida Comm " ion Expiration Date MAY 0 4 201C PLANNING & DEVELOPMENT CITY OF CLEARWATER Parcel #: BRIGHT AND BEAUTIFUL • RAY TO REACH Planning & Development Department 100 S. Myrtle Avenue, Suite 210 Clearwater, FL 33756 Telephone: (727) 562-4567 www.myclearwater.com CONTRACTOR RECONSTRUCTION/IMPROVEMENT AFFIDAVIT / / 4 6'4666 / 0(o 00 co Property Address: CM f)24 i/ L &Let,e/I-rudikrez, b7 Contractor Name: p4/Cu-5___ p ei - ' - 655V License #: C o 4-2, I .6, ? Address: 5319 C U Le E, - Ft) eruniKsviLte 3 4©Inhone: 7g? 144- OM I attest that I, or a member of my staff, personally inspected the above-described property and produced the attached itemized list of repairs, reconstruction and/or remodeling. This list is submitted for a Substantial Damage or Improvement Review. These damages/improvements are ALL OF THE DAMAGES / IMPROVEMENTS sustained by this structure, and that all additions, improvements or repairs proposed on the subject building are included in this estimate. I understand that I am subject to enforcement and penalties if an inspection of the property reveals that I have made repairs or improvements NOT INCLUDED ON THE ATTACHED LIST. This includes any non- conforming or illegal structures/additions, or repairs made to the existing structure without having presented plans for such work. I understand that any permit issued by the City of Clearwater pursuant to this affidavit does not authorize the reconstruction, repair or maintenance of any illegal additions, fences, sheds, or non- conforming uses or structures on the subject property. (See Attached Itemized List) Total Labor and Materials Overhead & Profit Total AFFIDAVIT $ 4 ouo aoo $ 44 00'6 STATE OF FLORIDA COUNTY OF PINELLAS Before me this day personally appeared /1 r` e ( deft 4e---55- who, being duly sworn, deposes and says that he/she has read, understands, and Gees to comply with all of the afor ►ention_ed conditions. ontractor's Sicrfiature SWORN TO AND SUBSCRIBED before me this RECEIVED BY: V.J.K MAY 0 4 20i8 PLANNING & DEVELOPMENT CITY OF CL. EAPWATER Date: day of 'q.} JASON MICHAEL AVERY Notary Public - State of Florida -r4.� Commission # GG 189362 My Comm. Expires Feb 25, 2022 ¢/d -ops? otary Pu • ' -St. of Florida ion Expiration Date BRIGHT AND BEAUTIFUL • BAY TO BEACH Parcel #: Property Address: Architect Name: Address: Planning & Development Department 100 S. Myrtle Avenue, Suite 210 Clearwater, FL 33756 Telephone: (727) 562-4567 www.myclearwater.com ARCHITECT/ENGINEER RECONSTRUCTION/IMPROVEMENT AFFIDAVIT 05 / al / f;- / 646(b / o4,3 / Dasa q go mo JPA- A-' /4446 c2,07114,47 -6g- 3 3761 License #: Phone: I have reviewed the contractor's list of work to be done with the plans prepared by my office. The list accurately reflects the scope of work indicated on my plans and specifications. The proposed estimated cost is in line with current average industry standards for the work reflected in my plans and specifications. STATE OF FLORIDA COUNTY OF PINELLAS See Attached Itemized List Total Labor and Materials Overhead & Profit Total $ AFFIDAVIT PERSONALLY APPEARED before me, the undersigned authority, who, being duly sworn, deposes and says that he/she has read, understands, and agrees to comply with all of the aforementioned conditions. Architect/Engineer's Signature Date SWORN TO AND SUBSCRIBED before me this day of A.D. RECEIVED BY: V.J.& Notary Public -State of Florida MAY 0 4 20ir= Commission Expiration Date PLANNING & DEVELOPMENT CITY OF CLEARWATER BRIGHT AND HEALTHFUL • BAY TO BEACH Parcel Planning & Development Department 100 S. Myrtle Avenue, Suite 210 Clearwater, FL 33756 Telephone: (727) 562-4567 www.myclearwater.com ESTIMATED COST OF RECONSTRUCTION/IMPROVEMENT 9-5- 2 I s 4-6610 o f a, oo co Property Address: 1 $b p iVkt- ca -tot 41 EiZ 5,5767 This Cost Estimate of Reconstruction/Improvement must be prepared and signed by a licensed General Contractor ITEMS COST LABOR + MATERIALS COMMENTS Concrete, Form, ETC / 7 5_ Carpentry Material (rough) c. a 5 Carpentry labor (rough) 44-a Roofing Insulation & Weather Strip Exterior Finish (stucco) ..---- .--`Doors, Doors,Windows & Shutters Lumber Finish 3 ab Carpenter labor (finish) a g O Hardware (finish) Hardware (rough) Cabinets (built-in) reO op d Floor covering (tile/rug) 51 j 0 Plumbing a 3 80 ShowedTub/Toilet — Electrical 57 4° Light Fixtures 6 00 Built-in Appliances —' HVAC 6 cl, S0 Paint / 7 g a Demolition and Removal 3 I g Overhead and Profit TOTAL 44 000 + OM Contractor Name: t L Afr" ' " _ as Contractor Lic. #: C-4 etal6 Address: 63/9 clic-J zy b!'`o w O' Phone #:7g7 744 0011 `/ -34-6 RPCEIVED E\(:64.K :.K 4 / g Signature: /4/1 MAY 0420i: PLANNING & DEVELOPMENT CITY OF CLEARWATER