1811 Atlantic Beach Dr RFNC24-0125 Application ' FOR INTERNAL OFFICE USE ONLY
C BUILDING PERMIT APPLICATION `_
C
; City of Atlantic Beach Building Department PERMIT# �ALL Information required to process
800 Seminole Road, Atlantic Beach, FL 32233 L\--
**
ALL
Phone: (904) 247-5826 Email: B"'tHln eptPcoab.us
C9505– :L__ _
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Job Address 1$U ASI ,'G C� • r RE#
Legal Description C7 — 05— 5-1 E a Zvu
Heated/Cooled SF Non-Heated/Cooled SF -__�
Valuation of Work(Replacement Cost) 4`�� ❑pool ❑Window/Door
•Class of Work: L/New ❑Addition DAlteration Repair ❑Move ❑Demo Yes No
•Use of existing/proposed structure(s): ❑Commercial Residential •If existing
iisgbm acture, is a fire sprinkler separate Tree Removal Pstemi I st�No .❑
•Will tree(s)be removed in association with proposed project? 0 Yes (Must
Describe in detail the type of work to be performed:
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Florida Product Approval# (For multiple products use r•! . t 37 q y
Property Owner information Name [L(, 1 ' Po�loc
ii Phone qo1l 3y =—
II State � Zip 32233
Address I Sig .444,n-il , ch DyA'
City '9Yjf;rr ee
Email 14.1aV hu nQ ,00n,cVS'P.he Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Name of Company :w re.w .. w� Rag� Phone g/O�{ ��3'C3�
Contractor Information�1 _ ( T l
Sy 70 1 L A City .j c4Nswv:�� State Fl Zip szzsti
I Address , .� five
6 / State Certification/Registration# �GS>�.59►
Qualifying Agent girl/Vas" in
Email 1c� esici1✓t�G G'W i nv. . Gu* Job Site Contact Number 90�/ 6 2 C3 y 7
st_ OR Exempt 0 Expiration Date �0 ( –Z •S
Worker's Compensation Insurer 6 p��ywS Yktiu�'1D''/
Architect's Name
Email Phone
Engineer's Name
Email Phone
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 city/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 YOU PAYING TWICE FOR IMPROVEMENTSO TOF THEMPROV MENT BEFORE THE FIRST
YOUR
IENT
MUST BE RECORDED AND POSTED ON
TH
:INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
, ATTORNEY BEFORE RECORDING YOUR NOTICE 0 COMMS .EM � T.
(Signature of Owner or Agent) /,ignature of Contractor)
gned and sworn to(or affirmed)before me this 2.. day of Signed and
sworn to(or affirmed)before me this 2. 511< day of
4-7\ V l O I� ^ V,, b Z o-14f1/ r•r `. Q- I.✓k.-rr
o u r 2.1Q 2a byr _ & ' ✓ ' .
nature of Notary ` �-- Signature of Notary I Ar
[ ] Personally Kn- n� OR [ Produced Identification [ ) Personally Known OR [L1oduc' Identification
pe of Identification: -(-2-L;21 – — Type of Identification •..I •'it # AIMM,,eRlit e."s
•
�' Notary Public,State Of Florida
1 Notary Public Star ci fyi.r:da # *
® Andrew Corey Commission No.HH 437370
4 oto.inll�.u. My Commission HH 363426 7..r/ My Commission Expires:812312027_
Expires 2/16/2027
Updated 03/07/1014
t� -' , Fence Addendum
r
City of Atlantic Beach Building Departmen PERMIT #
800 Seminole Road, Atlantic Beach, FL 32233
211.0
Phone: (904) 247-5826 Email: Building-Dept@coab.us — C U-
-- Date:
Job Address: I
II( 1 +, 'G & aCiN Dr 2
10 is'
+I -- Features:
Property Type: Lot Type/
One Street frontage (interior lot)
Residential
❑ More than one street frontage (corner lot,through lot,
❑ Commercial
etc.)
❑ Swimming Pool __
Fence Material: Fence Height (select all that apply):
❑ Wood
/Four Foot (4ft)
❑ Chain Link ❑ Six Foot(6ft)
❑ Vinyl ❑ Other
❑ Block/Stone (Plan details required for footings and/or
ret fining walls)
VOther Alvrk:nw1
Fence Location:
Please submit an accurate and current boundary survey showing all existing improvements (including building footprint,
driveway, swimming pool, etc.) and location of fence/wall and any gates. Plan details required for block wall footings and/c
retaining walls and any portion or fencing above 6ft in height.
Will the fence be built in an easement?
❑ Yes (must submit separate Revocable Encroachment Agreement)
Et/No
Will tree(s) be removed in association with proposed project?
❑ Yes (must submit separate Tree Removal Permit)
gNo ---
Conditions of Approval:
• All old fencing and debris must be removed from job site by contractor or homeowner.
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.
--�"" . oaor r",t.a-- SURA Ids�i wtITTO uLStifirs
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BEARING REFERENCE: •, ,, .i`II
NORTH UNE OF SUBJECT LOT AS N ST'IffU•E •at :'
• ��C • All BEARINGS 5HOV1'�1 HEREON REFERENCED 1101E10. N•) motif ;,`•k ,%i
��� f,� 4'H Black 300 Sterling Aluminum \ - \' ,F ft ' '�,.• . e .
s --4'H Black 300 Sterling Aluminum Gate \ .r 1. - i-46
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''‹= \ a $1lr' 40000' OM If MAT t' .1� 1•r 71 i'l�.rto%I''�: r "t iliT1I'�. E 11 r.J�)Ir i`tt•9.'4t1L lri.1;1 ,
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