1177 ATLANTIC BLVD DWAY25-0008 rsA' BUILDING PERMIT APPLICATION FOR INTERNAL OFFICE USE ONLY
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`° ty of Atlantic Beach Building Department PERMIT# Lam- k•O1 f25 -0045
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5v800 Seminole Road, Atlantic Beach, FL 32233 **ALL information required to process
-rni Phone: (904) 247-5826 Email: Building-Dept( coab.us
Job Address 1177 Atlantic Blvd RE# 170708 0000
Legal Description 18-34 18-2S-29E .187 ATLANTIC BEACH SEC H PT BLK 10 RECD 0/R 9686-291
ic Valuation of Work(Replacement Cost) , ...ii-.-1//0 j U0 6 Heated/Cooled SF Non-Heated/Cooled SF
•Class of Work: ❑ New 17 Addition EAlteration ❑X Repair ❑Move ['Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑X Commercial ❑Residential • If existing structure, is a fire sprinkler system installed?:❑yes❑X No
•Will tree(s) be removed in association with proposed project? ❑ Yes (Must submit separate Tree Removal Permit) ❑x No
Describe in detail the type of work to be performed:
remove driveway and replace concrete widen aprox 4 feet.see attatched drawing for underground retention to account for
change in impoervious area. remove parking pad and replace concrete
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Florida Product Approval# (For multiple products use Product Approval Information Sheet)
PROPERTY OWNER Name HULIHAN TERRITORY INC Phone 904 955 8320
Address 1177 ATLANTIC BLVD City ATLANTIC BEACH State FL Zip 32233
Email CODY@HULIHANTERRITORY.COM Owner or Agent CODY T DUBIN
T-[
CONTRACTOR Name of Company v 1ikci Terr► 1-c/ -T. 1-t (_, Phone
Address 17 7 4 -Ianf;C. B ival City 44-`pnv<,aje4cin State PI— Zip 32233
Qualifying Agent ff J_ , 1� State Certification/Registration#
Email G pdy [6h,J vlterrI TCr .c 0--.1 Job Site Contact Number q01-1— Q 5 S— X320
Worker's Compensation Insurer FC. `?j .. OR Exempt ❑ Expiration Date 3/2 g/26
Engineer of Record Architect of Record
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 IMPROVEMENTS TO YOUR PROPERTY.A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE
SITE OF THE IMPROVEMENT BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING,CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
"In lieu of signed, sworn and notarized signatures of the property owner,agent and/or contractor, and under penalties of
perjet4,..
, I declar hat I have read and examined the foregoing application and that the facts stated in it are true and correct."
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SIGNA URE F CO" •ACTOR PRINT OR TYPE NAME OF CONTRACTOR DATE
i Loci Dvhin 3-(-2025
SIGNATURE * •WNER OR AGENT PRINT OR TYPE NAME OF OWNER OR AGENT DATE
Building Permit Application 11.05.2024
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