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363 ATLANTIC BLVD UNIT 12 SIGN25-0012:;. BUILDING PERMIT APPLICATION J City of Atlantic Beach Building Department 800 Seminole Road, Atlantic Beach, FL 32233 Phone: (904) 247-5826 Email: Building-Dept@cciala.us Job Address 363 ATLANTIC BLVD #12 FOR INTERNAL OFFICE USE ONLY PERMIT # "ALL information required to process RE# 169730-0005 Legal Description 5-69 21 -2S -29E 1.4 ATLANTIC BEACH LOTS 7,9,11 TO 18, PT LOT 19 RECD 0/R 18250-510 BILK 1 Valuation of Work (Replacement Cost) 2439.00 Heated/Cooled SF Non-Heated/Cooled SF • Class of Work: 0 New ❑Addition ❑Alteration ❑Repair [:1 Move ❑Demo ❑ Pool ❑ Window/Door ■ Use of existing/proposed structure(s): ❑X Commercial ❑Residential • If existing structure, is a fire sprinkler system installed?:❑Yes ❑ No • Will tree(s) be removed in association with proposed project? ❑ Yes (Must submit separate Tree Removal Permit) ❑ No Describe in detail the type of work to be performed: INSTALLATION OF NON -ILLUMINATED WALL SIGN + "SAGEWOOD LANE" 18 SQ. FT. LINEAR FRONTAGE = 20 FT Florida Product Approval # Property Owner Information Name NSHORE LLC Address PO BOX 357742 (For multiple products use Product Aporoval Information Sheet) Phone 386-748-2889 City GAINESVILLE State FL Zip 32635 Email Owner or Agent (If Agent, Power of Attorney or Agency Letter Required) SEE ATTACHED Contractor Information Name of Company TAYLOR SIGN & DESIGN, INC Address 4162 STAUGUSTINE RD Qualifying Agent RANDALLTAYLOR Email KVARN@TAYLORSIGNCO.COM Worker's Compensation Insurer FFVA MUTUAL INSURANCE CO Architect's Name Engineer's Name CHRISTIAN LANGLEY City JACKSONVILLE Phone 904-396-4652 State FL Zip 32207 State Certification/Registration# ES12000117 Job Site Contact Number 904-396-4652 Email Email OR Exempt ❑ Expiration Date 8/11/2025 Phone Phone 888-371-3113 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. J � � (Signature of Owner or Agent) (Signature of Contractor) Signed a d sworn to (or affirmed) before me this day of Si ned and orn to (2r affirmed) before me this day of b ,1 V by y Signature of Notary lr4Signator f Notary [Personally Known OR [ ] Produced Identification [7ersonally Known OR [ ] Produced Identification Type of Identificat' iCATHL.EEN VARN Type of Identificati N VARN Notary Public Notary Public State of Florida 5tate of Florida Comm# HH184813 " Comm# HH184813 tiv $ Expires 10/11/2025 Expires 10/11/2025 LETTER OF AUTHORIZATION Affidavit To Whom It May Concern: This letter authorizes Taylor Sign & Design, Inc. (or their Agents or Subcontractors) to act as Agent, to secure permits or variances required by the local governing body, and to perform sign or awning installations, removals, or maintenance at the property located at: Property Address: 363 Atlantic Blvd #12 Atlantic Beach FL 32233 Company Name: NShore, LLC Name: Jamie Martinez Phone Number: 386-748-2889 Title: Property Manager Address: P O Box 357742 Gainesville FL 32635 . lao ie - SIGNATURE OF PROPERTY OWNER/AGENT STATE OF FZ- COUNTY OF Sworn to and subscnbed before me this day of %! 20,2-5 I Signature of Notary State of"—EiL— Print or Type Commissioned Name of Notary Public r P 4`� •• .�`s� LACHERYL L FOLK Personally Known y (Vf OR Produced Identification ( ) = m I HH 50 W at ExpnsDsw*w22.20W Type of Identification Produced: _ Commission Expires ( Notary Stamp or Seal Required) 0 CL ca U u ._ a 4i Q co ED 1 0 m LTJ 0 o 0 f.11 © 1 M L O O z 4-= Om �E CLS O a L Q cn cn a