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299 Atlantic Boulevard SIGN 2012 'st CITY OF ATLANTIC BEACH s) 800 SEMINOLE ROAD ;" ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 12-00001108 Date 10/09/12 Property Address . . . . . . 299 ATLANTIC BLVD Application type description SIGN PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 386 ---------------------------------------------------------------------------- Application desc INSTALL TWO TOW SIGNS IN PARKING LOT IN REAR ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ SOUTHCOAST CAPITAL PTNRSHP LTD OWNER 1600 INDEPENDENT SQUARE JACKSONVILLE FL 322025018 --- Structure Information 000 000 NEW SIGNAGE --------------------------------------------------------------------------- Permit . . . . . . SIGN PERMIT Additional desc . . Permit Fee . . . . 65 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 4/07/13 ---------------------------------------------------------------------------- Special Notes and Comments 2010 FLORIDA BUILDING CODE, FLORIDA FIRE PREVENTION CODE 2008 NATIONAL ELECTRIC CODE Signs must be at least 5 ' from property line. Any sign placed within the right-of-way must have a valid right-of-way permit . Avoid damage to underground water/sewer utilities . Verify vertical and horizontal location of utilities . Hand dig if necessary. If field coordination is needed, call 247-5834 . Steel pole mounted sign at southwest entrance to parking lot is in City right-of-way and must be removed. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00 STATE DBPR SURCHARGE 2 . 00 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 65 . 00 65 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Other Fee Total 4 . 00 4 . 00 . 00 . 00 Grand Total 69 . 00 69 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALI, CITI' OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. J IUILDIA G PERMa APPL cAnoN CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904)247-5826 Fax(904)247-5845 Job Address: © A,ia Efr,,t2� r �2 a ,�t �. P� rc,„<< Permit Number: Legal Description PaQy-t,j4 c Parcel# Valuation of Work$ ��5. oor Area o q. t. q t Proposed Work heated/cooled non-heated/cooled Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door Use of existing/proposed structure(s)(circle one): Commercial Residential If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No N/A Florida Product Approval# For multiple products use product approve orm Describe in detail the type of work to be performed:__a. eZP we`LF-L 2 r--1- !S L neS P iCTOQ Property Owner Information• Name:SCUM,Gozfa Sr CA P i P,i,- Pi1SiJ P L-r.:p Address:_) r•r D�P<_f r�11 b2 i v City L�,ti✓ State dip..3 3: Phone Cc")4- p �: Vf E-Mail or Fax#(Optional) iS i i L e i-E v -� 1—j LL�-2 �r1 Contractor Information• Company Name: Qualifying Agent: Address:.._. _. __- _ i hone State �p�.,,„,;.,,,,...�,.�;,. Office PJob Site/Cont State Certification/Registration# Architect Name&Phone# Engineer's Name&Phone# Fee Simple Title Holder Name and Address REQUIREM ENTs Bonding Company Name and Address Mortgage Lender Name and Address REVDATE; Application is hereby made to obtain a permit to do the work and installations as indicated I certi that no work or installation as commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes 17,111 and void f work is not commenced within siz(6)months, or if construction or work is suspended or abandoned for apertod of six(6)months at any time after work is commenced. !understand that separate permits must be secured for Eleclrieal Work,Plutnbing,Signs, Wells, Pools, Furnaces, Boileis, ,dealers, Tanks and Air Conditioners,etc WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO FOUR PROPERTY. IP YOU INTEND TO OBTAIN FINANCING CONSULT WITH FOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. l hereb cerlifv that 1 have read and examined this a plication and know the same to be true and correct. 411 provisions of laws and ordinances governing this type ojYwork will be complied with whether speci ted herein or not. The granting of a permit does not presume to give authority to violate or cancel the Provisions of any other federal,state, or local law regulating construction or the performance of construction. Signature of Owneg —_ \x Signature of Contrac r Print Name \Print Name ........................................................................................-............_. this4- D Sworn to and subscribed before meSworn to and subscribed be re me ay of 20 his Day of 20 Votary Publ. J' Notary Public P' C1 )DIA S.KIRKLAND MY COMMISSION#EE 008208 := EXPIRES:August 14,2014 Bonded TAru Notary Public underwriters Revised 0 6.1 0 n FILE COPY 1+n�'!t�1�yy�NM�R�'+gNrs�«t�av:na.w.,eww�» I-T 0 CIQ c� 0 7:Z7 C > r�CD p w m N 00 WOO m � 0 m � z r-- -4:- m � _ c c 'b � i � 1Llr� 1 r -.p e 5 G f �rr 17 C7 N 83°23'12" E 100.00' TfSfiAL $RACES TORO C S .X� MOM- 50 (P) /GHT-50'(P) I 50 (P) � r 1 0 0 5 1 t ; . 1 21 ' 18 - - 4' I g 0 LF O !f� 1 600 �I TCO L ( S s CL S(4 TO 5) � 11 77 a �.«.... � '�,r �'S�^':i3;�„y , .,fes /._ er p,..✓•• � f��� ; ' �/f�+' �� 9 . je r' °V` ✓may Y'd N �¢ . f%off � ���r '� ✓�,,+�,. � J" �.g �� 25'(P) 25'(P) 25'(P) jr s: � t: � . ��� � ,� � � �� � �� � �� � �� ,�, �� � �� � �� � �+ ' � � "t i ��� ... ,,- "� -�.., .�^ i ,. -• �a ,. ,,,- .> �..� s; �� � � �, g r�r, r y� ��' y,_� �� � 0. t d`� � 53^�� � "� 6 i�f :.4 � �" B. to' �, . t,tie P h '�' ..p! N h�� ,� .' � .,.��'�' �"'� ��,'������� ,^��Vii.-��, ,�' �;��s.� ^�� �-� Y W.b xY � �s, f ah _'�x '3tilY ��� �TMr Jam{^ ��� � P3�.ti M" fit' ' .^'� t s„ 5 �� i�y,. ,y S i �` §r�aa,..x t R ,, v L �tri! j� �k{ �'�� .'�a=.. f �g �i� p g � ti � s�EjF a '� '���_,�y�. .��'. s r z Asa s*,�,,� � �- 3 `t w'��a � � S e y, s s�� r_ sL��y1 � _ # �� >� � � �� ,�� .w ���; '� N � _ ��s� � � � h� 3S! t � i � � � � • v� e IS ,n i"'A'. 3� t .sky ' w c -sx 4, �;.rK+ is � �'t � � �' ,�] * •� •l, r- a EryT �FTg1 'Sk _ k 41 em • .r r - �s r t• ,ir k W'.�, _ �is4 a:• `ice A F Ei N , z, 1 3.. w Pr.h y. J�i~Fal e1 AM N{Wnnwn+wNwlaw•K^v.«yahwttlrw,a-a•t,✓.N!nwau.X:w.. , ; qq_ i LIM FILE COPY;--- } a z 0 i�dKr3 o _.W a h 'E r J o a :MN Si a z szYxB�xa "y4i P6jn. Y x €P c m + xotl8$_ Y ,y+zz zs` c b 1 aid, ka'J < o t8 V � J I ' � w 1 mss. 1 I --- g ---I Bid OD I'� ; ,;1 ..I `•til ____ ,]b � �,�I r S '1 5 O6'18'46'1F —>r4ie+'F «w'9�' �T''g u� F F� ., :a•':^� ' yl \ .1 : �Y p tt ': �' ' : ''. . . ear: � \r.', .a;.ffi•1 ___-`- t i 61ST C21ST DR/iX .. « 1 __-_ ...---� s RyRy y]ya F� y �p�n fo } City of Atlantic Beach APPLICATION NUMBER Building Department (To be aw4ned by the Bum ) .ADS% 800 SenMrroie Road Atlantic Beach,Florida 32233-5445 Phone(904)247,5626 - Fax(904)247-5845 " .,. . E-mail: bu6dkig-dept@coab.us ng-d -us Date routed: City vmh-eibe! Mf0!1AWW-eeeh.us APPLICATION REVIEW AND TRACKING FORM Property Address; Z� 1� Ar7A'A-rT7L be rtment review fired Yes No Brn Applicant: C /% `G /S✓fiP _ Vnni 8 Zoning Project: IGS �Zj� "Servkm J Other Agency Review or Permit Required Review of Receipt Date of Permit Verifiedft Florida Dept of Environmental Protech Florida Dept of TrareportoWn St Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other APPLICATION STATUS Reviewing Deparbnent First Review: approved. ElDenied. (Circle one.) Comments: 41, ff Qig;� PLANNING&ZONING Reviewed by: 4i —p�: a7-i Z- __ TREE ADMIN. Second Review: ❑Approved as revised. []Deffied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: pate: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. Comments: Reviewed by: Date: Rr*w 07/27/10 City of Atlantic Beach APPLICATION NUMBER Building Department (ro be assigned by the tta cbv Depmenot.) 800 Seminole Road Atlantic Beach.Florida 32233-5445 1022 Phone(904)247-5VS • Fax(904)247-5845 p E-n>all: buNd1rM1-dept@coab.us Date rotAed: City wA-aik! MtpJlwnww eoab.ue APPLICATION REVIEW AND TRACKING FORM Property Add Zak oFireServixcm ent review insd Yes No Applicant: Zon' 1:2 Project: �9 ctw Other Agency Review or Permit Required Review or Receipt Dats Of Permit Verified Ift Fbd&Dept of Erwironrnentat Protection Fbrids Dept of Thum portoWn St Johns River Wafer Management District Amry Corps of Enginms Division of Hotels and Restaurants Division of AWwk Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: Approved. ❑Denied. (Circle one.) Comments: BUILDING PLANNING&ZONING Reviewed by: Date: TREE ADMIN. Second Review_ QApprnved as revised. QDenied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: QApproved as revised. ElDenied. Comments: Reviewed by: Date: Rafted 1i7WHD 100 F + O City of Atlantic Beachy - r � APPLICATION NUMBER Building Department 4 (To be assigned by the Bull tog Departrnat) Soo sernirate Road ,._, ?Old' � . u.. AUantic Beach,Florida 32233-5445 s , ' Phone('904)247,5826 . Fax(W4)247-W46 E-trrail: us = ., Datenailed: w�a Cilyb-ob! M1p!1AAm ►.emh.us APPLICATION REVIEW AND TRACKING FORM Property Address: Z� I� 10717,4/17G De rtrnent review r6quired Yes No lfWx-41 B Applicant: C / !�S/�!� liTh nning S Zoning,. ✓ Project: sld-xi-S �z w Public Safety Fire Services Other Agency Review or Permit Required Review or Receipt Date of Permit VerifiedBy Fbdda Dept.of Envirornental Protection Florida Dept.of Transportation SL Johns River Water Management District Army Corps of Engirmers Division of Hob is and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS RevW&ing Department First Review: ied. (Girds one.) BUILDING 1 _ t4 1 rG�C` d r PLANNING&ZONING m>�S� Ilk v�lZeviev✓ed by: Date: L TREE ADMIN. Second Review: QApproved as revised. Denied. PUBLIC WORKS Comms: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: DApproved as revised. ❑Denied. Comments: Reviewed by: Date: Ra*W 07=10 City of Atlantic Beach Building Department ' APPLICATION NUMBER 800 SerNnole Road (ro be assigned by the B A&V Dpi) Adenfio Beech,Florida 32233-544,5 1 ) /o? Phone(904)247-5828 • Fax(904)247-5845° aJ vG E-malf: .us mulled.• City w�eb.eiiQ� Mipll�uww eesb.ug . �::, ._ IJ APPLICATION REVIEW AND TRACKING FORM Property Address: c ifilyo( &nnft nt review fired Yes No Applicant: 62G'/�� iO Z--T7V U_ �Zoninq-7Y ✓ Project: e'z ,) 7-DuJ Public Safety /f�:79y� ✓�%G-�- � dire SerAmksT Outer AgenW Review or Permit Required Review or ReceW Dabs of Penult Verified By Florida Dept.of Envirorrrrental Protection Florida DepL of Transportation SL Johns River Waler Management Disbict Arum►Caps of Engineers Dbision of Hotels and Restaurants Division of Akx*"a Beverages and Tobacco cow. APPLICATION STATUS RevitwrhV Dep>trtment First Review: \oApproved. ODenied. (Circle one.) Comments: BUILDING PLANNING&ZONING Reviewed by: Dale: J- Wa TREE ADMIN. Second Review: QApproved as revised. Denied. PVVO Comments: 1 PU U71 0 Reviewed b PUBUC r Date: FIRE SERVICES Third Review: QApproved as revised. ODenied. Comments: Reviewed by: Date: R&vie0d 0717110 �+s4yCde.. CITY OF ATLANTIC BEACH F ,. ®WNER / BUILDER AFFIDAVIT I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION CONTRACTING"REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW: DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTES: STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF YOU MAY BUILD OR IMPROVE A ONE-OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000.00 OR LESS. THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE. IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES. IL INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES. IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(1). AN"OCCUPATIONAL LICENSE" IS NOT ADEQUATE THE OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE BUILDING DEPARTMENT(247-5826)IF IN DOUBT. V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. ,\I'D �,.L� 2 z 04 4- ADDRESS 7-Q C4,e So j_LV C LLL-- i Ir- L 3�'�ej� PHONE NUMBER S Ca tTT L I b;` Gn D,-rte L. L P LT-_b PRINT NAM r SIGNATUR DATE Before me this day of_ 20 in the county of Duval,State of Florida,has personally appeared herin by himself/herself and affirms that all statements and declarations are true and accurate. Notary Public at Large,State ofCounty of Personally Known ❑Produced Identification- ? CLAUDIA S.KIRKUWD r MY COMMISSION#EE 008208 Notary Signature: : EXPIRES:August 14,2014 RFQ° Bonded Thru Notary Public Underwriters F:/BLDC✓Owner-Builder Affadavit;REVISED:4/16/2009