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1969 BRISTA DEL MAR CIR RFNC21-0127 . Building Permit Application Updated 10/9/18 City of Atlantic Beach Building Department **ALL INFORMATION `. 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY REQUIRED. IRED. Phone: (904) 247-5826 Email: Building-Dept@coab.us U Job Address: j c1C1 K40'4 QJ M. — C,'rcly Permit Number: I\ I.— O(2-7 Legal Description 0(0C) S;h (� 4,w111 y RE# 1 050 G —1 G 70 Valuation of Work(Replacement Cost)$ 91 cf g Heated/Cooled SF _Non-Heated/Cooled • Class of Work: )(New ❑Addition DAlteration ❑Repair ❑Move DDemo ❑Pool ❑Window/Door • Use of existing/proposed structure(s): ❑Commercial XResidential • If an existing structure, is a fire sprinkler system installed?: DYes XNo • Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) kNo Describe in detail the type of work to be performed: / Add1 5 c- y rNy G��tVM±✓luyyr so-r-- � trvrrie_ �U V': +- ��✓r1 et � 4 brti Florida Product Approval# for multiple products use product approval form Property Owner Information /� Name Ke.k11(-ec.,n kqh. Address /?6? /3,,.;s#v /._ A4 - Cr,r City At(anr;c Ac„,, State F/ Zip 322-33 Phone_ 9c`/ 57/ ,2-3"2- E-Mail z32E-MailKI< 1-_ /130 cam. com Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information Name of Company `J'p r; R.,/ Qualifying Agent zac&, Peyr� Address 5470 N% l.vti City S.acl,stmti/t✓c. State F/ Zip 3Z2S14 Office Phone 704/ 6$3 63L/7 Job Site Contact Number wState Certification/Registration# /6S 85'1 E-Mail .«f/, Pip ac- 5t�nr✓,�/f_ e Gam'+ Architect Name&Phone# Engineer's Name&Phone# _ ���tT� Workers Compensation Insurer (eo(ec e Nom^ OR Exempt 0 Expiration Date sr —I S 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 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 YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECO; 9I 0 YOUR OTI OF COMMENCEMENT. (Signature of Ow er or Agent) (Signature of Contractor) Signed�4ann-d''sworn to(or affirmed before me this day Signed and sworn to(or affirmed) before me this 5 day of 0 6ry ,�Z� by ��`uw a „ Oc+� ... 2-01.1 y - ,AI 's (Signature of Notary) ENRI0 61/4 -pG' Notary Public,State of Florida 4940N, Notary Public State of Florida [ ] Personally Known OR �)�;� Commission#GG 328087 4 Pers...1 ... . •:> Britani M Norman My comm.expires Apr.25.2023 ' my Commission MH 011346 [roduced Identification [ I Produced Identification 'd)aM1 Expires 06116/2024 Type of Identification: sA1 Y �, , , Type of Identification: - .ar$» MAP SHOWING BOUNDARY SURVEY OF LOT 90, SELVA NORTE' UNIT TWO, AS RECORDED IN PLAT BOOK 40, yin PAGES 37 AND 37A OF THE CURRENT PUBLIC RECORDS OF DUVAT, COUNTY, FLORIDA. 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Fence Addendum Updated 1/14/2021 v"tx'- City of Atlantic Beach Building Department 9.111I ~ 800 Seminole Road, Atlantic Beach, FL 32233 PERMIT# Phone: (904) 247-5826 Email: Building-Dept@coab.us Job Address: Date: i/H bolodelir Circ JO/ //,2i Property�o/ Type: Lot Type/ Features: L11'Residential ❑ One Street frontage (interior lot) ❑ Commercial 0 More than one street frontage(corner lot,through lot, etc.) 0 Swimming Pool Fence Material: Fence Height (select all that apply): O Wood a Four Foot(4ft) ❑ Chain Link 0 Six Foot(6ft) O Vinyl q•'bther 1-0 16 O Block/Stone(Plan details required for footings and/or retaining walls)Q ( Other /VQI))l00177 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/or 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) ©/ o Will tree(s) be removed in association with proposed project? ❑ Yes (must submit separate Tree Removal Permit) GJ'No Conditions of Approval: • Roll off container company must be on City approved list. Roll off container cannot be placed on City right-of-way. • 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.