547 SELVA LAKES CIR ACC21-0056 revision 12-2-21 Revision Request/Correction to Comments **ALL INFORMATION
HIGHLIGHTED IN
P 6LPA I City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 IImo�,,
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: ACC- - �C '
❑ Revision to Issued Permit OR Ig Corrections to Comments Date: 1 ' ^ 4-1
Project Address: ¶`i 1 `-t L- ( Mac C
Contractor/Contact Name: f TO# -RA) 1 `-1 L'4— Q (
Contact Phone: 9041- 21`7 6 Email: fa 1:;o, O i _TC-'pb(-,I ��✓ CO Vv1
Description of Proposed Revision/Corrections:
431 I IR- 2_ S 0)-9 e we uu l i LoT 6 0
J y1 Q I J/ affirm the revision/correction to comments is inclusive of the proposed changes.
(printed name)
• Will proposed revision/corrections add additional square footage to original submittal?
❑No ❑ Yes (additional s.f.to be added:
• Will proposed revision/corrections add additional increase in building value to original submittal?
❑No ❑*yes (additional increase in building value: $ ) (Contractor must sign if increase in valuation)
*Signature of Contractor/Agent:
(Office Use Only)
❑ Approved ❑ Denied ❑ Not Applicable to Department Permit Fee Due$
Revision/Plan Review Comments
Department Review Required:
Building
Planning&Zoning Reviewed By
Tree Administrator
Public Works
Public Utilities
Public Safety Date
Fire Services Updated 10/17/18
Ee1,A e Li iv 1T off— toT7C, U
�. Building Permit Application Updated 10/9/18
: . —.......:,.. .fCity of Atlantic Beach Building Department ` "ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-DeptPcoab.us,_ IS REQUIRED.
Job Address: 547 SELVA LAKES CIRCLE / �q _ Permit umber: ( — V C-' ....3(C 1
Legal Description - '7. 1 T'(2)-S ( (-- RE# i 7 Z.c 7-J~�.7 i
Valuation of Work(Replacement Cost)$ 3,500.00 Heated/Cooled SF Non-Heate Cooled
ECEIVE
• Class of Work: ❑New ❑Addition ❑Alteration CiRepair ❑Move
Ci OPool ❑Windo / oor
• Use of existing/proposed structure(s): DCommercial ❑Residential NOV 1 6 2021
• If an existing structure,is a fire sprinkler system installed?: LlYes CiNo y
• Will tree(s)be removed in association with proposed project?I lYes(must submit separate Tree RPrttwaffletmif}—QAlv----
Describe in detail the type of work to be performed:
PAVER WALKWAY ON SIDE HOUSE AND FRONT DOOR
Florida Product Approval tf for multiple products use product approval form
Property Owner Information
Name ELENI CRUISE __Address 547 SELVA LAKES CIRCLE
_
City ATLANTIC BEACH State F- Zip 32233 Phone 904-309-4978
E-Mail gatorcruises@comcast.net
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
-4t Contractor Information r /-.
Name of Company , 7a/ pw /w- L Z L Qualifying Agent - isy c.
Address 11 I ( LAS ' P; City '1 57.t.,.,,,. State r-c- Zip c.Z.51
Office Phone C/o d - /1/ - 6e. C o Job Site Contact Number t/01 (/ve C ?"
State Certification/Registration 4 6 Ri !Z4 c/f5 tf E-Maili`A-6,v 0 iT' P R , Aek,. ,-�
Architect Name&Phone# I- l n 1 L`Z.L
Engineers Name&Phone#t -/ A
Workers Compensation Insurer N( 11/4 OR Exempt1Xi Expiration Date
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
RECORDING YOUR NOTICE OF COMMENCEMENT. _
i
(Signature of Owner or Agent) (Signature of ontractor)
Signed and sworn to(or affirmed)before me this 9 day of Sii�ned and sworn to(or affirmed)before a this 'tt ) day of
Nikel 4�i✓, o-L - I . y C.,lE✓!lr r:,rv, e (i- L(kkj _._\ b a.r t: I�! )C;C..+
(Signature of Notary) (Sig ture of Notary)
I ) 'ersonally Known OR [ I V.eisonally Known OR
• . •,„ • • [0/Produced Identification 1 �` (� /
tg�gfftification: 4-/b(``(art 5 +)'j L
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Commission#HH 034840 • ', ""4, ZACHARY MCCUTCHEON
:a4(1f.'t tiotary public-State of Florida
o'Expires August 23,2024 n .: `
;f,..4%. . ( •., � ' Commission.HH 14878
... Bonded Thu Troy Fain Insurance 9adJ�.S 7019 pr f�.- My Comm.Expires Jul 5,2025