713 Sailfish Dr Dway Rev Submittal ALL
Revision Request/Correction to Comments **HIGHLI HIGHLIGHTED
ON
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
El Revision to Issued Permit OR ( ❑ Corrections to Comments Date: IV. io 21
Project Address: "�3 JL11 11'�I's 70
Contractor/Contact Name: r r i ('c k t w' I
Contact Phone: '14 V ( Email: , ut, 1-vA yik“•1 C'rr
Description of Proposed Revision/Corrections: �y� `
0ElMuv - CO^ Yeti ( ���( %ICW411�1 (MA. Yep` ' ‘,Ni MAN Cyr.
-L affirm the revision/correction to comments is inclusive of the proposed changes.
(printed name) c
CCEIVE
• Will proposed revision/corrections add additional square footage to original submit DEC 1 3 2021
IgNo ❑ Yes (additional s.f.to be added: )
BY:
• Will proposed revision/corrections add additional increase in building value to original submittal?
'�Vo ❑*Yes (additional increase in building value:$ —1 p )(Contractor must sign if increase in valuation)
// *Signature of Contractor/Agent: ' (�1�'
(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
..............", - ,,,,,_
Building Permit Application
City of Atlantic Beach Building Department
fe, I/adored 10/9/18
"All INFORMATION
$00 Seminole Road, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: BuildirbLI
e ) alcoa . S HIGHUGHTED IN GRAY
IS REQUIRED.
c‘,1--I,criL t-,`c., t.-‘,. tn.,— , *S7-2:.1:3:Permit Number:
Job Address:-A f"Z 5 c., 1 ci,sv-,. oe-.. DWAY21-0051 i. 1
Legal Description edt-V-1 . ...c)*-il Ur:4 ch -
ItC14 3Witt - vzso - tu uo.
Valuation of Work(Replacement Cost)S cl.70,04, _,.Heated/Cooled SF
Non.Heated/Cooled !„,1
*i Class of Work: EiNew OAddition EAlteration ' Repair EMove ODerno ITIPool LIVVindowiDoor
• Use of existing/proposed SITUCture(s): FICoMmucial 4Residential
4, If an existing structure,is a fire sprinkler system installed?: DYes ON° 1
Will trees be ferriOved in association 'i I ,ro)osed ,ro'ect?I 'Yes(must submit se i arate Tree -e
Rerrinv- lm&
Describe.in detail the type of work to be performed: D t_p...4.) Oi•4'e. .-..•.,. '..y ;0.,,,w A, ' ' Ch'.c-'. ,A... d. (.1/6-h.-0i fril.,-,<eye
rc,.e. A-le.. -67( 6,--cy ifst---1.t 1 ossl,,ti..+.'on.tt. i`pe,1-e,t
, .
Florida Product Approval# - --.
for multiple products use product approval form
property Owner Information
, .
Name .1c..e„I.,i ,.VA,..y,Se,,cL..cve-,l, Address -II'l S ki\C". .‘"N• .7;'' C.,
Stdte Fl-- Zip 9-2'1'? Phone °It-1 .,J.K 4'4- 1.--4102,-
E-Mail rIce..„1.,i j) ca L kciisr,11, tv%Le J..
____
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required) CAN
_ ,
Contractor Informatiog - i,;•.
Name of Company e C 1.c I A I, ' ."-]oVLIA Yr
i V.k
Qualifying Agent
Address 57-.3 f 0 "1.4, I-C.- N City ,)•,,--k 4,'"14.61 State FL.. Zip
Office Phone '‘? - 4 , C ei Job Site Contact Number
State Certification/Registration ft I `2/1.-, -gr/Ci 2 F-mail 'T t'e I i.....,4 I! eile_klekQD
Architect Name&Phone
Engineer's Name&Phone
Workers Compensation Insurer 44/:,/) ( , . ",5 -21,,_,, , !'; OR Exempt tl-Txpiration Date '"•- --C1-72.- C 2,d,„
[ 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 al!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 CONDIIIONERS,etc_ NOTIC
E.: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 7.ening. I"
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
,-• ,
RE.594DING YOU • NOTICE OF COMMENCEMENT. /
/
(51gnatute of Contractor)
iSignature of • r or 04,gent)
r affirmed)before me this_____K day of Si red and sworn to for affirmed)before me tAi& n_L?-').- day of
Signed and sworn to(o
, by /V-.e.,. it ill .1 Iliginrilso ,
,.' 7 A:eig',- ------ G......- .1,. jr„.444.
1 .•'?:\v-' 1--". of Nota•'
. ,.., ..‘ my col SSIONtl0.228145 .i
. (T,4Vile__402_6f-Okl$410a --------1 t4.1 ,-, ,,,q
14 r4„:.AF MIRES',Ina 12.2022
,...•;.l.'ii...',;;,,,...i,V,i;LKCIOViAL,KERR(IEERTsCrl,
'4'.. .4.'..• IP il/N,IIIIISSION# .Ca.,425
14,7 4,p,r„,?..,? Borxtioillizu Notary Pearl useknyrtters
,,, . .
::XPIRES:Ana 11,2C24 [ I Personally Known CrR
[ I Personally Known OR "--a:,;;X:il 5.,.,..;:i.-ToutgyPLOri:-..'-deorlIP:E [Yrcduced ldentification•
f-- -Produced Identification •,
Type of Identification: 6, ,e.,--- ,- Type of Ide.ntitication:
.. *iimikuIIIIIIIIMIMIIIIIIIIIIIIIIIIIIIIIII
f;y REVOCABLE ENCROACHMENT AGREEMENT
,:' ilo ,,,>, City of Atlantic Beach **ALL INFORMATION
f HIGHLIGHTED IN GRAY
800 Seminole Road,Atlantic Beach, FL 32233
y`IY
IS REQUIRED.
REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach, Florida, a municipal corporation organized and
existing under the laws of thState of Florida, hereinafter referred to as "CITY" and
.1.e e.LLA RA-A- u_.� of Atlantic Beach, Florida, hereinafter
referred to as "USER".
WITNESSETH:
That the CITY does hereby grant the USER permission on a revocable basis as described herein the right to enter upon
the property for the purpose as described in the City of Atlantic Beach.
This work is generally described as 1 Y P" CO VQrA(�
Any facility maintained, repaired, erected, and/or installed in the exercise of the privilege granted remains subject to
relocation or removal on thirty(30)days' notice by CITY to USER,said nRtice to USER shall be given by certified mail,return
receipt requested,to the following address ] \ 3 S f I\ '+.t-11 1)1' Aft r^A L_►3ele_i. kx.- 3 1.2 3 3
• In the event it is necessary for the CITY or the City's approved representative or other franchised utility to enter
upon the above described easement or property of the CITY, the USER shall replace at the USER's sole expense,
any and all material necessarily displaced during the action of maintaining, repairing, operating, replacing or
adding to of the utilities and facilities of the CITY or franchise utility provider.
• The facilities allowed by the permit shall meet the current requirements of the City Code, Building Codes, Land
Development Code and all other land use and code requirements of the CITY, including City Code Section 19-7(h)
which states "Driveways that cross sidewalks: City sidewalks may not be replaced with other materials, but must
be replaced with smooth concrete left natural in color so that it matches the existing and adjoining sidewalks."
• The USER, prior to making any changes from the approved plans and/or method, must obtain written approval
from the City of Atlantic Beach Public Works Department, for said change within 30 days after the day of
completion.
• This permit shall inure to the benefit of, and be binding upon, the USER and their respective successors and
assigns.
• USER shall meet the terms and conditions of this permit and to all of the applicable State and CITY laws and/or
specifications, to include utilities locate requirements and use limitations/requirements of easements, public
right-of-ways and other public land. USER further agrees that the CITY and its officers and employees shall be
saved harmless by the USER from any of the work herein under the terms of this permit and that all of said
liabilities are hereby assumed by tj-i0 UER.
O ) --eA) IC—' -II 1 Date V2.. (5 - 2.02
Property Owner/Agent(signed in presenc-e-of Notary Public)
STATE OF FLORIDA, COUNTY OF DUVAL ^-�
The foregoing instrument was acknowledged this 1 3 day of >e) , 20 Z (,
by P� -6, C'1 v`c- 1`-1c. C ( ,who personally appeared before me and
--(.printed nae of Signer)
acnoyvledged t h she s' ed the instrument voluntarily for the purpose expressed in it.
U Department Approval:
Signature of Notary Public,State 41lorida
o<t`:'46-„ TON!GiNDLESPERGER
[ ] Personally Known (''
,? it c* MY COMMISSION#GG 35317
it
[ ] Produced Identification(Type) r L.
9;r EXPIRES:October 6,2023 Sc t Williams, Public Works Director
"'`-°;'F,°d Bonded Thai Notary Public Underwriters
H:\Applications&Forms\Word&Excel Document Originals\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18