2400 SEMINOLE RD ACC20-0003 SHED 01.Lvi-,r„ City of Atlantic Beach APPLICATION NUMBER
ALj Building Department rcEr
V t' (To be assigned by the Building Department.)
s800 Seminole Road
j-,,r,, Atlantic Beach, Florida 32233-54AN 0 8 202J keC z0 - O0OPhone(904)247-5826 • Fax(905845
1:0110. E-mail: building-dept@coab.usDate routed: 1 / 7 !/z0
City web-site: http://www.coab.usBY
APPLICATION REVIEW AND TRACKING FORM
Property Address: 24 00 S-Lf`1 I ti OLE Department review required Yes No
<Bufiding j
Applicant: 0 L&.)1 C (e___ Plann ni g&& oni--'ng`�
Tree Administrator
Project: � C f ) a(r-4 D Public Works'= .,
LPr ib tc_UIilities-
13 f v x z4 I O Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
Florida Dept. of Environmental Protection
Florida Dept. of Transportation
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 Department First Review: I Vproved. Denied. I 'Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING ✓
Reviewed by r2 e�r ,04,14ate: A X--- 0/
TREE ADMIN.
Second Review: ['Approved as revised. ❑Denied. I INot applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ['Approved as revised. I (Denied. ❑Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
£)'tu''`i Building Permit Application Updated 10/9/18
�a
City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
\-,• 01119'
IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: 2400 Seminole Road,Atlantic Beach,Florida 32233 Permit Number: 0.-CZ( —UCS_
Legal Description PT LOT 2 DIV 3 RECD O/R 18752-24 RE# 168354-0010
Valuation of Work(Replacement Cost)$ (67 1a0`() Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration ❑Repair OMove ❑Demo DPool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial ❑Residential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes ❑No
• Will treels)be removed in association with proposed proiect? ❑Yes(must submit separate Tree Removal Permit) ❑No
Describe in detail the type of work to be performed: Garden shed
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name Gatsby Land Trust Address 839 Ponte Vedra Boulevard
City Ponte Vedra Beach, State FL Zip 32082 Phone 904-367-5959
E-mail cmanley@sleimandevelopment.com
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Owner
Contractor Information
Name of Company Gatsby Land Trust Qualifying Agent
Address 839 Ponte Vedra Boulevard City Ponte Vedra Beach State FL Zip 32082
Office Phone 904367-5959 Job Site Contact Number
State Certification/Registration# E-mail m
Architect Name&Phone# 'kg->Lc?-))q 9 'Zti.-55 7'i v. yo(An
' J (Oc' r6,t-1 t d✓-co Al•
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt 0 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 P' • 'ERTY. IF YOU INTEND
TO OBTAIN FINAN�I , CONSULT WITH YOUR LENDER OR AN Al r� NEY BEFORE
RECORDING YOU rAy'TICE OF COMMENCEMENT. /�
gn/,d,re of Owner or Agent) :nature of Contractor)
rZ • to
Signed and sworn to(or affir ed)before me this' day of Signed and sworn to(or affirmed)before me this 3 day of
'b(Wee; , 3t CI ,byr�fl 54,,rw.n 0()Off , ab\" ,b (2{A4.1 5\,e, ('t4 ,-
jSig_nature of Notary) (Signature of Notary)
"" CATHERINE MIDKIFFCATHERINE MIDKIFF
��Y Pf/B�/�
� °�;Notary Public-State of Florida ,,,,,,`,141,14(!,,
[ Personally K o� y-.' *E Commission # GG 362458 [ I Personally Known OR :; a ,,s Notary Public-state of Florida
[ I Produced Id �r"... $ My Commission Expires [ I Produced Identification ;�,,- ,. '= Commission # GG 362458
l rr7:
`ry'',unl"�`
August 06, 2023 -'ota:��: My Commission Expires
Type of Identifi inn• 0 Type of Identification: „ P
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