566 Plaza Fence Submittal x;,a, Building Permit Application Updated 10/9/18
:, ;'1 City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road,, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: S 6 6 Pk 4z 130,1 _ PermitrNumber:
Legal Description 3>j -14 �l�- - $ " u�� f lam'1 .i RE# 170703 -c2o jr
Valuation of Work(Replacement Cost)$ 3 0C-70 Heated/Cooled 4F Non-Heate
• Class of Work: ❑New ❑Addition ❑Alteration kRepair ❑Move ❑Demo ❑Pool :Window • orFEB 03 2022
• Use of existing/proposed structure(s): ❑Commercial ,Residential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes C' to BY'
• Will tree(s)be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) *o
Describe in detail the type of work to be performed:
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ep ✓� c� �'v� O{ C,r s+-:VHj �Gv1w ir1 gav»t !vC„i%Ut S°tmc, /1►MrA I
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name 3.4A pc,"...., Address SCG PI"ze' RJ _
City Att`,n7;c /3-e'-eI, State F/ Zip 3-1_Z.31 Phone 701 SZ-/ 3SZ 6
E-Mail 141055%John 0 yatl.00. cow)
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company Super;... F„„, w: Qualifying Agent Z.",c-4 f .wJ
Address 5'170 ;91,,,.,,, o,vL City 3'....1,s ..;llv.. State F1 Zip 3ZZS11
Office Phone 904 6' 3 C31"/ Job Site Contact Number
State Certification/Registration# I CS 8151 E-Mail O4 cc.. (g? Imo,;y 'AIc,14sU»v;l/t
Architect Name&Phone# _
Engineer's Name&Phone# �/
Workers Compensation Insurer fe cI�r-1 /U,a}+A.4 I OR Exempt o Expiration Date
Application is hereby made to obtain a perm.t 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 A ATTOR . Y c EFORE
REC01(7 i O R NOTICE OF COMMENCEMENT. , .4, ,
C`� �/+]
(Si nature of Owner or Agent) (Signature of Contractor)
S_Igned and sworn to(or affirmed)before me tbik o: day of igne and sworn to(or affirmed)before me t'Vs 3 day of
velottaTritt_kiL__- kt-tv it-e,r- ,21_4_27, by 3-0ViNN•ity/10.
(Signature ci Notary) (Signature of Notary)
40v►pb� Joidyenn Chambers
e4 `, Notary Public
State of Florida w.. � �r
I )Personally Known OR •� [ ]PQrsonally Known OR ..;ir►�•,• CHRISTIAN GILES
'�j MY�n�i��1 � Uroduced Identification '�''
[Produced Identification [ ,•. • - MY COMMISSION#HH 117153
°� ConrNesion No.GG 216442
Type of Identification: L_.li L_ Type of Identification:_ :a: -`•<- • ?Et&AI)4143,2-0 25
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Fence Addendum Updated 1/14/2021
City of Atlantic Beach Building Department
/ 800 Seminole Road, Atlantic Beach, FL 32233 PERMIT #
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: si4 0q? a Date: 31 �Oz-L�
Property Type: Lot Type/ Features:
,Residential 'One Street frontage(interior lot)
❑ Commercial ❑ More than one street frontage(corner lot,through lot,
etc.)
❑ Swimming Pool
Fence Material: Fence Height (select all that apply):
Wood ❑ Four Foot(4ft)
❑ Chain Link :lSix Foot(6ft)
❑ Vinyl 0 Other
❑ Block/Stone(Plan details required for footings and/or
retaining walls)
❑ Other
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)
No
Will tree(s) be removed in association with proposed project?
❑ Yes (must submit separate Tree Removal Permit)
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.
MAP SHOWING BOUNDARY SURVEY OF
LOT 4 _BLOCK / AS SHOWN ON MAP OF
64E.4 'A' 4',91/41 —
AS RECORDED IN PLAT BOOK . . PAGES 4.41G.4.4 or THE £?b%QEA/r Pa9(.Je .PEGe205 dF Pu✓4e-eb, A-4 $
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