2017 DUNA VISTA CT RFNC22-0011 Building Permit Application Updated 10/9/18
- �. City of Atlantic Beach Building Department **ALL INFORMATION
j 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
r0'tj IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.usT. i
Job Address: 2e11 "DbJA Vt5TA (,T. Permit Number: \ N cZZ-- 001 1
Legal Description J�,� ?09-2s-,g96-SeLVANOt1Et J Thio LoT67 RE# t(�f1.514. - t(01_,L1 `
Valuation of Work(Replacement Cost)$ 1(,33( Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ''New DAddition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial /esidential//
• If an existing structure,is a fire sprinkler system installed?: ❑Yes (7J No
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) ❑No
Describe in detail the type of work to be performed: W1011: eft, "iC� I 1^).5:4C L 4/6ai ly'hiez,f>
Florida Product Approval# for multiple products use product approval form
Propert Owner Information rt-//�� �t^^
Name O W 4T 1 6-e -Wfl €( . Address ..20, 7 'DOM v15T� GT,
City )47-64N)7i(. LG4 State Z(_, Zip 3ZZ33 Phone
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information p
Name of Company �t t e"5 ee,90c, ,r Pee6oZ/ Qualifying Agent JD-) V I5'c----
Address aW4M4Yt'ST,c-c yPetss De. a) City J4cPo..r✓t t LE State tc`-- Zip 30Za3.
Office Phone g $32r T5-11 Job Site Contact Number
State Certification/Registration# E-Mail (3CACHes 'F7 cr•-1,4/L. c
Architect Name&Phone#
Engineer's Name&Phone# ,
Workers Compensation Insurer 4 b r / 4/i".S'T' OR Exempt a Expiration Date 1 1/ Z 3
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
RECORD.'' G YOUR NOTICE OF COMMENCEMENT. igi
Sign. ure . Owner,/a A ent) (Signature of Contractor)
tl�' cert U 6 1-k— �jtre Pen 5G .a-r fe n 5 f-,pi e
Signed and sworn to(or affirmed)before metthis ?day of SignedSiand sworn to(or affirmed)before me this day of
Pau gA-21, ad ,by 5' ':zf Vd . F%&4litt , 030i` , by c-x,5.5!,1 r 1344.461--€01344.461--€0it1 J '
• i. .1/. / LI,-` �
• P.i.�00 /Notary Public State of Floriggign. .re of Notary)
h�,� Notary Public State of Florida (S•:nature of Notary 4't. Jessica A Dolquist
, Jessica A Dolquist .
• My Commission HH 142217 i My Commission HH 142217
l :}'d Expires 081102025 of Expires Oen 4/2025
D►tti [ Per oaly o. •; ►,/ '-r • • i1, i •'
c • ••uces lienti ication [ ]Produced Identification
ype of Identification: LI" Type of Identification:
-- 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: Date:
ZD' 7 —!a„i,e Z/7/o Z a
Property Type: Lot Type/ Features:
,2 Residential J21'One Street frontage (interior lot)
❑ Commercial /❑ More than one street frontage (corner lot,through lot,
etc.)
521 Swimming Pool
Fence Material: Fence Height (select all that apply):
Wood ❑ Four Foot(4ft)
❑ Chain Link Six Foot(6ft)
❑ Vinyl la Other a
❑ 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)
g 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.
REVOCABLE ENCROACHMENT AGREEMENT
City of Atlantic Beach **ALL INFORMATION
HIGHLIGHTED IN GRAY
800 Seminole Road,Atlantic Beach,FL 32233 IS REQUIRED.
REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach, Florida,a municipal corporation organized and
existing under the laws of the State of Florida, hereinafter referred to as "CITY"and
‘10E4 t eIbG�i W�Z, � 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 "Fe r 6V x_'17
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 notice to USER shall be given by certified mail, return
receipt requested,to the following address ZU i1j7V r/A Ill 4►A CI" krL_ c.r., Pt— 3 233
• 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 her-. . r- he USER.
— .1o"Jij-134 —P4-61v'57 Date 2A/Z
•roperty Owner/Agent(si: -d in presence of Notary Public)
STATE OF FLORIDA, COUNTY OF DUVAL
The foregoing instrument was ackn d this . ( day of FP_ID , 20
by C.V _ _ _ ,who personally appeared before me and
"printed name of Signer)
ac• owledged.he/ - signed he instrument voluntarily for the purpose expressed in it.
Department Approval:
Signa ure of Notary Public,State of loris-
ersonally Known TONI GINDLESPERGER
[ ]Produced Identification(Type) , *•.�•t MY COMMISSION fGO353178 cott Williams, Public Works Director
• �o: EXPIRES:October 6,2023
` eo^e:ed Thru Notary Public UndenrtMers
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