1853 SEA OATS DR RFNC22-0013 revision 2-24-22 Revision Request/Correction to Comments **ALL INFORMATION
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#: REMCZZ-CO( 3
❑ Revision to Issued Permit OR ❑ Corrections to Comments Date: 2/Z4/2-"z--
Project
zProject Address: I CATS Z R-
Contractor/Contact Name: 4EA45.7stonIG CotP
Contact Phone: 4'UC l.4 1— actyc X Email: NAlt—$FCLY t_P_k/1L SS0_,2.co AA
Description of Proposed Revision/Corrections:
L°D/ C7)2 LfC —T1 to/
MrctwxG(L& -T affirm the revision/correction to comments is inclusive of the proposed changes.
(printed name)
• �W,ill proposed revision/corrections add additional square footage to original submittal?
L7No ❑ Yes (additional s.f.to be added:
• Wjll-proposed revision/corrections add additional increa e in building value to original submittal?
i No ❑*Yes (additional increase in building va $ 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
Building Permit Application
updatedic/9/18
City of Atlantic Beach Building Department
i
"ALL INFORMATION
800 Seminole Road,Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
4-onis.0-.
Phone: (904) 247-5826 Email: Building-Dept@coab.us rs REQUIRED.
----- _-_
Job Address: .__/1( S.-3 P---el D ct---fe-S __Permit Number:
-----> Le' gal Description ( b1 24 131-604„1. r.,14,4- $4,442,{41.4-(,),J tr-43 RE# 17Z0Z0 -0 4 a.
Valuation of Work(Replacement Cost)$ .2 e LI 1. a 4, Heated/Cooled SF Non-Heated/Cooled
Class of Work: gew °Addition °Alteration °Repair OMove °Demo °Pool OWindow/Door
a Use of eNisting/proposed structure(s): °Commercial °Residential
r if an existing structure,is a fire sprinkler system installed?: °Yes Ghia
6 Will tr.eli)be removed inilca.?iiation with propcsed pr -eci 'lmis._&ka it 42301:are Tree Re-move)Pernfre—ONo._,,,,.._7
,...---
Describe in detail the type of work to be performed: F,.‘„.•,,,visi 4 kfli.,..11 47,/ a 6 3,,,,,.
,"-%eica :
1.
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...› Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name tle% btl4,344.Fv• cf Address IS-; 94 6413 PA.
city ....4..newm_cXii-- Is - - .t:-• zp .3214 > Phone 104-
E-Mail Mad(...0,443-. K- ..e,,,ir-ci..6512.12A C044 4
Owner or Agent(lf Agent,Power of Attorney or Agency Letter Required) K
Contractor information
.._ . . .,.... -.
Name of Company i-ler1 5--fcre_nii_Lti._1- __ s_s_a_12.-4, _Qualifying Pont. Pekl -v*41.(402--
Address77,-Y 17 -71:7,..i/4-yr.:ail<k. _.„4.-_$L:1- My -It,d-u",;...oul i 1-.- State Pi., Zip 722i .6
Office Phone 9rCo•Y ...?4,--_,7.717 Job Site Contact Number yc.-9 Y-illig-3/92_7 _
State Certification/Registration# 1 322 691 E-Mail eia 4444 e las".-04-491ii r.co.*
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Compensation Insurer OR Exempt r:i 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 ail work will be performed to meet the standards of all the laws regulating
construction in this jurisdiction.i under's-tan°tnat a separate permit must oe seriireth for ELECTRICALW_;R:::!'1.1.:7/IBMG,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 vat be done in compliance with all
applicable laws regulating construction and zoning.
WARNING TO OWNER: YOUR FAILURE TO RECORD A i •—:-OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROV . TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING,CONSULT WITH YO , • LENDER OR AN ATTORNEY BEFORE
/
1C RECORDING • a ' NOTI, ., IF c a k.0 ENT.
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\ ---% 6,---- SO T.i
IF fSiellatt4of Owner or Agent
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(Signature of Contractor)
. ----"') Signed and sworn to(or affirmed)before me this A4-day of Signed and sworn to(or affirmed)before me this‘1,5'. day of
\I
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,3 3...-,,,.3 , e fiotary)
maAL4 TAA. 0--J-- ',.eik-, CARRIE A.MOSLEY
•.. ... MY COMMISSION#HH161347
: ,. .4ii.:4-3.rin..AT-"6-411hddh'P.geERT G HALL
Personally Known OR ,....ty..-a-v.W EXPIRES:August 6,2025 -.1iq g-11°Wa Utt i:.: ,c,..A...19..V . .
r..--, o- Commission fl GG 254695
Vi Produced Identification ,,or 1%,.., Bonded Thni Notary Public undentows :-213 Identification "-Y> i
1 -tor- -- My Comm.Expires Oct 24,2022
Type of Identification: CIAS''''"^:"- .,,mtification: — . e_________ arteme....r.m....0.4tww,jwregli-tiatiefted-NeEety Assn:
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Doc#2022040042,OR 8K20142 Page 11R,
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12CO l2_ R1 K1:5C8I RA CMUIT COURT DUVAL
JO Form 29
After Recording return to: COUNTY
ARM...SThONG F•Eitii.. .. CC) RECORDING $10.00
--'": 7 .. .fle:Ni_) AVENt,t;::
•.C.(..5014VIL..r.::,F1_0121)A .32a0*
Permft No.
Tax Folic ;-''t NOTICE OF CiC.7fuct'aE-:icta-a.
;=6-.: 713_13
74-Tots of Fioridcs a
711.-.7E lli\:II-3,Z1::;1,13.1 hereby g'....i.es notice tw+in,!:-.rovement will be made to certain real prepar4.-:,end ill occer cia:Ice.with
Chapter 71Z„Florida Srres,tie followirto information f.:provided in this Notce of Conunefirnen-
L Legoil deszriprtion of properly exid street address if available: 1 7 2.0 zo-DS 1/Z_
30 - 204:9 - zs - 2-€E ; 54-U* 1,002/4/.4- ci/turci
tor 2( Pt_/4 1
nera; description rri'improvement: LSTAl.l AT1ON OF FENCE
,,urt: ft kettf--0/(1-4-er(- Ii77
..;.d.clress: ies- 564- 041-5 DZ. /14247c Aciezu 19._ ` az...- --
. :::::,-e...reit•in-Iv operty:
• '' -,-.,....and address of fee simple titleholder(if other tI'cn Owner) N/A
, ',.:‘,,ntraribt.:Name and address ARMSTRONG FENCE CO,. 3226 lAaEYRAHD AVB\RJEZTACKSONVT1l FI,FL 32205
Th,zne number SO 353-2333 Fox number(optional,if service by fax is acceotable_ 904 356-?..332
4. Suret,,c Name and addre!..:s N/A
Pi-ione.num.,.:,-r N/A Fax number(optional,if service by fax is.acceptc.ti;lej N1r-.
Amount et gond S N/A
Zi. Le.nder:t•lome and add.- s N/A
Phone number N/A Fox number(optiond,if service by fax is acceptable) iWit.
6. Per-sans within the Stcte of Florida designated by Owner upon whom notices or other documents may be served as provided
•,, ...,.....,,,...., ,- ....,.. k.,..fc.:.ji.,rwrida Statutes:(name.and address): N/A
.,-•••;•-.4 Fel-sans N/A
(-fix!mower(optional,if service by fox is acceptable) NIA
t.:;--iiart to hirn. off or RA:rser,Owner designates IVA of N/A 1-c receive a
Moti.m as provided in Section 713.13(1)(b),Florida Statutes.
-- ••••••.‘t...-•:(-kot person or vri-tly destgnr.ted by owner N/A Fax number(optional,if service by fax is
acceptable) NIA
Z. Exr.tration dote of Notice of Corrtnienceinent he expiration date is one(I)year from The dote of recording unless a
different dote is specified)
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State: of Florida Stnature off:Owner
coiiiit-1.), 64) 111%719td 6( A?Faittecb de4r-c
2_209.a b ...'i IL
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vho is parsonatly known to kle or who;los produced e , i a ) ' )1(kilS-,
q icieritifircrtion • or did not .../.' akg,an o -
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-1-33 —53— ,Cgq -0 Notary Pubic Signature)
• , 1
.,,,-*(.4,_\ DEBORAH ANN ST.HART
Revised'.0/200-2_
,.
1 It:It.' Notary Public-State of Florida ii; p.T. Commission if GG 228366 ,
I ':-':.'0A-1.T.i'' My Comm.Expires Jul 7,2022
Bonded through National Notary Assn.
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