476 WHITING LN RFNC22-0021 Duiming remult /Application Upiwrd 10,1:lE
City of Atlantic Beach Building Department
"ALL INFORMATION
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. . 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
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Phone: (904) 247-5826 Email: Building:Dept@coab US IS REQUIRED.
Job Address: LI?c LA,;4.57 t...,,, Permit Nurnber.RF I.N. az z-ooz L
Legal Descnption OtcP_____SL,L -Aftly RE#J7/!-L5100
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Valuation of Wort'(Replacement Cost)S /COO Heated/Cooled SF Non-Heated/Cooled
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• Class of Work: hew CAddition rlAlteration LIRepalr °Move 0Derno DPool 0%A/widow/Door
• Use of existing/proposed structure(s): I Ifornmercial ilitfiesidential
i
! • If an existing structure,is a fire sprinkler system installed?. 0Yes M(No
• Will tree s h- remo ed in association with *to'osed ero eft? Yes must submit se. rate Tree Removal Perm
Describe in detail the type of work to be performed'
r.s+dbiss C li v../ ; k S ,4- Q./ vc.4., yewel
Honda Product Approval t I._ for multiple products usc product approval form
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Property Owner Information
Name .C_extrv 1../em.res Address _47C 141%44", L
AA
_________
City vl.irle.. z...... State Ft lip 322-31 Phone cf oy I-1 65 31C3
[-Mail G ea YR'at=i dvtae_..7f 3 0 OD,MA/I - C-OW1
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required) ________ _
Contractor Information
Name of Company S up...Icy- F.,,,„,.. ofw.1 R..// Qualifying Agent Z•rc4
Address c 4170 i 1.:9 ), AL,_ City 3-weies.o.,./1if.. State F./ Zip 31Z.S LI
Office Phone 4704 CV3 C3117 lob Site Contact Number 7O'1 3/4 3 5?2-5
State Certification/Registration# /Cs 3.57 E-Mail °lone c-CO ,Ce4le-1, ,.)cif 04 Sowie,Ve... Ce.-Ort
Architect Name&Phone# HA
Engineer's Name&Phone ll NA _
Workers Compensation insurer F„4,00r-ir ..,,,,4.44„,1 OR Exempt:,-] Expiration Date cor//51Z02.z_
AppLcation 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 standaras 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 7 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
REC• r •ING YOUR NO OF COMMENCEMENT.
.-- ...I
e
—. --- (SIgnature of Owner or Agent) (Signature of Contractor)
S:gried and sworn to(or affirmed)before me this -day of Signed and sworn tc(or affirmed)before m this 7 da v of
NNACIL,SLC.A ._, a-0›D by %eti 4,r‘ InfiE:Q:g.SA 4 c.v...4 , zozz_
* .IS I?)1.014LAIV‘ bit
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(Signature of Notary) f SIF,nat L re of Notary)
limilIwiloidandWoillwaraimilindir, iter"vm, Notary Pubic Stain al f borxta
tl-Personally Known OR 1 .:,•"-: -.\.i:f4,.,. ANGELA V.SCARBOROUGH Ilt<rs-onatly Known OR :r l'; Bream RA Norman
I J Produced Identification
Type of identification-ion! Notary Public-State of Florida I f I Produced Identificavon sk; ,di IP C°11/notrrn""i:"1346
,,±Wgi Commission#GG 27E185
pi Tvpe of Identlication . D'f' -"Parri
----i - !' ---rty-05mtn.Infirm mar 14,Pm 0 - • - • -
MAP SHOWING SURVEY OF
LOT 10, BLOCK 12, REPLAT OF PART OF ROYAL PALMS UNIT TWO A AS
RECORDED IN PLAT BOOK 31, PAGES 16, 16A, 16B, 16C AND 16D OF THE
CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
SA8A1_0 DRIVE_
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NOTES:
1. THIS IS A BOUNDARY SURVEY.
2. BEARINGS ARE BASED ON THE EAST UNE OF LOT 10,
BLOCK 12, BEING SOUTH 0716'02' EAST, AS PER PLAT.
3. BUILDING RESTRICTION LINES AS PER PLAT.
THIS SURVEY IS CERTIFIED TO:
LAWRENCE E. HAYDEN, JR. ESQ.; OLD REPUBLIC
NATIONAL TITLE INSURANCE COMPANY; JEFFREY
THE PROPERTY DESCRIBED HEREON LIES IN FLOOD ZONE COLE WOODS AND CAROLYN REUTER WOODS.
"X" (AREA OF MINIMAL FLOOD HAZARD) AS WELL AS CAN
BE DETERMINED FROM THE FLOOD INSURANCE RATE MAP
NUMBER 12031C0408J, REVISED NOVEMBER 02, 2018 FOR
DUVAL COUNTY, FLORIDA.
STEPHEN W. CREWS, P.S.M.
NOT VMD WITHOUT THE SIGNATURE AND THE oFll01NK FLORIDA UC. SURVEYOR and MAPPER Na LS 5996
SEAL OF A FLORIDA LICENSED SURVEYdt AND MAPPER.' FLORIDA UC. SURVEYING & MAPPING BUSINESS No. LB 3672
CHECKED BY: BOATWRIGHT LAND SURVEYORS, INC. DA E: 01, 2021
DRAWN BY: DAF
FILE: 2021-1434 1500 ROBERTS DRIVE, JACKSONVILLE BEACH, FLORIDA 241-8550 SHEET_1_OF 1