444 AQUATIC DR RESO2-0010 .... _ 1
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,, r-A:'` ,- Building Permit Application Updated 10/9/18
._. ,...=;6.,„.!,44:a1) City of Atlantic Beach Building Department **ALL INFORMATION .
, !WA" 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904 247-5826 Email: Building-Dept(�coab.US IS REQUIRED.
Job Address r�, 9,1 - -. Permit Number: \--\ , c �_,CC)i
Legal Description i - -Z - E ` , - _ (� RE# 1 U/ `-5f (v
Valuation of Work(Replacement Cost)$ 335-0 Heated/Cooled SF Non-Heated/Cooled___
• Class of Work: ❑New 4ddition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial 1sidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes ❑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:
e X'-elnd gC4-1*-- (2,7\Alfb 1 (P•C‘541-`)Ck ' re e4 .
Florida Product Approval# for multiple products use product approval form
Property Owner
Information
Name11,ii.j., y— � 'Address (I-1 I.J Cr ✓1 �-- - `
City ,,( 4rt_ _
State r L Zip: 3-zZ3 3 _Phon /VII Z3 3 3Si`7
E-Mail
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information
1CIe ( Quali$416___13eigit,
' Agent )' - -
NameofCompany
Address_j_ and 'City. :State 'FL Zip -3ZZ37
Office Phone �) 37t- 11 Job Site Contact Number ,L �--
State Certification/Registration#>-••` ;`f-NPT) Y: 'E-Mail � t, ,'r)( • co--)--,
Architect Name&Phone#
Engineer's Name&Phone# •
Workers Compensation Insurer> I r i T l H .I-j7,4 e-_ OR Exempt❑ Expiration Date .q/?6,/7,-z_
Application is hereby made to obtain a permit to do tale 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
RECORDING YOUR OTICE OF COMMENCEMENT.
(Signature of Owner or Agent) cc�� (Signature of Contractor)
Signed and sworn to(or affirmed)before me this d-� day of 'Wed and wornito(or affi , before me this 7 day of
OaYC� , �o8 - ,by T - , roc' eo()!� OZ• by AL.( :. • �.
S , �� ��
} re of Not ISSALORDA j ,�.e00—.
, . �t MY COMMISSION#GG 228145
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.�`. EXPIRES:June 12,2022
O P rsonally Known OR :fok;i o°r ) ersonally Known 0'
Bonded Thru NotaryPublic Undankrll"le
roduced Identifica ion- F.. roduced Identificati ,:,qi. , ,, TONI GINDLESPERGER
Type of Identification: V(IVef'S (CUTS -L Type of Identification: ir'?•' :,';°": .. -. .. __ ., . -
te: 'ia(r. :*:
' '%...4* EXPIRES:October 6,2023
''Fps "c' Bonded Thru Notary Public Underwriters
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BOUNDARY SURVEY
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e o No e"Te e f SURVEYORS CERTIFICATE �Y
MERESY CERTIFY NAT THIS BOJIDARY SURVEY .
SATRUEPhD,REDU'I REPREIRECTT UI Of b ' SURVEYING
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SURVEY PREPARED LOOS MY CI RECTI Rl I.
�• NOT VA'JDWITHOUT ANAUTHENTICATED ELECTRONIC ,.}•
STATE OF • SIGNATURE ANO AUTHENTICATED ELECTRONIC SEAL 4.....----
• L B 7 B93
•-o• 4i c A, e' o ORARAISED EMBOSSED SEAL AND SIGNATURE SERVING FLORIDA
", '""`t�o Digitally signed by
.�/ Kenneth I 6250 N.MIUTARYTRAP, SUITE 102
/' Kenneth J.Osborne WEST PALM BEACH,FL 33407
Date;2017.11.27 PHCPIE (551)6+0-4800
ISIVNEDJ -- - - - -- Osborne 16'.57:73-05'00' STATEWIDE PHCNE (800)2264807
KENNETH J OSB NE pp 1` (��IL' pp ( CC STATEWIDE FACSIINILE (BOO)741.0576
MOFESLONAL SURVEYOR AND WAPPER CL.•7 �J(C LT r1:Mi 11 0-}'I � [Ir
WEBSITE: nttpGlargelturveytngnal
� CITY OF ATLANTIC BEACH
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: : • r 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
(904) 247-5800
SURVEY AGREEMENT
NOTICE
All new projects creating more than 250 Square Feet of impervious surface or requiring on-site storm water
retention, including swimming pools, will require pre-construction and post-construction topographic surveys,
as required by COAB, Section 24-66 and described in Bulletin 2-18, Surveys. The surveys must be new
original documents, from a licensed surveyor, signed, sealed, and dated.
Other small projects, such as fences and construction less than 250 SF, will not require a new topographical
survey, but a current original-size survey with all relevant details is still needed. These surveys, when included
as part of a building permit application, must be complete, up-to-date, and original size and scale, as produced
by the surveyor.
Copies of old surveys lacking details or copies not of original size cannot be accepted. Building permit
applications with unacceptable surveys cannot be reviewed and the application will be returned to the
applicant.
Thank you for your cooperation in this matter.
AGREEMENT
I have read and understand the Notice above and affirm that the outdated survey I am
submitting is still accurate and complete, and all structures and impervious surfaces on the
property are shown on the survey.
I further understand that, if the survey is found to be inaccurate or incomplete, a $50.00 Plan
Resubmittal Fee will be charged; or if the permit has been issued, a Stop Work Order will be
posted with the associated $110.00 Fee.
JOB ADDRESS 9 LI IVR- Voikrg
OWNER or CONTRACTOR 'rint) �(�(ti l l rYM
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Signature _ Date 3/30/ ZZ
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