44 5th St RFNC22-0039 --,:,,,,,' . Building Permit Application ;;;,_...,
City of Atlantic Beach Building Department ..ALL INFORMATION
- 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@coab.us � IS REQUIRED_
lob Address: ' i` Li 541 $+ Permit Number..( `r c N CZ Z- OC)3 9
Legal Description 01 OC..),_ SIt,"I.. 4inrnlyT ROI I7C.1Go -cvoa.--___.
Valuation of Work(Replacement Cost)$ 15 Cie) Heated/Cooled SF Non-Heated/Cooled ___
• Class of Work: DNew CAddition DAlteration ldepair OMove DDemo DPool QWindow/Doer
• Use of existing/proposed structure(sj: DCommercial Residential
• If an existing structure,is a fire sprinkler system installed?: DYes HNo
• Will trees)be removed in association with proposed project?i 7Yes(must submit separate Tree Removal Permit) 94o
Describe in detail the type of work to be performed
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Florida Product Approval n for multiple products use product approval form
Property Owner Information
Name ,5tila__.AKAY. ILt II Address 99 54 S+
- ---------
City A.+1 :c a....), State 1'1 Zip 31-233 Phone 70`I 510 C W4
E-Mail s hiss OTS e wia:I.cwv,
Owner or Agent Of Agent,Power of Attorney or Agency Letter Required)
Contractor Information /�
Name of Company�uPcir;c- F a...•.f R-%I Qualifying Agent 2....04 /9,..4...,
Address St'170 Fl;gls,. 4 Ate., City _5-K.. s !11e State FI Zip 3ZZSr-I _
Office Phone rl'O1 j r~Si 6349 lob Site Contact Number gat( 3)Z 3525
State Certification/Registration tf /!S 85 .1 E-Mail C3t•ere-0 ‘emcyrs i cL,cowcs►,
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Architect Name&Phone k Al A Jv ci
Engineer's Name&Phone N Al A
Workers Compensation Insurer L.1 Le..-+y Me ewe I OR Exempt cl Expiration Date 1' IZ/I 5/11-
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 Fl . ING, CONS T WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING Y• ly CE O.�OM ENCEMENT.L I0 AF !'.%'✓lam'
(Si, t we of Owner.r Agent) //G _
�i (Signature of Contractor)
Si•ned and sw•• , for affirmed]before me this a day of Signed and sworn to(or affirmed)befo e r e this 7 day of
r ink /.0 ZOrA,
Al),`C. E'1 uv-,C1-1 f)C, Air;I , W7.1 .by__�f� ' — a.'
X/
tgnat::r. f Notary) (5i.^_:1.:;.re of Notary,
y CHRISTIANA V O'CONNOR va,=otary e„ Stain d Florey
kiPersonalty Known OR kv -' Notary Public.State of Flontla -iNe aIfy Known OR Brian M Norman
f j Produced identificatrc '" , t, Commission#HH 225946 "I Produced Identification 3Nv�esObr C«mrsswnt6>M2a n.,°1134-
,rw, �
Type of identification: My Comm.expires Feb.7,2026 Nye of identification: -
a' =_
C \Fence Addendum Updated1/14/2021
City of Atlantic Beach Building Department
// 800 Seminole Road, Atlantic Beach, FL 32233
- ;0. PERMIT#
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: 74Date:
34''t 3' S i-(--/L LL
Pr,perty Type: Lot Type/ Features:
Ll 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):
UVNood Lit'Four Foot (4ft)
❑ Chain Link ❑ Six Foot (6ft)
❑ Vinyl ❑ 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)
liNo
Will tree(s) be removed in association with proposed project?
❑ Yes (must submit separate Tree Removal Permit)
EIN o
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.
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