1251 SELVA MARINA CIR RESO22-0020 -may, Building Permit Application Updated 10/9/18
£ City of Atlantic Beach Building Department **ALL INFORMATION
VtIP 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: 12 SI Se-\J a mmri , C Permit Number: R E SOZZ- 00 20
Legal Description "70-11.2 1(0 2'T E O v-cLi ck 9I -c-e Got .2 RE# 9 51 Q
Valuation of Work(Replacement Cost)$ *23,660,00 Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ONew ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial ❑Residential
• 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) Ohio
Describe in detail the type of work to be performed: 61--141 % Z c c-\ Ti. r j CL 1 (C�'r t L-3Artificial Turf installation, back yard P �t L works
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name T O ur-14-4r�r-y F"TJ V C Address / 5G.A1/4, n.6,Or C-.1-
1 r Com(f
City A State P J Zip 3 22 �j 3 Phone
E-Mail 1-5 6V-kc'+`, c4 5 e -tem‘. C-0 0'1-,
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company Florida Turf Company Qualifying Agent Alexander Ertel
Address 1985 Mayport Road City Atlantic BeachState FL Zip 32233
Office Phone 904 758-TURF Job Site Contact Number
State Certification/Registration# n/a E-Mail alex@floridaturfcompany.com
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer AmTrust North America OR Exempt❑ Expiration Date 7/18/22
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 A ATTORNEY BEFORE
RECORDING YOUR NOTICE OF(COMMENCEMENT. 0
t
(Signature of Owner or Agent) (Signature of Contractor)
Signed and sworn to(or affir -d b,'ore me this day of Signed and sworn to(or affirmed)before me this 18 day of
✓�► _/ w _ April 2022 by
• Colette Poe
+,ryr^u'•` COL TJ POORE : d ^
Nota .1• s.4 #k ••1' •to (Signature of to
Commission*b�- • •: ry) ( g ry)
Corti/' My Comm.Expires Nov 12,2024
Bonded through National Notary Assn.
I I p: - j. Personally Known OR '4•4',T
—— — —
,�•produced Identification -1-He _ q U ( )Produced Identification 'ie� ('.. COLETTE J POORE
Type of Identification: I- 1 (1 - `' ' ' Type of Identification: a ``: Notary Public•State of fl•nda
Commission N HH 056361 My Comm.Expkes Nov 12,2024
5or.ced through National Notary Assn.