647 SELVA LAKES CIRCLE RESO22-0035 TURF '�cB•� Building Permit Application
rUpdated 10/9/18
City of Atlantic Beach Building Department •'ALL INFORMATION
\uFrr 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: 647 SFLVA LAKFS CIRCI E Permit Number: 1 C .... C Z Z.,— QO
Legal Description LOT 154,SELVA LAKES,UNIT 3 RE#
Valuation of Work(Replacement Cost)$3500.00 Heated/Cooled SF NIA Non-Heated/Cooled NIA
• Class of Work: ❑New ❑Addition rI1Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial f?JResidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes I-dNo
• Will tree(s)be removed in association with proposed project?❑Yes(must submit separate Tree Removal Permit) VINO
Describe in detail the type of work to be performed:
500 SQ FT ARTIFICIAL TURF INSTALLATION OF PET TURF. PET TURF IS ALREADY APPROVED BY COA
Florida Product Approval#NO PRODUCT CODE FOR ARTIFICIAL TURF AT THE STATE for multiple products use product approval form
Property Owner Information
Name JONATHAN TORRES Address 647 SELVA LAKES CIRCLE
City ATLANTIC BEACH State FL Zip 32233 Phone 518-368-0090
E-Mail lonathan.richard.torres@gmail.com
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required) JONATHAN TORRES
Contractor Information
Name of Company SOUTHERN TURF Qualifying Agent TODD KROHN
Address 102 PINE STREET City NEPTUNE BEACH State FL Zip 32266
Office Phone 904-386-4747 Job Site Contact Number 904-386-4747
State Certification/Registration# NOT REQUIRED E-mail todd@southernturf.org
Architect Name&Phone# N/A
Engineer's Name&Phone# N/A
Workers Compensation Insurer BERKSHIRE-HATHAWAY INSURANCE OR Exempt o Expiration Date 5-23-2022
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 ANCING, CONSULT WITH YOUR LENDER 0 ATTOMEY BEFORE
RECORDI • a UR NO E OF COMMENCEMENT.
AW l I \.,/
gnature of Owner or Agent) (Signature of Contractor)
Signed .•,• to or affirmed)before me this )° d y of Sj ned and sworn to(or affirmed)before me this Zday of
'i1'e 7'� by Crlk-4 .p. ' �5 f e .� 2 Q? by ltce A f J7i7
,h.i,a. iii.iikuiLLZ.. .
r I ;`i�`Y` c ZACHARY KAHALY
♦ ♦'+. MICHAEL VENTOURAS ;n/,�6''', P
; ,, „„,\7,...: Notary Public-State of Florida 0
Notary Public•State of Florida , 4:
Personally Know . F 'r Commission p HH 151037 sonally Known OR �.. Commission a GG 424046
°v°`' Produced Identification 0v,... My Comm.:xpires Oct 20,2023 1
[ ]Produced Identifi etioh- My Comm.Expires Jui 8,2025 [ ]
Sanded through Natior,ei 4ctary Assn. p
Type of Identificatio Type of Identification: _ ..
AOL Mail 6/22/22 10:23 AM
Torres survey contractcl @aol..../Inbox
Todd Krohn<todd@southernturf.org> Jun 22 at 10:16 AM
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To:contractcl@aol.com,todd@southernturtorg
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