670 PLAZA RFNC22-0076 r, Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: Vlo /
PLAZAPermit Number. �NL 7
Legal Description,30-94/ 172 S•29e ItWALPALMSUNI?,2 Lai-el a i.-K g RE# 171 ZQ4 - 0006
Valuation of Work(Replacement Cost) $ 2yOa Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ElNew ElAddition ❑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 proiect? ❑Yes (must submit separate Tree Removal Permit) ❑No
Describe in detail the type of work to be performed: '-c f LA— G 'L O pc' Pe"- 'u JTH" 6 'v1,4-dYL FC^' e-
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name G-LE1✓i 1441 LC / Address (.)o ?L-AZ'1
City
1474A"'716 7 0,4c14 State c- Zip 3z 2.33 Phone
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company3t4cl4cSrE rDeee-o- Qualifying Agent .vim �vLO of 5—
Address TNI.{ M/ € 51 C`(f'j;5 5 DR, A) City Pcetvti✓,i..& ' State Zip 3Z 2-33
Office Phone q 7P Fl 7? ' Job Site Contact Number
State Certification/Registration# E-Mail 36.a Cf;t"3 F DP�G'A"L-
Architect Name& Phone#
Engineer's Name& Phone# j
Workers Compensation Insurer '4''"i sevST OR Exempt❑ Expiration Date 61�/23
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 I PROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINA CING, CONSU T ,.0/ H YOUR LENDER OR AN ATTORNEY BEFORE
RECORDI Y R NOTICE 0 •a i ME,k EMENT. 7
(Signature of Owner or Agent) (Signature of Contractor)
A .57.eve � rf'enc,� .
nejd and sworn to(or affirmed) before m this a•'1 day of Signed and sworn to(or affirmed) before mee this o�R day of
ZZ, by Q 1 C.Z74t'U `t �(.t 1_5 , v�, by ��I CJGA W 1.9 u 5�
tort Notary Public State of f i.irida „ + votary Public Sta a of
�p Jessica A Dolquist �p Jessica A Dolquist
•
H 142217
Commission H
My My Commissiv,.“1-1142217
�[ )Personally Known OR ' f Expires 0611412025 "ersonally Known OR E�cp Tres 21
iysl Produced Identification •roduced Identification 4 ",
` ..vee' s �+"'v
V
Type of Identification: V Type of Identification:
Fence Addendum Updated 1/14/2021
j1
• iCity of Atlantic Beach Building Department
�,JV 800 Seminole Road, Atlantic Beach, FL 32233 PERMIT#
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: Date: /
Q .cetiJ 7 /ZGiI2 2_
Property Type: Lot Type/ Features:
1Residential VOne 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):
ood 21/*Four Foot(4ft)
❑ Chain Link /Six Foot(6ft)
❑ Vinyl 0 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)
/-No
Will tree(s) be removed in association with proposed project?
❑ Yes(must submit separate Tree Removal Permit)
) 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.
1t
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