645 OCEAN BLVD RESO22-0050 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
Abp'; y IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coah.us
u � -c CO
Job Address: / �0(.00 �� aC- Permit Number: ' � —00 V
Ytegal Description P/IFV C. .,0/1,9C./Cc"'ti/VP ie /y7TZArsay4/,/, *El./
/7O)Z&:"7.000_
Valuation of Work(Replacement Cost)$ /''Dc)v _Heated/Cooled SF [ Non-Heated/Cooled
• Class of Work: ❑New ❑Addition DAlteration ❑Repair ❑Move ❑Demo ❑Pool OWindow/Door
• Use of existing/proposed structure(s): ❑Commercial /d'Residential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes gNo
• Will tree(s)be removed in association with proposed project?❑Yes(must submit separate Tree Removal Permit) DIo
Describe in detail the type of work to be performed: ff
N37/;it,(.r}tl`an) of Lrr(f4t l!>/LY Azro POOL AzIAL-
lorida Product Approval# for multiple products use product approval form
Property Owner Information
Name �'' S09i-/ rrp/, Address 64/5- 6-41,)
City /SrTz-4"-4- e 6E99e44 State )C Zip 3-2.2 33 Phone ?:0y•- 7-6132-
E-Mail -5-17^ 7 ) mzi GI,JY) \ _ I
Owner orA-07-17)tAgent.Power of Attorney or Agency Letter Required) J -L D r « LE yVlCY)
Contractor Information
Name of Company TLA f/UCVNIf ,i 'Z D. Qualifying Agent
Address lJ/j d#JZ,lr}r. -f j ✓Q c- /7/ City fre...J, 1 C,'6 1 State �K. Zip 'ZZ 3 3
Office Phone ,!59-?97- 9/2/ Job Site Contact Number
State Certification/Registration# E-Mail P /%f. JL4'1A)202:7 Fr--4,g , . G 9y1
Architect Name&Phone# _
Engineer's Name&Phone#
Workers Compensation Insurer /4rnQST Nekry A, 04-724 .4- OR Exempt r- Expiration Date 'D- _
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 a'!
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 NOTICE OF COMMENCEMENT.
(Signal -d7 I twner or Agent) - (Signature of Con ractor)
Signed c -/sswor ' (''or affirmed)before me this 5 day of Siigned and sworn to(or affirmed)before me this-day of
b, '�M►ti E) .h1> a v✓Si if , 2tA], ,by ..5,q e///st
QN MAYO ( 0`1...k UEL-MASON MAYO
� 'NiftyPtitrlft•State of Florida '
►�, � Notary Public c-State 7 Florida
@` Commission k HH 279623 - '> o, Commission.#HH 279623
Personally
y n My Comm.Expires Jun 12,2026 IOr!` MY Comm.Expires Jun 22,2026
�
Personall r Bonded through National Notary Assn. ersonally Known OR , Bonded through National Notary Assn. 0
(
O Produced io' ( )Produced Identification
Type of Identify. Type of Identification:
MAP SHOWING BOUNDARY SURVEY OF
HIE MST 1/2 OF LOT 4, DANIEL AND 1-4ACKETTS REPLAY OF BLOCK 16, ATLAtd11C BEACH, A
CCORTO THE PLAT
THEREOF AS RECORDED IN PLAT BOOK 9, PAGE 35 OF THE CURRENT PUBLIC RECORDS ODUVALOING COUNTY, FLORIDA.
SEVENTH (40' R/W) STREET
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4- 70ii 17 :ego
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O WEST 1/2 OF a' . e
• ' ! STORY 1110001.1100616 LO
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p-i - _} DEED 80.83'
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< —_ 0 * 4, -4A .Ise COMPUTED 80.81' m
X • T `EED�8483" •.. .1 1' 80.85' rwo1 u.
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2 LOT 1
LOT 2
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NOTES. SIXTH (40' R/W) STREET
1. ANGLES ESTABLISHED IN RIF FIE O. 0ISC�t
2. FIELDip>]itl( 01/19/2017. 6 ..,._ __•
• • .; S
BENCH MARK INFORAIA110N; 0 10 >0 i�►� al
STATION IS A STANDARD CORPS OF ENOINNERS BROKE DIV STAFFED,
PL-11A-1, SET IN 1960, RECORDED ELEVATION IS 11516! NOVD 1920 (N FEET)
CONVERSIDON 10 NAN) SS 10TH THE VERTOON METHOD OWES AN I
B VQA116. 91.'5.73', Allo ELEVATION'S THUS SHWA ONTHIS NAP ARE IN 6R E sO Z z- C)C1 > 20 ft... _.. -_._.._ .. 8001( 02/17
NTHO � A � 01KEIT, 5338 SHANNON AVENUEIntiOOLR
JACKSONVILLE. FLORIDA 32254x
PHONE •(B04)-22B-8086 •--.
—WOO FENCE
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