699 SEASPRAY RESO22-0051 ,: ::.' -'"i%,,,,. Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department **ALL INFORMATION
.:_ t 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us/
Job Address: W r9Permit Number: RE-SC)Z Z
Legal Description 30-qH n-14-/Ae (f1 1'O!r+4 I. U .10 8/k 1 RE# �1 lin-mo0
Valuation of Work(Replacement Cost)$ /5-5-O Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition Ateration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial 7fResidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes ❑No
• Will tree(s)be removed in association with proposed prosect? ❑Yes(must submit separate Tree Removal Permit) _lo
Describe in detail the type of work to be performed:
9`/TATA i IN / OQ01/A I 1 (246. t i/c e c -►ter l &rl i Pao 'a
Florida Product Approval# for multiple products use product approval form
Prosert Owner Information / �j
Name Oro hAddress (p 4J 1 yr-,,,A
City State FL Zip 371-33 Phone
E-Mail _
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) /
Contractor Information ' &D'/1/� ,J/y-•L Qualifying Agent I�Gt/1� �v °'"�/
Name of Company
Address IRA.0 /f'�p,Var."t- i / City ii 6 State FL Zip 3u133
Office Phone foy 1117111 Job Site Contact Number }4-r(,L • f04 3.1 /Oo
State Certification/Registration# E-Mail tad 2 gefiLlVA 6 . 60./1^%
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer —n✓S /' OR Exempt 0 Expiration Date f/3D�Z.
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 AN ATTORNEY BEFORE
RECORDING YOUR NOT C O COMMENCEMENT. :----
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(Signature of O ner or Agent) /M ' (Signature of Contractor)
ned and sworn to(or affir .ed)be ore me this/L./day of iSig ed and sworn„to(or a irm-d)be : me this 5" day of
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r;----'-"---..,,,••„' • ESPERGER ' ( nate ' ot.y� :nae,l�•, •sr+aJ
{,'2..'•.V.'',:%. MY COMMISSION#GG 3531 • - '
FX?IR.ES:October 6,2023
f ] Personally Knowduidttdeivir'ters [ rrersonally Known } ,,''''' TONI GINDLESPERGER r
14]Produced • a"ion [ )Produced Identificat off'buy '.'' MY COMMISSION#GG 353178
Type of Identification: ( Type of Identification: t.:+ ;ES:October 6,2023
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CITY OF ATLANTIC BEACH
c3i 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
(904) 247-5800
SURVEY AGREEMENT
NOTICE
All new projects creating more than 250 Square Feet of impervious surface or requiring on-site storm water
retention, including swimming pools, will require pre-construction and post-construction topographic surveys,
as required by COAB, Section 24-66 and described in Bulletin 2-18, Surveys. The surveys must be new
original documents, from a licensed surveyor, signed, sealed, and dated.
Other small projects, such as fences and construction less than 250 SF, will not require a new topographical
survey, but a current original-size survey with all relevant details is still needed. These surveys, when included
as part of a building permit application, must be complete, up-to-date, and original size and scale, as produced
by the surveyor.
Copies of old surveys lacking details or copies not of original size cannot be accepted. Building permit
applications with unacceptable surveys cannot be reviewed and the application will be returned to the
applicant.
Thank you for your cooperation in this matter.
AGREEMENT
I have read and understand the Notice above and affirm that the outdated survey I am
submitting is still accurate and complete, and all structures and impervious surfaces on the
property are shown on the survey.
I further understand that, if the survey is found to be inaccurate or incomplete, a $50.00 Plan
Resubmittal Fee will be charged; or if the permit has been issued, a Stop Work Order will be
posted with the associated $110.00 Fee.
JOB ADDRESS C ,l.s (7/5-de
OWNER or CONTRACTOR (Print)
Signature `. " Date
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