583 ROYAL PALMS DR RFNC22-0097 Building Permit Application Updated 10/9/18
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City of Atlantic Beach Building Department **ALL INFORMATION
A, ,;,,' 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
'�s_� IS REQUIRED.
Phone: (904)1247-5826 Email: Building-Dept@coab.us 2
Job Address: -JgJ +`,�,7'41- PA�-�, VP.- Permit Number: ` `ENC.. LZ.- 6C]ci7
Legal Description 30-/,-/ !7S' t IWAtP,vo L'# 12 Coy iz /3c.K f RE# 17/Zg� - 0o.,�)
Valuation of Work(Replacement Cost)$ (44 NJb Heated/Cooled SF Non-Heated/Cooled
• Class of Work: rlew ❑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 ENO
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) into
Describe in detail the type of work to be performed: Uf^B�Ti OZ. L( 1.4/ PC" ` 2,,P'-AcC,V-z,, b ,,, t
'TAC.`
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name 6' -44-4.-44tesi - Address r?(3 tJ ---- I,'Lt{''"' () g.
City 6,4A7-04-/r- (C- C;e4 r-1--- State ►_c_ Zip ?2 Z-3 3 Phone
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company 5 AC:I4r-5 FI"c pc ie I-' 4O_4 Qualifying Agent J0^) ' z-a 'y-T—
Address gS`(N N'I.rbch IC, C`(PQt:. 1!y City 3.4/ State JL Zip 3z Z 3"z>
Office Phone 9G-el 7 --7 5-'5--- Job Site Contact Number
State Certification/Registration# E-Mail TEf4C(4"
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer Aire..)5'7"-- OR Exempt o Expiration Date C31,(/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 TW E FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN`FIN ' CI: , " SULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORD! !t?0T E OF COMMENCEMENT.Ilit _......----." 42 '‘AVI ‘
(S:natu - of Owner or Agent) (Signature of Contractor)
Signed and sworn to(or affirmed)before me this Le day of Signed and sworn to(or affirmed)before me this io day of
t)ekbrr , at a a ,by l'— i 6. / ,u s t lk.-1-6 her , a0 ,b .c4t�57 -
(Signature of Notak)
It Notary Public State of Florida
Jessica A issionDolquist ,�1ar^ri Public State of Florida
Commission HH 142217 r 't Jessica A[ ]Personally Known . ' s 09!14!2025 rid Personally Known OR • My CommissionHH142217
N Produced Identific ion n'^ [ 1 Produced Identification ‘ties Expfres09h4/2025
•
Type of Identification: Type of Identification: _ ,. . . . „ _ _ - _ _
(-"---Lii- Fence Addendum Updated 1/14/2021
em
s City of Atlantic Beach Building Department
Vi ,, `~ 800 Seminole Road, Atlantic Beach, FL 32233 PERMIT #
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: Date:
Property Type: Lot Type/ Features:
(d"Residential ❑ One 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):
Wood .0.Four Foot (4ft)
❑ Chain Link �ix Foot (6ft)
❑ Vinyl ❑ Other
E Block/Stone (Plan details required for footings and/or
retaining walls)
O 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?
O Yes (must submit separate Revocable Encroachment Agreement)
2"N o
Will tree(s) be removed in association with proposed project?
O Yes (must submit separate Tree Removal Permit)
1No
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.
r
MAP SHOWING SURVEY OF
LOT 12, BLOCK 8, OPAL PALM UNIT NO. 2, A8 RECORDED IA PLAT BOOK 30, PAOFB 94 4 94A, 0I
CURRENT THE CENT PULL RECORDS OF DUVAL COUNTY, FLORIDA.
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APPROVED
C TY OF ATI ANTIC REACH
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I HEREBY CERTIFY THAT I HAVE SURVEYED THE LANDS AR SHOWN IN THE ABOVE CAPTION
AND THERE ARE MI EINCROACHMENT$. AS syow/'• H. A. DURDEN & ASSOCIATES,
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JACKSONVILLE BEACH FLA. 1
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