592 CRUISER LN RFNC22-0098 '''''-;"/-/, Building Permit Application Updated 10/9/18
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r h I City of Atlantic Beach Building Department **ALL INFORMATION
l) / 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: 50 Z L-24U15` e- LA-/ Permit Number: R N C-2a- o 9 scj
Legal Description 3T1 /7-25.-c2y6 5- 1);"4(Z., r aj isZ.4RE# j 7 V 7U.3 - 03 Z r
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Valuation of Work(Replacement Cost) $
r6�l, / Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ((New EAddition EAlteration ❑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 121Qo
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) .0-No
Describe in detail thte type of work to be performed:•yi-,0-z,&-C-9-2..9 'r A_ /,,Ucr - -- 7u,&--.4„
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name \J LSML Iv -Lt% 1 ' Address ,�Z C i_.' 'S 2 L "-
City )9'I L "Ji cE- f- C, - State L Zip _Z'a Z ;.:3 Phone 8-4-(7 e-,/0 7 S—
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company 4(4( S --/ircc4CLKll-PcQ6,,,1_..4 Qualifying Agent J 0 ti -DG2z LC t.,1 S
Address �r-fti-ftVV1,44 '�•_ 'zc 5
c� C�/ S Ci) e City J A)C State r-t Zip 3'2 Z33
Office Phone t-72-/ 74)5c -7 71,_<-- Job Site Contact Number
State Certification/Registration# E-Mail ACHe.> PC d/4,6,4/ z • << •-i
Architect Name& Phone#
Engineer's Name& Phone#
Workers Compensation Insurer /i_ 7-7--,7? f%s'7 OR Exempt❑ Expiration Date ?/.t /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 IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTI • • ►i MENCEMENT. 7
(Signature of Owner or Agent) (Signatur- of Contractor)
Signed and sworn to(or affir 1-•) before me this (p day of Signed and sworn to(or affirmed) before me this (P day of
COotxr , ?Ootid ess,' • 4 t 00bpr , a6 da , e . A • ,
Si:nature of Not! )
/ • ' Notary Public State of Florida
.eflifoN Notary Public State of Florida Jessica A Dolquist
Jessica A Dolquist My Commission HH 142217
[ ]Personally Known OR t j My Commission HH 142217 pQ Personally Known OR 6,1 Expires 08/14/2025
d� Expires 08/1412025
Produced Identificatign b►a [ ] Produced Identification
Type of Identification: f-.1 . • . Type of Identification:
f- Fence Addendum Updated1/14/2021
City of Atlantic Beach Building Department
800 Seminole Road, Atlantic Beach, FL 32233 PERMIT #
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: Date:
JAZ. Cv/ � �— //6�ZZ_
Property Type: Lot Type/ Features:
Residential ZrOne 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 E Four Foot (4ft)
❑ Chain Link �ix Foot (6ft)
❑ Vinyl ❑ 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)
VN o
Will tree(s) be removed in association with proposed project?
❑ Yes (must submit separate Tree Removal Permit)
L 'No
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.
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MAP SHOWING' BOUNDARY SURVEY OF
LOT 28, BLOCK 2, SEASPRAY AS RECORDED IN PLAT BOOK 35, PACES 64 & 64A,
OF TIE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
CERTIFIED TO;
SCOTT F. GRIFFIN AND CHRISTOPHER T. GRIFFIN
DANK OF AMERICA, N,A, f.OLD REPUBLIC NATIONAL TITLE INSURANCE COMPANY
ICHARD T. MOREHEAD TITLE & ESCROW. INC. 9
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