44 5th St REFN22-0099 � .. Building Permit Application Updated 10/9/18
$:N� City of Atlantic Beach Building Department **ALL INFORMATION
` ' 800 Seminole Road, Atlantic Beach, FL 32233
HIGHLIGHTED IN GRAY
or
IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: y1"� 3+t, S4- A+l.tl•rc 13,4cA F! 32233 Permit Number:F k eZ z -o _ 5'9
Legal Description 0100 SiN ti -,r„)y RE# 1701 CG -0000
Valuation of Work(Replacement Cost)$ S000 Heated/Cooled SF Non-Heated/Cooled
• Class of Work: DNew DAddition DAlteration Repair
er�❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): DCommercial /Residential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes (�No
• Will tree s be removed in association with •ro•osed .ro ect? Oyes must submit se.arate Tree Removal Permit No
Describe in detail the type of work to be performed:
RrIc;," cx.;st.; L 'N u ;� Sanw iCX.P,+:c„ cJ lotycwl-
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name .544. AKl N• .it Address 9'i Sst, Sf
City A}j4.,t•'t (AA State H Zip 312.33 Phone 104 510 c00-{
E-Mail 13e-}Sy ro5s grhat;l _carr•
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information ,p
Name of Company S`iPON; po
w• or", Rot,,/ Qualifying Agent
Address 5470 N;9J,✓•,y ,Qw City J,cGscw:HZ State F! Zip 31131'1
Office Phone /out G83 G341 Job Site Contact Number
State Certification/Registration# /63$51 E-Mail 0-440.c. Q•CCevis.;A)4c,l,scmvlitc, a cow)
Architect Name& Phone#
Engineer's Name&Phone#
Workers Compensation Insurer L;1,cvey A.440.4� _OR Exempt 0 Expiration Date 17.1i 5/2Z
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 NO I E OF COMIENCEMENT.
c- 0
(Signature of Owner or Agent) :gnature of Contractor)
�ed a sworn to(or affirmed)before me this I ( day of Signed and sworn to(or affirmed)before me this S day of
7.bY A zcnz , ,4/ B i f -
_ I . - j
SPRYP�-" ,tl GINDLESPE- - .�i�,� skinIf iT#�V�
�'gnatur No : y) (Signature of Notar
: MY COMMISS10 #GG
EXPIRES:0L.•• - • •+
�,or Notary Public State of Ronda
I__` ;;,;`'' Eonded Tlru f otary Public Undel 0.4111w
Personally Known OR Britani M Norman
[ ]Produced Identification [ ]Produced Identification +� Ex Commission 06/1 ron 24 011346
\ moi•,�� Expires 06t18120�4
Type of Identification: J r ___ Type of Identification: _ _ _ -
(•=7:,;-Z,,;21-,', ---,-/j :• ::,..i1;7 e?1C2A c• -14-.7-77 agr--7
I L121 ' 1,1 1-rot tri
______________.7°c_ j-7\7 4 1-( 516." )c " c-7'zil' H`1-A4 1--4 -' rl'u-''''''' 'Av7 NNIY•xl
- NVic), _'Llc
1 ,
...if ,
rik
7 1 .
--- -at--fri ..1.42,,io-ki -
- _ .*--
1 ‘ t - -
, 20,_ -, Lc) •Q•0 7 - (
I42 oCYZ .---
, i -r-:,•• !,,,
, cs.
j
; I F
Iii
-,---
.
. T-1
r--M—: 7,•,
•
I
---Z I 7-1 . 7- tf0111605'` tY1Q1-1
_g_
i v 0 ' •H T' --ra. 1 . 1-1
.' - _ _______
_ •),- 1CP 2kii-]J-il ,i/ _:. ' 11v1-01 .-,71-;;Q . h
-- -- ,
, . . -.--(1 --f• )-210.i.e: ! . 1:31-1r-7-/ ,; i
r I
II, t ,P)riti_e-71 /
!
1111177
i I ).._ ....
vaziy eAttl._ •
1_________4 .
. '
. , : LZ -,yrvt,f rfr=it-i ! z
-0--' 7VZY Ni
' , .
, I • , , -i • s-
, ) 1_-_.___ - . i
IC
N '-J.:-:' —--+ _ _ _ __. ___ _sii_ _1____11, ____._ _
. i
I
1 ! r'1'5,1-°• cilc.., :
).4,21144,,ziel ___._ _._.____4, ,'_./..0.011, -17,,KM171 -S-,"•
__:__U.-
IQ"2./--17
— - -- i.1*--2------- )47hel
it,_
,
1,, ,,,, _ :ANz10 tvfg-4
i
),Ao-1- - ..j ,._
Fence Addendum Updated 1/14/2021
e-- _ 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:
L/L/ '7 (-1 .S7 ) o -if- L/
Property Type: Lot Type/ Features:
esidential ❑ One Street frontage (interior lot)
E Commercial 11/6-Pre than one street frontage (corner lot, through lot,
etc.)
❑ Swimming Pool
Fence Material: Fence�� Height (select all that apply):
9 Wood E 'Four Foot (4ft)
❑ Chain Link ❑ Six 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)
RIo
Will tree(s) be removed in association with proposed project?
❑ Yep (must submit separate Tree Removal Permit)
[YiV/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.