360 3rd St RESO22-0067 mmemplom
„.-'1 "-',... Building Permit Application Updaredl0/9/18
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City of Atlantic Beach Building Department "ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
�c)s,}r Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED,
Job Address:_ 36,D_._ c'Fr- ,_ r r Permit Number.Lk ,(/ REso ZZ- C�oCo7
Legal Description 4 11)144)/�i 1/ to /9-6 ` z v RE#
Valuation of Work(Replacement Cost)$ j /i90 Heated/Cooled SF Aitt Non-Heated/Cooled f-',/,'
• Class of Work: ANew DAddition DAlteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial Qftesidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes JNo
• Will[reels)be removed in association with proposed project?❑Yes(must submit separate Tree Removal Permit)/No
Describe in detail the type of work to be performed: 14/rexv /y/�P�Ibte2A-4,4,F
/-Rr/A,(ice I 2/ /10,C5 a- /f- S7:4744,GSe..Pe/ iA /AiiS
Florida Product Approval# A/D s/—..re .P/0 de.c/ (0(h, for multiple products use product approval form
Property Owner Information
Name .4f-R/C+E' e4 j,)//.// Address 3620 3/d St'
City At'2'- /5G/I State f—/ Zip ___4-4.-Z.215 Phone 90 Q.3/ 722'7
E-Mail S O/ v'07 'AI)/ . / *Al
Owner or Agent(7f Agent,Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company S()G,A-C✓rI -AL2Y Qualifying Agent iU /)
City E/-'n& . State F/ Zip 3,Z Z. C.
Address /U7 Pm.i- 5-1.-- A/ ��
Office Phone d QV-386 `VY /7 Job Site Contact Number !: 7,-V,'`(
State Certification/Registration# E-Mail ?'Dili), �'-�r�f.4".'/27'2'LL- 6 v q
Architect Name&Phone U `_f/x4
Engineer's Name&Phone# ^//gy —/ G 3
Workers Compensation Insurer ,p/�)/Stn'/< OR Exempt❑ Expiration Date -5
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 ANS;' ORNEY : FORE
RECORD G YOU:• NOTIC 0/ •MMENCEMENT.
.ii "` Av' (Signatur .f Contractor)
Signature . Owner;r Agent)Signed and sworn to(or affirme f
I -i dayof Signed and sworn to(or affirmed)before me this day of
� 1 , ..i '- • r�\)before me this' ' h Ccol., C_ b •s.. _r 1"...
/ "7l` �,t, , LOROK t (Sig :ture of Notary) V
:*: ,•, 1, ° forf COMM ION#HH 228158
; .,; �:oI; AMY GORMAN
-,,•ioF ? EXPIRES:June 12,2026 ,Ji .0,, AMY
Notary Public,State of Florida •
[ ]P rsonally Known OR -��....i.r, ( ]Personally Known O' _ �A Commission#HH 273537
[A,produced I d e n t i f i c a t i n lath
[ Produced Identification � � �s�_ y comm.expires June 8,2026
T - c c L Type of Identification:_ _ ------
Type of Identification: )'L t 'tver ((C t f J
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PROPERTY ADDRESS:360 3RD STREET ATLANTIC BEACH,FLORIDA 32233 SURVEY NUMBER 1306.0351
0,FIELD WORK DATE:6/7/2013 REVISION DATE(S):IREV.O 6/10/20131
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LOT 24 LOT 22 LOT 20 LOT 18
BLK 4 5LK 4 BLK 4 BLK 4 `
7 cost
4, I hereby certify that thi: ., of ;Se•::on described property has 1
been made under my.1: '0 rt best of-1aknowledge and belief,it is i
�`, a true and accurate repfe, w''.".. rvey that^.-to the minimum technical NOTP3:
.��r FENCE OWNERSHIP NOT DETERMINED
standards set forth byl,.. ,i'0....00,,
� 0• . .I Land Surveyors as
described in Chapter o 7of"`s3ere:F•'min •. e Code.
! ie FLORIDA 1'
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y s2°N4t ousWYDW�' 40 30 20 10 0 2I 40
GRAPHIC SCALE
Wesley B.Haas
Stab of Frond.P case aNSurveyor.m as e, �.
Gane-No.3708 I inch—40 feet
Use ATMs Sunny for Purposes whereon Intended wRrwutwmun Venal:Won,wI Wel*.User.Sok Rbe.ndWithWithout W
Wabityathe suvga. I,
Nothing Wean dull beCrratud to Ow ANY RION of B..dts to Afeon.Odor thin those Crn$.d.
11
FLOOD INFORMATION: POINTS OF INTEREST
BY PERFORMING A SEARCH WITH THE LOCAL GOVERNING NONE VISIBLE
MUNICIPALITY OR W W W.FEMA.GOV,THE PROPERTY APPEARS TO BE
LOCATED IN ZONE X.THIS PROPERTY WAS FOUND IN THE CITY OF
ATLANTIC BEACH,COMMUNITY NUMBER 120)75,DATED 06/03/13.
Florida Land AFFILIATE
CUENT NUMBER 'DATE:6/10/2013
Title Association
BUYER:Eileen Campbell and Patrick Campbell
FL-TAMEMBERS
SELLER:
3 *'x
CERTIFIED TO:EILEEN CAMPBELL AND PATRICK CAMPBELL;COLLINS,BROWN,
CALDWELL,BARKETT,GARAVAGLIA AND LAWN,CHARTERED;
OLD REPUBLIC NATIONAL TITLE INSURANCE COMPANY;BANK
OF AMERICA www.surveystars.corn
Land Surveyors, Inc. P 866-735-1916•F 666-744-2882
This is page 1 of 2 and is not valid without all pages. LB.7337 12220 Towne Lake Drive,Suite 55•Ft.Myers,FL 33913