1080 W Plaza DEMO20-0012 . M City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Dpepar)trnent.)
ei 800 Seminole Road
j 2 Atlantic Beach, Florida 322335445
Phone(904)2475826 Fax(904)247-5845 4-3-20
E-mail: building-dept@coeb.us Date routed:
Citywebsile: http:Mww+.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 1040 V&t /� f,q artmentreviewre uired Yes No
d �r I
Building
Applicant: PQ G Laved New Ih9 Planning B Zoning
Tr mem instor
Project: ib�m �8 �� Public Wrks
nine.
Public Safety
Fire Services
Other Agency Review or Permit Required Review or Receipt Date J
of Permit Verified B
Flonda Dept.of Environmental Protection
Fonda Dept.of Transportation
St Johns River Water Management District
Any Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other: (i1 /rV G
APPLICATION STATUS
Reviewing Department First Review: ❑Approved. enied. ❑Not applicable
(Circle one.) Comments:
BUILDING L�
PLANNING&ZONING Reviewed b ' Date: l-I1-Z0
TREEADMIN. Second R.v..w EYPproved as revised. 1❑]Degn�ieed... ❑Not applicable
PUBLICWORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by/ Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. ❑Nat applicable
Comments:
Reviewed by: Date:
Revised 05119/3917
IT
Building Permit Application updmed,o,,,,a
AL
City of Atlantic Beach Building Department *'ALL IN FORMATION
1800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept0coal us IS REQUIRED.
Job Address: /ORO W, QLALA s7- Permit Number:
Legal Description Ice°' GI 3 -7 kNJfw PES {c ee, RE# /7p9r�/- OSOD
Valuation of Work(Replacement Cost)$ Heated/Cooled SF Non-Heated/Cooled
• CiassofWork: []New OAddltion OAlteration ORepair OMove Amo OPool OWindow/Door
• Use ofexisting/proposed structure(s): OCommercial SWe'sidential
• Han existing structure,is afire sprinkler system Installed?: Oyes Be.
o V5 Tree Removal Permiti ONO
Describe in detail the type of work to be performed:
Deno {IousE /!A/0 .Ylxd r.1/ f4FAR A60N6f&1-1' /�-
Florida Product Approval# for multiple products use product approval form
Property Owner Information 1— /�
Name T/�g w9/r? Q.1//Q.S Address 7J63 4>k-?J14f
City TR} State_Zip3ZLS6 Phone
E-Mail
Owner or Agent(If Agent,Power of Attorney or Agency letter Required)
Contractor Information
Name of Company $}CL IR0! G619 eAbaTi,s QualifyingAgent d LAddress 2 � -AalL
St to zl 124,1-6
Office Phone :ZY/RG 70 Job Site Con ct Numbe{�j dd/
State Certificatlon/Registration#bEAf 9—/A7/63-Mail f�J 4+.uDLr r:E9C Ne xur}
Architect Name&Phone#
Engineers Name&Phone#
Workers Compensation insurer empt0 Expiration Date
Application is hereby made to obtain a permit to cro the work and installations as Indicated.l 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 ofthis
permit,there may he 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
RECR#DIN YOU TICE F COMMENCEMENT. �.f
�itrA ?- w W.
(Signature oiOwner or Agent) Agmture of Contractor) __pp
Sig and sworn to(or affnme before me this•> day pf SpedO a.qnd�sworn to(or affirmed)beforeme this 36day of
iL �7,024 6 L4 gpd
' (Signature of Notary) (Signature of Notary)
n Personally Kn I STEVEN A YULKEY ,! ;1}+"+' ;,: STEV[N q YULK[V
MY COMMISSION a OGOdfNd4 r'r rersonally Known OR
( I Produced Idem MV COMMI8cvwn# ;n,1 d
EXPIRES NovmaM 11.202U f I Produced Identification
Type of ldentiflgti n Type of ldentifotion: EXPIREa Nowmp•r21,2020
MAP SHOWING BOUNDARY,
TREE & TOPOGRAPHIC SURVEY OF
LOTS_ 1 2&3 BLOCK 175 AS SHONM ON MAP OF
SECTION"H"ATLANTIC BEACH
A8 RECORDED IN PIAT gpCR 13 PAO� 90 CFTHE a„urr
CERTIFIED TO:Me
WEST PLAZA STREET
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P & G Land Clearing Wb-
Fax :
944o Rewis Rd.
Jacksonville, FL 32220
Phone : (904) 781-3670(904) 781-0792
Re: 1080 W. PLAZA
We have never put up silt fence, or port-o-let. We used a machine and dump
trucks and will be through in part of one day.
Thanks,
FRANKIE LLOYD
P & G LANDCLEARfRING INC
*101-194V