1731 SEA OATS DR DWAY23-0001 Building Permit Application Updated l0/9/18
ok-------
(
„,�.. City of Atlantic Beach Building Department **ALL INFORMATION
;4J 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
°';�J IS REQUIRED.
Phone: (904) 247-5826 EmailnBuilding-Dept@coab.us ;� }n� / 7
Job Address: /7 3/ �� OM a t,.� Permit Number: k-.�`�'ir�-( 1.3 00 0 1
Legal Description lo "� G/ J "uCI'( /c _Q(„ a /friAt h �i # `7[� Z o” 0 Lt--r7
Valuation of Work(Replacement Cost)$ (7 OO O Heated/Cooled SF Non-Heated/Cooled
• Class of Work: yi.New ❑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 'EiNo
• Will trees) be removed in association with proposed proiect? ❑Yes(must submit separate Tree Removal Permit) No
Describe in detail the type of work to be performed:
eq,,,,, ,,, L1(--(1- -- d'.-14.5).--LiaY Y - p/a`� �t -1` -A(/-P( )
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name / !'fes 4'102 )/ Address / 9 -51 5-00 °f � ,,..t
.
City r--1(2,ic- ;?-e t State EC_ Zip 1 7 2-. To �j Z - 1-164/
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information _
Name of Company 4 ~ OA.,,f3 S __L,„_, Qualifying Agent .,�/'1V Q) OAcii
Address - '2-3- Co/4'J /2- . City .�aX 1,6,4State Sc-- Zip 3 L?Si,)
Office Phone c JL/ S-4 - -'l y, Job Site Contact Numb r (4i +Z
State Certification/Registration# E-Mail et—, Ci,,(1 (4 */ -), (,,h
Architect Name&Phone# /4
Engineer's Name&Phone# /i./
Workers Compensation Insurer - -t' OR Exempt❑ Expiration Date ,cpeZ Z)'P
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 P I , TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINAN I G ••NSULT WITH YOUR LENDER OR A 3 RNEY BEFORE
RECORDING YOUR OT', OF COMMENCEMENT.
(Signa re of Owner or Agent) : ature of Contractor) _
S ned and sworn to(or . ' ed) before me thisday of Signed and s ern to(or affir ed before me this day of
?O2 3 M «:ti A — 2023,by ` AA • �Mih a.- s
Ad�0 TONI '• �1-r�1W1 ) —
iVa 15
�i.. , .J-. Sig ,ot.
+ , MY COMMISSIO -
�' r 6,2023 Il
' ' " EXPIRES:Octobe
''.+.��P' Public Underwriters
o. :. �e ._ Notary ___ __ _
;,- ...... .-- [ ]Personally Known OR B ., TONI GINDLESPERGEP,
Produced Identification [ ]Produced Identification `4:., _.' `:
Q ;, I :,,; MY COMMISSION#GG 353178
Type of Identification: —C- Type of Identification: L _i=:al EXPIRES:October 0,2023
FOF,!`Oe'' Bonded Thru Notary Pvb!ic Underwriters
,.iijo1%,� REVOCABLE ENCROACHMENT AGREEMENT
'i fin+; City of Atlantic Beach **ALL INFORMATION
800 Seminole Road,Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
IS REQUIRED.
pi vs'
REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach, Florida,a municipal corporation organized and
exis 'ng under the laws of t e State of Florida, hereinafter referred to as "CITY" and
oorP 1 is f i?j 3 QL/ of Atlantic Beach, Florida, hereinafter
refer ed to as"USER".
WITNESSETH:
That the CITY does hereby grant the USER permission on a revocable basis as described herein the right to enter upon
the property for the purpose as described in the City of Atlantic Beach.
This work is generally described as l 'r-) t 3 C�a,- Q 0A- .-, t-" .
Any facility maintained, repaired, erected, and/or installed in the exercise of the privilege granted remains subject to
relocation or removal on thirty(30)days'notice by CITY to USER,said notice to USER shall be given by certified mail,return
receipt requested,to the following address .
• In the event it is necessary for the CITY or the City's approved representative or other franchised utility to enter
upon the above described easement or property of the CITY, the USER shall replace at the USER's sole expense,
any and all material necessarily displaced during the action of maintaining, repairing, operating, replacing or
adding to of the utilities and facilities of the CITY or franchise utility provider.
• The facilities allowed by the permit shall meet the current requirements of the City Code, Building Codes, Land
Development Code and all other land use and code requirements of the CITY, including City Code Section 19-7(h)
which states "Driveways that cross sidewalks: City sidewalks may not be replaced with other materials, but must
be replaced with smooth concrete left natural in color so that it matches the existing and adjoining sidewalks."
• The USER, prior to making any changes from the approved plans and/or method, must obtain written approval
from the City of Atlantic Beach Public Works Department, for said change within 30 days after the day of
completion.
• This permit shall inure to the benefit of, and be binding upon, the USER and their respective successors and
assigns.
• USER shall meet the terms and conditions of this permit and to all of the applicable State and CITY laws and/or
specifications, to include utilities locate requirements and use limitations/requirements of easements, public
right-. -ways and other public land. USER further agrees that the CITY and its officers and employees shall be
saved V.rmless by the USER from any of the work herein under the terms of this permit and that all of said
liab itie = e h-"911.y assumed by the USER. (-7
V Date j /5
Property Owner/Agent(signed in presence of Notary Public)
STATE OF FLORIDA,COUNTY OF DUVAL
The foregoing instrument was acknowledged this Z----- day of 0-1\ , 20 -2_3
by " MALL C4A-"t 1 ,whoersonall
p y appeared before me and
(pr. -• name of Signer)
acknowl- •:ed that a/s' - : :ned the instrument voluntarily for the purpose expressed in it.
ii
i • `"r�`aSc: TONJ GINOL Department Approval:
Signature of Nota Public,State of • da ,: ESPERGER
MY #
j� mss: I
[ [Personally Known t ov: CD r f 78
[ ]Produced Identification(Type)
Bond:� "'N0� tiriS2023 I•tt Williams, Public Works Director
H:\Applications&Forms\Word&Excel Document Originals\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18
'rvr#5r- 5r10WiNG SURVEY OF
LOT k, BLOCK 15, SELVA MARINA UNIT NO. 8, AS RECORDED IN PLAT BOOK 3k, PAGE 85 OF THE
CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
,*IT--- -----•-••••=1 ......„_
it,( A/ C LC _41 e. 67
ieO.R/rw
3.— �'DLNt9.1/2_/.T.N--gyp S. 33'4/"E' _ - - - 93.37' / .....'"1,7 7 •"/.Zc/✓ —
-"X --- .—.�__ a� _� K �— __
14:-t:- " - -- /.7' �-_Fa•.,C.E: x -_n/ _.1111 s �s 27G•33'
Y0 a4-�cba. FiL7di2 Tx
! 3
Y q
ji
xl *
V
•u
i it
yjd
i 28 G \ ` 4
t, x 2y. 2`� IL
NI An o o L, N...‘7 , { N
'� o' Iv I
• N
�i I t•:
1'
�i I h' /G'' • V
r
.. - a¢
4,:__.-* ao.g' .1 i
/5' /9.4'
u� °
1.
g,-� /-SjOrZr"/3A7Crl - iI
°1 .z.../47FR dA fe ki �*
1lJ ."4,7 r75/ '
LI t4
N 9.9' c1 (i ) m
N28.7. vi b N
kli
•1' t4
.- 22 ' /9 5'
.____
-fir. ,- 3p' �.R L
N
N
(I .
A/ 3'42 ' 25"rNA ...9b6/'
,. = 4644 36' - fl 'J7 •.Z ./Ao/-/
Z::•4 CA! / Vf
K. A.\DURDEN
//
& ASSOCIATE S I N� - _. .. 14. 6..4._ c,,,) a- -.
LA`elf & HYDROGRAPHIC
- -..._SURVEYORS
POST OFFICE BOX 50670--_.-.� SIGNED__ . ..h _.. ---- -- _. _. 19.179
b8 8TH STREET SOUTH
JACKSONVILLE BEACH. FLA 3225n SCALE• _.^—_/*_'__.gt7'__—.____-__ - _ __