403 Oceanwalk Drive North DWAY23-0004 Building Permit Application Updated 10/9/18
'' City of Atlantic Beach Building Department **ALL INFORMATION
�
, ,.0_,
// 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
IS REQUIRED.
Phone: (904) 247-5826 Email:, /Buillding-Dept@coab.us 2
Job Address: 903 Oee7,1L,o ,,r4k�� 40,r�"ve- �AX.,'7•!, Permit Number: 1:2)1/0 PILI Z3-COCA-
Legal
`
Legal Description _, //O / 9et,,,,j if !/�• ,/ E# 1 CO 946) - 1-5z0
Valuation of Work(Replacement Cost)$ /700' Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration epair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial 'residential
• If an existing structure, is a fire sprinkler system installed?: DYes Flo
• Will tree(s)be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) o
Describe in detail the type/ of work to be perform d: ,
, «✓,/kerne,- o Co, (.7,-t. c.�.. e',/07. //,744 pricer.-5-
Florida Product Approval# for multiple products use product approval form
Property Owner Informs • n
Name ."—ieI7 j Address gal(9cc,c9.1,ris,IAr .a ci
City ,,Z41-7//./:/., ,-,s_I State /C/ Zip `7�2r33 Phone 91.71- ?7 '-45069
E-Mail (-7 e4;(2-5$ `/02 &' ,r,,,. I.6 i
Owner or Agent(If t, Power of Attorney or Agency Lette(3quired)
Contractor Information , ./74-05e12,2_,
,/O54 7�`d .<lin-
te-- _
Name of Company r . ^ / Qualifying Agent /e-'lviw/ (A/,etit/,c._
Address S i Y 3y T ,4 iLCity j K State —i4- Zip Z'z�v
Office Phone Choy- $(1v—V/51 Job Site Contact Number
State Certification/Registration# E-Mail /)/G(y,-ar.�..(.� .off , K,
Architect Name& Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exemp. Expiration Date I e f t 4 /z�
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 NOTICE OF COMMENCEMENT.
4— Z-- —
ignature dT Owner or Agent) (Signature of Contractor)
Signed and sworn to(or affirmed)before me this ')0 day of S ned and sworn to(or a, ed)before me this Z g day of
-1/42wiv -,-,) , aO Eby J, -L 1 b((j5 - � Z.2 A0 , _
_.-.. _41111Mi%1111= .
.I •4.:Y• =' JENNIFER JOHNSTON (Si ture of Notary) �'�����
•,: MY COMMISSION#HH 057579
n EXPIRES:October27,2024 YP TONI GINDLESPER R
>! F r E( yip] y�ublic Undenrrtters [ ]Personally '.•'s� 4'°`: MY COMMISSION#GG 353178
'�' �••F�Prs Known OR ,•,
[ ]
[ oduced Identification �_ Produced Identification ,,..k,:7 EXPIRES:October 6,2023
Type of Identification: �— V Type of Identification: f F '° dedThruNotaryPublicUnderwriters
•sr�wi- REVOCABLE ENCROACHMENT AGREEMENT
el ria\ City of Atlantic Beach **ALL INFORMATION
f 800 Seminole Road,Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
IS REQUIRED.
Ensp
REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach, Florida, a municipal corporation organized and
existing under e laws off .11 Stat f Florida, hereinafter referred to as "CITY" and
ajf /2/.1f of Atlantic Beach, Florida, hereinafter
referred 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 ,c_t`ccir,c..-f o 41;,,,a/c1 di if" AI l/er—s .
Any facility maintained, repaired, erected, and/or installed in the exercise of the priviYege gra trf ed remains subject to
relocation or removal on thirty(30)days'notice by CITY to USER,said noticeA USER shall b give by ce tif' d m L), return
receipt requested,to the following address y0,� Q«,N.�% , A ,7/i,-1c A/ •
• 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-of-ways and other public land. USER further agrees that the CITY and its officers and employees shall be
saved harmless by the USER from any of the work herein under the terms of this permit and that all of said
liabilities are hereby assumed by
y the USER.
es1GGe-��
__..---
Property Ower/Agent(si ned in presence of Notary Public) Date (3-b J
.6 c)-
STATE OF FLORIDA, COUNTY OF DUVAL
The foregoing instrument was acknowledged this LJ day of 3 CLi2l,li✓L , 20
by ID --Q--?\A M9 few S ,who personally appeared before me and
(printed name of Signer)
acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it.
----- --_ �� Department Approval:
CD =�P7777; •
Signature ootary Pblic,State of FloridaPersonal) Known +\/ My8T0N COMMISSION#HH 057579
[ ) y .•"r°",,k Bonded EXPIRES:October 27,
[1).Foduced Identification(Type) FL b l-= RO�YPublicund - illiams, Public Works Director
H:\Applications&Forms\Word&Excel Document Originals\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18
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OD AMPS REVISED 4/17/1989. ' ' _ _ THAT THIS SURVEY MEETS THE MINIMUM TECHNICAL STANDARDS
ITY PANEL N0. 120075 0001 D. II II I S A_ IAl F I II
PURSUANT
2�HHSECTION-6ORIDA2.027ADMIFLORN
IDAOSTATUTES BY THE FLORIDA BOARD OF LAND RANDCHAPTER
RS,
SiS ,..„ 101 f 0 � INC. ' Ail
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FLORIDA REGISTERED SURVEYOR N0. 4707
H. BRUCE DURDEN• JR.
POST OFFICE BOX 50670
1103 SOUTH THIRD STREET DATE SEPTEMEBER 3. 1993
JACKSONVILLE BEACH. FLORIDA 32250
(904) 249-7261 SCALE: 111 - 20'
THIS SURVEY NOT VALID UNLESS THIS PRINT IS EMBOSSED WITH THE SEAL OF THE ABOVE SIGNED.
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LOT 10, OCEANWALK UNIT FOUR
AS RECORDED IN PLAT BOOK 42, PAGES 18, 18A, 18B 6 18C
OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
F'O1;SW of the f o`og .,r P,eview of the foregoing
KATHRYN ABBY HANNA PARK
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