2251 BAREFOOT TR FOUN23-0001 Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
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� IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: ZZ'cI 3/4/2-6r007- %/ZA CE Permit Number: r UL N Z 000 I
Legal Description 4K-/?0f3 -ZS--2q'09-ZS- z37-ZS-Z4', oc-t4 W C�UVS
i2RE# 16 1416,-3-06 �Z
Valuation of Work(Replacement Cost)$ S//Oc) •00 Heated/Cooled SF Z Sc./ / Non-Heated/Cooled Z..C$ 5 .F.
• Class of Work: ❑New EAddition ❑Alteration Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial gResidential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes jANo
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) T64No
Describe in detail the type of work to be performed:
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Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name t ,t)AJ WN 3 . /JAG/1 A/ Address ZZS't j/21GE
City /Q7L4/01/C 3t.,4cN State /-L. Zip 3Z Z 3 3 Phone Cf'o4(-6,/Z-06O9
E-Mail /I/A
Owner or Agent (If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company usv17AS .ZNC Qualifying Agent Xi//y C,/ f?/114Ald /
AddressZm 5= z �ciJ -4,2 5-7/2 7 city47-z4i30.4c1,1 State FL Zip "Z 2 3 3
Office Phone goy- ZYt- zs- Job Site Contact Number 70 X27 �,GGA.j c Croy- 75"y-z 6$
State Certification/Registration# CrS C 054 3o g E-mail g,L cM .MA//),WFou,. DA9,d'VS7En,srNC.�.
Architect Name&Phone# ti//1
Engineer's Name& Phone# Zi/t', C ,/v2414,v T/x. boy 237-Z'9Y 3
Workers Compensation Insurer 2?i /L ,CI OR Exempt ❑ Expiration Date Ol'/O Z/Zo2
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
RECORDIN /YOUR N TE O CEMENT.
(Si nature of Owner or Agent) (Signature of Contractor)
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Signed and sworn to(or affirmed)before this /771-lay of Signed and sworn to(or affirm t [def e ethis
me day of
Taft)uA2y , 20 Z-3 , by ETN I-6%AM ��lu�i:r1� , ��� , li/ 1/tilm, i' A
(signature of Notary) (Signature of Notar )
• IBtLLY C.MCMAFUN "OPNotary PubNFondac Stale of
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Personally Known OR =�' ,. ' \ MYCO$MA$SSl0l4# 2 1tst [lj y My C mm e o Perry
ersonall Known OR My Commas/on GG 945276
M 13,2023 I �i di Expires 01108/2024
[ ]Produced Identification ;°� ^�. o EXPIRES:May [ ] Produced Identificatio• a�
of F ' Bonded Tr,1 NofarY
Type of Identification: °'' ___Pubic Type of Identification: