1846 SEMINOLE RD RFNC23-0034 Building Permit Application Updated 10/9/18
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City of Atlantic Beach Building Department **ALL INFORMATION
-..,______//, 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
1-ti;1» IS REQUIRED.
Phone: (904)/ ' '
247-5"8926 Email: Building-Dept@coab.us1 v/\JobAddress: c ,i4, R- �l� PermitNumber: E C Z - O3 34
Legal Description 1 l 7 f) c 2 I <_-_/vim A Icy AI Vaf}' g 3�,-J/) C7-) ilk' RE# I -1 202 O C S✓t y
Valuation of Work(Replacement Cost)$ N�� Heated/Cooled SF Non-Heated/Cooled
• Class of Work:/S(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?: ❑YesNo
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit se rate iree Removal Permit)-No
Describe in detail theAppe of w rk to be performed: /#4 r, E zj 6 /,9/4 4 1 ''. a ' -A)e*E
$of ca.) Oc&lib
Florida Product Approval# for multiple products use product approval form
Propert Owner Informa 'on t
Name ff/lse '', .1/ Address / v pY6. 5f/If/f)PI cJ
City / 4 a ar State-) L---- Zip Phone 5 t3 /'3i?'2---
E-Mail h'1/4C v'1r e:Pc?,v(c a vHcoc-/.v)/,-/-
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Compan _ _ A 'Qualifyin Agent .626 .,. /4,/beS tiL-�
Address` {t) 4'4.i..tV 6 -'/ ?_ City d- State -Ft__ Zip 322.22
Office Phone /2 3 Job Site Contact Number - —- v..
State Certification/Registration# E-Mail [/ /L -."D / Li / r 4 �_
Architect Name& Phone#
Engineer's Name&Phone# A . _
Workers Compensation Insurer tai! • (f • // R Exempt 0 Expiration Date 8f 23
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 OBTA FINANCING, CONSULT WITH YOUR LENDER OR ATT!"NEY BB .
RECOR G t TICE OF COMMENCEMENT. /
(Signature. 0 ner or Agent) /(Signatureo Co ractor)
.�ned�and
�swo��C(v� tr c�bef�re me this �ay of Si ned d sworn taffirmed)befo�Qme&., day of
I l i �' Cit b fi b
U
a ur- .i . a e of Notary)
ersonally Known OR K " °g.} sonally Known OR
TONI GINDLESPERGEP, ,,��gvp�s•., MAVRA D.OBERTI
Produced Identification =2g• '�i;-•, 1Produced Identification �o�q�
( ] �`: NotaryPublic•State of Florida
Type of Identification: `�i /`•T\�:* MY COMMISSION#GG 353178 Npe of Identification: ,a, <i Cnmmiscinn q(iiGL9992 7
;;. �, .. tXi lRhS:Uctober 6,2023 of n. My Comm.Expires May 15,2024
1 ',!:?:,F,`;‘, Bonded Thru Notary Public Underwriters Bonded through National Notary Assn.
HU'.J0I4JU - .J. HOWARD SHEFFIELD PA; Pap• 5
NOV-21-98 16. 27 FROM RES LEND ID.9043614630 PACE 5
MAr- SHOWTNG SURVE i OE
LOT 7 BLACK 1 SE:LVA MARINA UNIT NA.' 9 AS RECORDED IN PLAT BOOK 36 PAGE 20 OF THE CURRE1T
PUBLIC RFOROS OF IXWAL COUNTY, FLORIDA.
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SEMINOLE ROAD
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`.' NOTES •
BEARINGS AS PER PLAT
B.R.L AS PER PLAT
,, I HRRFAY CERTIFY THAT THE PROPERTY SHOWN HEREON LIES IN FOOD ZONE 'B" AS SHOWN ON THE FLOOD
HAZARD BOUNDARY MAP FOR ATLANTIC BEACH, FLORIDA.
I HEREBY CFRITIFY 'IC) MARX ALAN POPP. INVESTORS H01E MORRCJ►GE THAT I HAVE SURVEYED THE LANEtS
'r AS SI-04N IN THE ABOVE CAP'TICNI AND THAT THIS MAP IS A TRUE AND CORRECT REPRESENTATION OF
-: THAT SURVEY AND TI(AT T11E SURVEY REPRESENTED) HERON RESTS THE H'QNIMUM STANDARD REQUIREMENTS
ADOPTED By THE FLORIDA STA'T'E BOARD OF PROFESSIONAL LAND SURVEYORS CHAPTER 21-HR AND THE
• FLORIDA LAND TITLE ASSOCIATION.
ri' 'i-4 Fence Addendum Updated1/14/2021
.
,,, j City of Atlantic Beach Building Department
„,. 800 Seminole Road, Atlantic Beach, FL 32233 PERMIT#
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: Date:
.i s14; 5Z 04 c Ap. le P 3/20/7o73
Property Type: Lot Type/ Features:
Residential )4 One Street frontage (interior lot)
❑ Commercial ❑ More than one street frontage (corner lot,through lot,
etc.)
❑ Swimming Pool
Fence Material: Fence Height (select all that apply):
`Wood ❑ Four Foot(4ft)
❑ Chain Link ' Six Foot(6ft)
❑ Vinyl ❑ Other
❑ Block/Stone (Plan details required for footings and/or
retaining walls)
❑ Other
Fence Location:
Please submit an accurate and current boundary survey showing all existing improvements (including building footprint,
driveway, swimming pool, etc.) and location of fence/wall and any gates. Plan details required for block wall footings and/or
retaining walls and any portion or fencing above 6ft in height.
Will the fence be built in an easement?
❑ Yes (must submit separate Revocable Encroachment Agreement)
Cj(No
Will tree(s) be removed in association with proposed project?
❑ Yes (must submit separate Tree Removal Permit)
No
Conditions of Approval:
• Roll off container company must be on City approved list. Roll off container cannot be placed on City right-of-way.
• All old fencing and debris must be removed from job site by contractor or homeowner.
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.