470 GARDEN LN RESO23-0048 l•
r 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
'F; IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: 41-7 D &0-r-k Lan e Permit Number: RES 0 Z 3C015
Legal Description 5S-31 89"Z? 1E Set V a mo-r- # Go- w.,-" d t TRE# 17 2020 '52 20
Valuation of Work(Replacement Cost)$ j''O 0 Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ONew ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo OPool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial ❑Residential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes ❑No
• Will tree(s)be removed in association with proposed proiect? ❑Yes(must submit separate Tree Removal Permit) ONo
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 7'kOm-a9 .Z, �kyr.�PS��d �V in, Address 47 0 £ a-4er, L ••E'
City 66State Ft- Zip iZ 23'3 Phone {p 0?- c{T7 -6 6 S ?
E-Mail T? .S6 - Cher
Owner or Agent(If Agent, Power Of Attorney or Agency Letter Required)
Contractor Information
Name of Company R.nriPa `•f L,r COr-vTa '•y TEC Qualifying Agent t \ n.•�Cr c, - c I
Address 1 Qi /r&Avor.- Roo-, CityfkCk a is eiccl.State F L Zip "3:2�3 3
Office Phone y 2`-(- Job Site Contact Number
State Certification/Registration# h\Ck E-Mail akelco .0‘Or Cvr•s,OL"d
a.ty . r}.
Architect Name&Phone# r
Engineer's Name&Phone# An
Workers Compensation Insurer 1\nNtf A/0/41L A r-•C!-rc.AA OR Exempt 0 Expiration Date `7(I 4120:2
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
RE Y . R NOTICE OF COMMENCEMENT. Oikt.
)
ture of Owner or Agent) (Signature of Contractor)
Signed and sworn to(or affirmed) before me thiss33 day of Signed and sworn to(or affirmed)before me thishiday of
l 0 b ��c Y rim fl- 23 ,by�Co �1��1 �A-- Pao r-e
i�Y1�''• COLETTE JPOo• '• �' ''
.9.��a�. '• Notary Public•State of Flor(6ag .ture of Notary) (Signature of Notary)
am"T ' Commission N NH 056368 —
ai. My Comm.Expires Nov 12,2024 '. '`•. COLETTE J POORE
Bonded through National Notary Assn.
T;': Notary Public•State of Florida
]'Peisananyienow . [Personally Known OR ! Ali Commission 8 HH 056368
(2•Produced Identification [ ]Produced Identification) \ an. • My Comm.Expires Nov 12,2024 I
Type of Identification: (C0 L •• -- 1 S 30 40 Type of Identification: Bonded through National Notary Assn. I
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BOUNDARY SURVEY
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GARDEN LANE _
60' RNV(IMPROVED) q_
SURVEY NOTES C-1 R=25.00'
CONCH TL DOVE CROSSING INTO RI:,' L-9.94'
ON SOUTHERLY SIDE OF LOT
THERE ARE FENCES NEAR THE BOUNDARY =22°46'49"
OF THE PROPERTY
Na E4tS SURVEYORS CERTIFICaTE TARGE T
4 I IEEERT CERTP.,if-i17 THIS SOUN:ARY SJR%E•
IS A TRUE AND CORRECT REPRESENTATION OFA SURVEYING
R EYING LLC
SURVEY PREPARED UNDER MY D61Ecion Lf jt ti/ j jj�J
NOT WALT)'AIN/D..11 API AUTHENTICATED ELECTRONIC
a SIAM OF SIGNATJRE ANC 4JiIEIIIICATED ELEC1RCPDC SE' Cr•r,. LB#7893
OR A PIJSEO EMUS550 SEAT ANU S17•N4TURF
Kenneth J.Czlg"ally"<'"r
SERVING FLORIDA
hrnnrlh 1 Osb°rnc. 6250 N.MILITARY TRAIL,SUI IE 102
Date.2026.05 13 'NEST PFLLi 6EaCH FL 33e0T
`'Zit>Z— Osborne yg;43:a7-0dG0 PHONE 1561}6=6�82J
(SIGNED) STATEWIDE PHONE 1863)216-0301
I KENNETH OSBOoaEFJ c 4+:,-P ER=r-11:. ..,I'-).jFUI',T I.j:.l,i f11,`- i,;. STATEWIDE FACSI?.!RE 806)741.0576
I" WEBSITE:hep:r+ta'ge urneying.°et