Revision RequestCorrection to Comments - 427 SARGO RD RESA23-0010 Revision 5-2-23_1Revision Request/Correction to Comments "ALL INFORMATION
k HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY 15 REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@cciab.us PERMIT #: E b
Revision to Issued Permit OR ❑ Corrections to Comments Date:
Project Address: ' c. ti• R -
Contra ctor/Contact Name: Hou"S�
Contact Phone: _� 1 6f � Email: POUS�-Gv, A, fro.. ren 6rk0l d , Ulrl
Description of Proposed Revision / Corrections:
r S r' u moi/
a . L
• •
Ido as i affirm the revision/correction to comments is inclusive of the proposed changes.
(printed name)
• Wil roposed revision/corrections add additional square footage to original submittal?
No ® Yes (additional s.f. to be added: )
• proposed revision/corrections add additional increase in building value to original submittal?
No ®*Yes (additional increase in building value: $ ) (Contractor must sign if increase in valuation)
*Signature of Contractor/Agent: j 1\ Z
F Approved N Denied
Revision/Plan Review Comme
Department Review Required:
Building
Planning & Zoning
Tree Administrator
Public Works
Public Utilities
Public Safety
Fire Services
(Office Use Only)
Not Applicable to Department Permit Fee Due $
Reviewed By
Date
Upda fed 10/17/18
FLORIDA INDIVIDUAL ACKNOWLEDGMENT
F.S. 117.05(13)
IL�B��kGOA�Jtgrlr�0!!a a�apaaav ax+xso as iaa�k
State of Florida
Countyof The foregoing instrument was acknowledged before
me by means of
Place Notary Seal Stamp Above
E::i ysical Presence,
—OR—
[I Online Notarization,
this day of y
Dote Morkth Year
Name of Person Acknowledging
Signature of Notary Public — State of Florida
U --G fkG. l Gv C,• c --
Nome of Notary Typed, Printed or ttomped
❑ Personally known
*+F3t,oduced Identification
Type of Identification Produced:
OPTIONAL
Completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Document
Title or Type of Document- 1 ��I�, C.- —A Ir CO
Document Date: _ <— 1 y Number of Pages: A41
Signer(s) Other Than Named Above,
x.2020 National Notary Association
M1304-11 (11120)
SST w l
4
GtJAOpLIJ'r GaRCI-
Nctary Public - State o' F.•f-
'`
CommtrsianaGG5a637(
My COMM. Expires Jar 12, 202„
Place Notary Seal Stamp Above
E::i ysical Presence,
—OR—
[I Online Notarization,
this day of y
Dote Morkth Year
Name of Person Acknowledging
Signature of Notary Public — State of Florida
U --G fkG. l Gv C,• c --
Nome of Notary Typed, Printed or ttomped
❑ Personally known
*+F3t,oduced Identification
Type of Identification Produced:
OPTIONAL
Completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Document
Title or Type of Document- 1 ��I�, C.- —A Ir CO
Document Date: _ <— 1 y Number of Pages: A41
Signer(s) Other Than Named Above,
x.2020 National Notary Association
M1304-11 (11120)
RIGHT-OF-WAY / EASEMENT PERMIT APPLICATION "ALL INFORMATION
J n ° City of Atlantic Beach HIGHLIGHTED IN GRAY IS
�r
800 Seminole Road, Atlantic Beach, FL 32233 REQUIRED.
urr r
PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES
JobAddress CV I -J. tor, ,c &&& FL J;L;M Permit Number P ES A J 3-o d O
Contractor Information
Company Hot 6nA Il-r,r, Qualifying Agent
Address `447 c;r_rzj&, rA. City ko,n�-,L PVX-J, State Zip 12}x'3
Phone Lq !?6&4 Email kauli• .n A ✓
State Certification/Registration #
Architect /S'1,,&i a,,6 aunts,.o Phone�Email 6^C&6
• 144 -
Engineer
Phone Email
Workers Compensation Insurer OR Exempt❑Expiration Date
• Permittee declares that prior to filing this application they have ascertained the location of all existing utilities, both aerial
and underground and the accurate locations are shown on the sketches.
• Whenever necessary for the construction, repair, improvement, maintenance, safe and efficient operation, alteration or
relocation of all, or any portion of said street or easement as determined by the Public Works Director, any or all said poles,
wires, pipes, cables or other facilities and appurtenances authorized hereunder, shall be immediately removed from said
street or easement or reset or relocated hereon as required by the Public Works Director and at the expense of the
Permittee unless reimbursement is authorized.
• All work shall meet City of Atlantic Beach or Florida Department of Transportation Standards and be performed under the
supervision of n6Lh-6,•,r, Y. (Project Superintendent)
with (Company Name) A//Ir _ ^Phone 9Jf9 6LgQ6`-{ 1
• All materials and equipment shall be subject to inspection by the Public Works Director.
• All city property shall be restored to its original condition as far as practical, in keeping with City specifications and the
manner satisfactory to the City.
• A sketch of plans covering details of this installation, as well as a copy of a recent survey shall be made a part of this permit.
Calculations showing any increase in impervious area on owner's lot or in the City right-of-way are to be included with
this application.
• The permittee shall commence actual construction in good faith within �j�}_ days. If the beginning date is more than 60
days from date of permit approval then permittee must review the permit with the Public Works Director to make sure no
changes have occurred in the area that would affect the permitted construction.
• It is understood and agreed that the rights and privileges herein set out are granted only to the extent of the City's right,
title and interest in the land to be entered upon and used by the holder, and the holder will, at all times, assume all risk of
and indemnify, defend and save harmless the City of Atlantic Beach from and against any and all loss, damage and cost of
expenses arising in any manner of the exercise or attempted exercises by the holder of the aforesaid rights and privileges.
• The Public Works Director shall be notified 24 hours prior to starting work and again immediately upon completion.
Date /:) l 1 /� 3
[re (signed in presence of Notary Public)
STATE OF FLORIDA, COUNTY OF DUVALI
The foregoing instrument was acknowledged this 1 day of rnel 1-� 20 C�13-
by A, v c)�r r,— who personally appeared before me and
(printed name of Permittee)
��" GUADALUPE GARCIA
acknowledged that he/she signed the instrument voluntarily for the purpose expressed in iIno-WrT-
? Notary Puh;it • State of Florida
, o� Cammissiop d GG 446372
My Comm, Expvet Jan t 2. 2024
(] Personallyt ��•• II
Signature of lic, St f Florida -1-Produced Identification (Type) ` Y1 L +--
H:NApphcat+ons & Forms\Word oocuments�201801001 Right -of -Way Easement Permit Appkuation-docx ReVISIOn Date: 10/1/16