530 SHERRY DR POOL23-0026 Kulik Permit ApplicationBuilding Permit Application
City of Atlantic Beach Building Department
800 Seminole Road, Atlantic Beach, FL 32233
Buildin coab.usPhone: (904) 247-5826 Email:
5cO SHERRY DR ATLANTIC BEACH, FL 32233Job Address:
Legal Description 10-1616-2S-29E SALTAIR SEC 3 LOT 344
Permit Number:
Valuation of Work (Replacement Cost) S Heated/Cooled SF
updated 10/9/18
**ALL INFORMATION
IIIGHLIGIITED IN GRAY
IS REQUIRED.
RE# 170472-0000
Non- Heated/Cooled
• Classof work: HNew E]Addition HAlteration HRepair HMove HDemo EPool Hwindow/Door
• Use of existing/proposed structure(s): HCommercial EZResidential
Florida Product Approval #
_P_roDertvownerlnform_ati_a_a
Name
City
KULIK MICHAEL
Atlantic Beach State FL
E-Mail
Address
for multiple products use product approval form
530 SHERRY DR
32233 phone 904-982-6789
Owner or Agent (lf Agent, Power of Attorney or Agency Letter Required)
Contractor I nformation
Name of Company
Address
Southern Elegance Pools
522 1 3th Ave North
Office Phone 904-982€789
State Certification/Registration #
Architect Name & Phone #
Qualifying AgentJax Peach
Charles Cribbs
state FL
Job Site Contact Number
cpc 1458631 E-Mail southemetegancepoois@gmail.com
Engineer's Name & Phone #Nicholas W. Eckhardt, P.E. -(904)451-0630
Workers Compensation Insurer OR Exempt Ea Expiration Date 3/20/2024
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
secured for ELECTRICAL WORK, PLUMBING, SIGNS,construction in this jurisdiction. I understand that a separate permit must be
HEATERS,TANKS,and AIR CONDITIONERS, etc.WELLS, POOLS, FURNACES, BOILERS,
mit, there may be additional restrictions applicable to this propertyer
ln addition to the requirements of t
that may be found in the public records of this county, an
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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 T0 OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS T0 YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
RECORDING YOUR NOTICE OF .COMMENCEMENT.~zzLf2rf=t=Jg#--~~Charles Cribbs
AITORNEY BEFORE
(Signature of
POOL23-0026
By Mike Jones at 2:48 pm, Sep 25, 2023
REVIEWED FOR CODE COMPLIANCE
POOL23-0026