370 12TH ST RFNC24-0015 ;tom,; , BUILDING PERMIT APPLICATION
y�. �r . '�� FOR JNTERNAL OFFICE USE ONLY
7..‘ . , ;1 City of Atlantic Beach Building Department PERMIT# I�F"NC Zl( ' b D
800 Seminole Road, Atlantic Beach, FL 32233
j!'�`' Phone• ""ALL Information required to process
(904) 247-5826 Email: Building-Deptt coab,us.
Job Address Y/0
0
►), kv�ct RE# 171 Iv! - 0000 ,
g Legal Description _____:_2_a___
- 2 _ _q_____“: _L. 2 C _Lc� •
Valuation of Work =.� J `�
(Replacement Cost) ` �700 Heated/Cooled SF Non-Heated/Cooled SF
•Class of Work: Pf New ❑Addition ❑Alteration F�1Repair EMove nDemo n Pool El Window/Door
•Use of existing/proposed structure(s) n Commercial PResidential •If existing structure, is a fire sprinkler system installed'? []Yes❑No
•Will tree(s)be removed in association with proposed project? n Yes (Must submit separate Tree Removal Permit) QNo
Describe in detail the type of work to be performed:
rImo_ R.r 1,cc. 6�l4 U r� fie- ci ✓t ear yard P v' mYfiu'. -
Florida Product Approval# (For multiple products use Product Anoroval Information Sheet)
Property Owner Information Name Jane«n t�tlawtn 1\�vecP,��,c J rush Phone 617 7g9 7q7 6
Address ' D
( U4r;r,4 1� City Wqt,,4n State MA Zip 02448'
Email Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
O�ttlooln . Com
Contractor Information Name of Company 3 '� Phone 101-/ c '3 63y''
Address S 970 N, ,u.y A,., _ City ,),r.Lc ,42/-r_, State t( Zip 312.5'1
Qualifying Agent fLi
f2 ,,, State Certification/Registration# /‘58.57
Email Job Site Contact Number 701i
1 Worker's Compensation Insurer gantit MS s4tineiuN OR Exempt Expiration Date 10/ D(/i
iArchitect's Name Email Phone
! Engineer's Name Email Phone
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 city/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 YOU PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT
MUST BE RECORDED AND POSTED ON THE SITE OF THE IMPROVEMENT BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSv. ULT WITH YOUR LENDER OR AN
ATTORNE __,..
Y BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
a......
/„./......„__________
g(Si nature of Owner or Agent) re of Contractor)
Signed and sworn to(or affirmed)before me this / rd day of Signed and sworn to(or affirmed)before me this 7 day of
Februcx , 2Oa LI by Ard.ze o_ RDhihStal ra I.ru-r,y , 2-O2 H by &v./P
JJ
Signature of Notary 9C�_ Signature of Notary ���lt�{ ar�'n.-ft,
Nji t<<,
[ ) Personally Known OR [Produced Identification V1 Personally Known OR ( j Produced Identification
T e of Identification: /Il[( SO Ck»S Li CJ_ SQ Typ',,TI
,�y ntitIVlinNY ANN STRIC LAND
BRANDIE KRICK �, -Notary Public-State of Florida
00 ` = •= Commission 0 HH 288842
' Notary Public,State of Florida %_‘,.4al i My Commission Expires
,..—,, Commission#HH 319660 �''��' �" July 12, 2028
""—r' My comm.expires Oct.6,2026
gy . v.�..._-��,�. ..x��
Fence Addendum Updated 1/14/P021
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:
370 24, S* 2- ►Z `1U
Property Type: Lot Type/ Features:
Residential C 'One Street frontage (interior lot)
❑ Commercial ❑ More than one street frontage (corner lot, through lot,
etc.)
❑ Swimming Pool
F nce Material: Fence Height (select all that apply):
Wood ❑ Fpur Foot (4ft)
❑ Chain Link 16/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?
0/Yes (must submit separate Revocable Encroachment Agreement)
id No
Will tree(s) be removed in association with proposed project?
❑/Yes (must submit separate Tree Removal Permit)
IYNo
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.
MAP OF SURVEY
LOT 7 AND THAT TRIANGULAR PART OF LOT 8 LYING EASTERLY OF A LINE RUNNING SOUTHERLY
FROM THE NORTHWESTERLY CORNER OF SAID LOT 7 TO A POINT IN THE SOUTHERLY LINE OF SAID
LOT 8, 5 FEET SELVA MARINA,yUNITENo. 1, ACCORDING TO PLAT THEREOF RLY FROM THE UTHWESTERLY NS RECORDED ER OF SAID OIN PLAT T 7, LBOOK IN L2,OCK
23,
PAGE 4, OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
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RETENTION AREA 4
''121
•
141 xe' aux rtxa 1 �' x
91 N 101 6" two 0 C WCN
•
444,
OF 46 _ _ .. 95.00'
i FIELD
25.0'-.- S 83.42'00 ... W 94�' i
(� Y'S�oT 7 THEs 1N 1�2 OF BLOCK 14
t sI BE A°4
cDR R or ATLANTI s PaGE
89
1 PLA1 p00K
LOT 9
THE PROPERTY SHOWN HEREON APPEARS TO LIE IN FLOOD ZONE "X' (AREA
OUTSIDE 500 YEAR FLOOD PLAIN) AS WELL AS CAN BE DETERMINED FROM
NOTES: THE "FLOOD INSURANCE RATE MAP' COMMUNITY PANEL NUMBER 120075
2. THIS IS A BASNDARY SURVEY. DUVAL
2. BEARINGS BARED ON THE EAST LINE 0001 D REVISED APRIL 17, 1989 FOR THE CITY OF ATLANTIC BEACH,
OF LOT 7 AS BONG 50991'13"E AS PER COUNTY, FLORIDA.
PLAT.
3. BUILDING RESTRICTION LINE AS PER THIS SURVEY WAS MADE FOR THE BENEFIT OF
PLAT.
4. BENCH MARK USED IS A NAIL IN A TODD S. BUDNICK AND CHRISTY H. BUDNICK,
WOOD POWER POLE AT THE SOUTHEAST GIBRALTAR TITLE SERVICES, FIDELITY
363 12th OF STREET.
FOR RESIDENCE No. NATIONAL TITLE INS. CO. AND REGIONS BANK
363 STREET. ELEVAn0A1 10.88
N.C.V.D. (1929) OSA REGIS MORT i E.
-NOT VALID WITHOUT THE SCNATURE AND THE DO N W. 00ATWRIGHT, P.S.M.
ORIGINAL R AND SEAL OF A FLORIDA LICENSED FLORIDA LIC. SURVEYOR and MAPPER Na LS 3295
SURVEYOR AND MAPPER FINAL SURVEY - JULY 14. 2009 FLORIDA UC SURVEYIyC de MAPPING BUSINESS No. LB 3672
BY: l BOATWRIGHT LAND SURVEYORS, INC. DATE:CELEBER 22,2008
. s ``
tE.CK SY: 5`t';— 2009-0435 1500 ROBERTS DRIVE. JACKSONVRIE BEACH. FLORIDA 241-8550 il SHEET. —L—OF?
RCF- 2008-1028