1241 OCEAN BLVD RFNC24-0021 nt_r241)
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fir" DING PERMIT APPLICATION FOR INTERNAL OFFICE USE ONLY
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kiwi- • City of Atlantic Beach Building DepartmentPERMIT# F Z
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800 Seminole Road,Atlantic Beach, FL 32233
**ALA Information required to process
' Phone: (904) 247-5826 Email:Duilding.-Deot@coab.us -_-
Job Address I14 1 OGS» Bilid RE# I.7 I 7 f -0000
Legal Description 10-11 i 6-2 5-2q E
Valuation of Work(Replacement Cost) - ji_ 4f D O Heated/Cooled SF Non-Heated/Cooled SF
•Class of Work: u New ❑Addition ❑AlterationRillepair DMove ❑Demo 0 Pool ❑Window/Door
•Use of existing/proposed structure(s): ❑Commercial esidential •If existing structure,is a fire sprinkler system installed?:❑Yes 0 No _
•Will tree(s)be removed in association with proposed project? ❑Yes (Must submit separate Tree Removal Permit) ENo
Describe in detail the type of work to be performed: /�D ) "
RaMroviny an/ rcriothy 2.2-a ' 046 ' fle..../oc.- c^ IJ .+.n ve,. ow,/q, 24' c 4/4 1. ^"/ ------
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Florida Product Approvalal#� (For multiple products use Product Aooroval Information Sheet) _
- Property Owner Information Name Sake F M Lc„r+nay TT.,ts+ Phone 904 nr l 6/2-il
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- Address 12.4 t�cep.n 6Iyel City A+}ter,. (3,...1State F I Zip 3 2.Z33Z33
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Email Sok,N cvQ Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Q.Kwrltuc-ii ct Jy:svf3.ccvn
Contractor information Name of Company Suferlw t":„.1,, S Rail] Phone 769 683 639q
Address 5970 1;6► dy Ate, City J,IL(,s i ik- State F l Zip 31-Z5y
Qualifying Agent Purl." State Certification/Registration# i(;S 959
Email O e,,�t>02.7jNGls chits ,cam Job Site Contact Number god C�3 6349
Worker's Compensation insurer 6 �� ` OR Exempt ❑ Expiration Date 10 —01 — 24
- Architect'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
INSPE ION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
,/ TTO EY EFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
/ / //
(Signature of Owner or A ///% it
Ag t) Ignature of Contractor)
Sig ed and sworn to(or affirmed)before m this C s day of Signed and sworn to(or affirmed)before me this 3 I day of
/-Et3 U¢/Z Y , 2®21/9 by 49006, r44.7fi• -70/4601:40.21/4nn !! p
S.,�Ho,+y ,jj z�y by tir..•.t P
Signature of Notaryk4d �a %% J 2e��l�ctfc, Signature of Notary,lZ g r�J'►nJ�M ..{i i, t .0(
[ J Personally Known OR [ oduced Identification [`�Personaliy Known OR , t[l(I Produced Identification
TypeOugialitikoAcali.41 Type of Identification:
OFFICIAL SEAL '` a:► ► ;
ABDUL OADIR JUNAGADHWALA 1 :°`; Notary Pubilc-State of Florida
( ;7 = Commission• HH 286642
Notary Public,State of Illinois 1 sit�IM1�, My Commission Expires
Commission No 981004 1 limo July 12, 2026
My Commission Expires November 08,2027
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Fence Addendum Updated 1/14/2021
_�:z.. !; 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:
129 oceum Ic Z l-+
Property Type: LotmaType/ Features:
Residential �d One Street frontage (interior lot)
❑ Commercial ❑ More than one street frontage (corner lot,through lot,
etc.)
.IJ Shwimming Pool
Fence Material: Fence Height (select all that apply):
,Id Wood ❑ Fourl/ Foot (4ft)
❑ Chain Link .121‘ Foot (6ft)
❑ Vinyl 0 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)
� 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.
MAP SHOWING SURVEY OF )Z41
LOT 7 TOGETHER WITH THE SOUTH 16 FEET OF LOT 8, BLOCK 50, OCifid
MANDALAY AS RECORDED IN PLAT BOOK 10, PAGE 11, OF THE
CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
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LOT 8, EXCEPT THE SOUTH 16 FEET THEREOF to laj
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ai IRRIGATIONNo ( 124.40' FIELD ) n 0 I z W
d 3' WOOD FENCE VALVE I \ LOT 9
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/ ��X4.7' r FINISH FLOOR=13.54 -'� I K o
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�� s NUMBER 1241 8 / WOOD DECK I " cCS
'`0 2�2� s.1' FINISH FLOOR=15.31 m (� LOT 6
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