475 SKATE RD DWAY24-0014 Ss -vi BUILDING PERMIT APPLICATION FOR INTERNAL OFFICE USE ONLY
City of Atlantic Beach Building Department PERMIT# f31)3 A`1Z4-Ob (�
°' 800 Seminole Road, Atlantic Beach, FL 32233 **
ALL information required to process
���;"' Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address 14--i5 5 K f-ik(& &OQp RE#
Legal Description Lij t lbC ` CD f41-1 a�,p l 'PM\ r
Valuation of Work(Replacement Cost) ,C;e3. a° Heated/Cooled SF I B Z.. Non-Heated/Cooled SF
•Class of Work: New ID Addition ❑Alteration ❑Repair ❑Move EDemo ❑Pool ❑Window/Door
•Use of existing/proposed structure(s): ❑Commercial Residential • If existing structure, is a fire sprinkler system installed?:❑Yes*o
•Will tree(s) be removed in association with proposed project? ❑Yes (Must submit separate Tree Removal Permit) ❑ No
Describe in detail the type of work to be performed:
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Florida Product Approval# (For multiple products use Product Approval Information Sheet)
Property Owner Information Name L gal c-0 rtes Phone 104-11( -1t I
Address GD 3 l S ¶ c . City cg ,o, State'R.I Zip 3, S' a
Email py\r IS D(ANA•G4ve r or Agent(If Agent, Power of Attorney or Agency Letter Required)
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Name of Com
Contractor Information pany t timi-0 4. CD,JQ T,e,.tUCsi' Phone 901 •:&.1.9V-0(06)
Address 1.00 3 \c&tik ' p ,,,,,1 34-1,2‘ City QesaC.\ State F l Zip 3 So
Qualifying Agent 'p i,-�-, 1 NJ cr co 2 State Certification/Registration#
Email oitoc Q c4'J cry,A, eOrr Job Site Contact Number 901-1 - ).461.-0106)Worker's Compensation Insurer (1 OR Exempt Expiration Date
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
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATT EY B OR RECORDING YOUR NOTICE OF COMMENGcMENT.
CAl-t. a.,,,, —/- z--L.
(Signature of 0 r or Agent) -=-. nature of Contractor)
Signed an. sworn to(or Au, ed)before me this 27 9ay of Signed and sworn to(or �. ed)before me this 27 day of
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Signature of Notary di. 4ftW Signature of Notary
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[ ] Personally Known OR [ ] Produc•• • -ntification [ I Personally Known OR [ ]Produced . •ntification
Type of Identification: :7-- - L-- Type of I . �
°°` �.. TONI GINDLESPERGER N
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4200727122MY COMMISSION#HH 407122
MY COMMISSI�'N#HH in,
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� p rob2r 6, ` ;./aN i EXPIRES:October 6,2027
" ��`�Q; EXPIRES: fbvg°;
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MAP SHOWING BOUNDARY SURVEY OF
LOT 2, BLOCK 18, REPLAT OF PART OF ROYAL PALMS UNIT TWO-A, AS RECORDED IN PLAT BOOK 31,
PAGES 16 THROUGH 16-D, OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
CERTIFIED TO:
LANDRY PROPERTIES, LLC
CROCKETT LAW, PA
OLD REPUBLIC
LOT 24 LOT 23
BLOCK 18 BLOCK 18
10' EASEMENT FOR
DRAINAGE & UTILITIES
S 07'16'02" E 80.65' (PLAT)
t.0' S 07'20'57" E 80.51'7MEASUREDF
=
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29'
D.0'
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W LOT 2 0
D BLOCK 18W
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m C '_-9,7- 1 4• „I.-COVERED-w ENTRE
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LOT 1
BLOCK 18 / LOT 31.3
/P' ..,,,,_5 ONE STORY BLOCK 18
° BRICK b
w POSTED #475 - 3
ci
300 0.2 /-1.2ar0Lr) _ Q) co3 t�^^� 55.7' ' lC1' tl�^lo iv CV • 1 { 25' BUILDING a)MQt' :.. . • RESTRICTION LINE NNJu Z y A ao
00
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m n N1D8.61' (PLAT)
108.25�(MEASURED) ::.
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BLOCK N 07 0'10” W 80.70' (MEASURED)
N 07' 6'02" W 80.65' (PLAT)
SKATE ROAD
(60' RIGHT OF WAY)
LEGEND:
Q = SET 1/2 REBAR PC = POINT OF CURVATURE
STAMPED PSM/6146
• - FOUND 1/2• IRON PIPE PT POINT OF TANGENCY
NO IDENTIFICATION PRC - POINT OF REVERSE
(UNLESS OTHERWISE NOTED) CURVATURE
•- 4•x4• CONCRETE MONUMENT PCC - POINT OF COMPOUND
A/C = AIR CONDITIONER CURVATURE
—X— = FENCE O - CONCRETE
Ray Thompson REVISIONS
SURVEYING, Inc. DATE DESCRIPTION
Going the DISTANCE for You M1-- CROCKETT LAW P.L.
1825 University Boulevard West L REALESTATE LAW
Jacksonville,Florida 32217
(Phone)904-448-5125
(Fax) 904-448-5178
JOB # 25993 I DATE OF FIELD SURVEY: 1-24-2015 1 SCALE: 1" = 20'
NOTES: CERTIFICATE --7.- ,.
1: BEARINGS ARE BASED ON THE PLAT-- BEARING OF --N-$Z'4 �@ •_E___ I HEREBY CERTIFY THAT THI' , N c %IN&,'64a�NDER MY RESPONSIBLE CHARGE
ALONG THE NORTHERLY BOUNDARY UNE OF SUBJECT PARCEL. AND MEETS THE STANDAR, . 'PRACTICE Ag "-' ORTH BY THE FLORIDA
2: BY GRAPHIC PLOTTING ONLY THE CAPTIONED LANDS LIE WITHIN FLOOD ZONE BOARD OF PROFESSION ••VEYORS.AN® MAPP1.• IN CHAPTER 5J-17, FLORIDA
" X " AS SHOWN ON THE NATIONAL FLOOD INSURANCE MAP, ADMINISTRATIVE Co: • ••DANT TO SECTION 47 ORIDA STATUTES.
DATED: JUNE 3, 2013, COMMUNITY NUMBER: 120077 PANEL D4Q8-11_ .
3: THIS SURVEY REFLECTS ALL EASEMENTS & RIGHT OF WAY AS PER RECORDED / ag
--_ `f _� —
PLAT &/OR TITLE COMMITMENT IF SUPPUED. UNLESS OTHERWISE STATED. NO
OTHER TITLE VERIFICATION HAS BEEN PERFORMED BY THE UNDERSIGNED. ',•AYMOWTHOMP fr
4: THIS SURVEY IS NOT VAUD WITHOUT AN AUTHENTICATED ELECTRONIC SIGNATURE REGISTERED SUR •44,.' FIND MAPP,E' 6146 STATE OF FLORIDA
AND AUTHENTICATED ELECTRONIC SEAL. LIC `CI.=S'9.W-p • . 7469
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LAND SURVEYS 0 CONSTRUCTION SURVEYS 0 SUBDIVISIONS
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