494 SELVA LAKES CIR RFNC24-0042 - BUILDING PERMIT APPLICATION FOR INTERNAL OFFICE USE ONLY
'. Cityof Atlantic Beach BuildingDepartment /� /1
r PERMIT# I I--NI `l-V0�
800 Seminole Road, Atlantic Beach, FL 32233 **ALL information required to process
`<::_,Dr:'`' Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address 4CH ✓AL.A6ite_5 e ig RE# ,7t&7 Sr
Legal Description ///-S.-S. 17- 2,_,2496: SEC✓ALA✓3GS ( Z2,,
Valuation of Work(Replacement Cost) 'St() Heated/Cooled SF Non-Heated/Cooled SF
•Class of Work: ❑ New ❑Addition ❑Alteration cakepair ['Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial 7Residential • If existing structure, is a fire sprinkler system installed?:❑Yes❑No
• Will tree(s) be removed in association with proposed project? ❑Yes (Must submit separate Tree Removal Permit) P-No
Describe in detail the type of work to be performed:
2 ems'p 'tit> ;-g---i 1 ;:7.Act- n,C t.J 1.J 5A14-9gz,> 5;y/tr 41T�1 L rr=e,-.,e-C
Florida Product Approval# (For multiple products use Product Approval Information Sheet)
Property Owner Information Name 4... 71.,4 ;Q_1,; (...)6,4„,1/(1 Phone9,5/y7A 9J
Address � S�G(/A L-A/its di e___e___ City /-7/.. C acw, State `L Zip �? 2_3
Email Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information Name of Company E./(1CI -en1CI QC(A: f-C9 APhone (,12 ' 77
Address (,I 114,41:7,_9(—t.ce y prz,e-s-L, P /J City •,1 4e,/�JA../ii(,`e_ State C:=L Zip 12Z-
Qualifying Agent J(0r‘.) t azejA ( I-1; State Certification/Registration#
Email )404 L--��D 76i C/1'7,4/(,_ eit rvr Job Site Contact Number gL 7L/,::Y 7 ,s-----
Worker's Compensation Insurer / ,-,-T 1 OR Exempt ❑ Expiration Date S 'z
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
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
a bz.)1t __ - ..
(Signature of Owner or Agent) Ci,en, h-O ).Rar re f Contractor)
Signed and sworn to(or affirmed)before me this Cs day of Signed and sworn to(or affirmed) before me this Co day of
/11ReL_N , aQay by SSiCd 4l�ld)it 4MA�LN , o;Oo 'i' by s ' SS/Cc4 A/ t-v,Si-
Signature of NotaryJ.43 /� Signature ofi.
/t g e Notaryl ��
[ ] Personally K wn OR [4 Produ d Identification [,4PersonallyKnown OR [ ] Produc-d Identification
Type of Identification: b „ ,..,..: Type of Identification: Public State of Florida
+P lessics A DOiouisl as,ca • •: u
• MY Comrnissb^HM 147217 : My Commission HH 142217
•
10,E^ar:
Expires 0i,t dr2025 �br wde Expires 08,14/2025
Fence Addendum Updated 1/14/2021
,._...' 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:
LJALA —5Cfe _ x119/2c1
Property Type: Lot Type/ Features:
Z Residential (One Street frontage (interior lot)
❑ Commercial ❑ More than one street frontage (corner lot, through lot,
etc.)
❑ Swimming Pool
Fence Material: Fence Height (select all that apply):
Wood Four Foot (4ft)
� .,❑ Chain Link ❑ 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?
❑ Yes (must submit separate Revocable Encroachment Agreement)
3/N o
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.
r 1u►-31-03 01:14am From-Washington Mutual +T27 523 4605 x_225 o nnc'0 7 r. 77
_,. _ — .. .-Iv - I ‘ 1 ..) _ VG I Vr
LOT 26, SELVA'LAKES, AS RECORDED IN PLAT BOOK PAGES 55 AND 55A
OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
,,EL V,4 l('Imo`- �oc�l of(d
LAKES CIRCLE
60'R/6HT-OF-11/AY
Found_%J7'iron Pier
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NOTES
BEARINGS ARE BASED ON THE WEST LINE OF LOT 26
AS BEiNG N.06.18'00"W.BY PLAT.
NO BUILDING RESTRICTION LINE BY PLAT.BUT THERE MAY BE
RESTRICTION UNES OR EASEMENTS THAT AFFECT THIS
PROPERTY BY ZONING OR RECORDED IN THE PUBLIC RECORDS
OF THIS COUNTY THAT ARE NOT SHOWN ON THIS SURVEY.
THIS PROPERTY LIES IN FLOOD ZONE"h'BY FLOOD MAPS
REVISED 4/I7/I98D, COMMUNITY PANEL NO.120075 0001 D.
I HEREBY CERTIFY TO: ANITA L.ABDULLAH
FIRST AMERICAN TITLE INSURANCE CO.
PEOPLES FIRST COMMUNITY BANK
THAT THIS SURVEY MEETS THE MINIMUM TECHNICAL
STANDARDS AS SET FORTH BY THE FLORIDA BOARD OF
PROFESSIONAL SURVEYORS AND MAPPERS, PURSUANT TO
SECTION 472.027 FLORIDA STATUTES AND CHAPTER
LAND 61G77-6 FLORIDA ADMINISTRATIVE CODE.
77
SURVEYORS INC. 1(1
�-�
LB 6645 PROFESSIONAL LAND SURVEYOR NO.1674 FLORIDA
H. BRUCE DURDEN. SR.
1 103 SOUTH THIRD STREET DATE: NOVEMBER 7, 1996
JACKSONVILLE BEACH, FLORIDA 32250 SCALE: I"=20'
(904) 249-7261 FAX (904) 241-1252
This MAP OF SURVEY /5 NOT VAL/O ANO MAY BE USED FOR-INFORMATIONAL PURPOSES ONLY UNLESS IT IS SIGNED
AND HAS THE ORIGINAL RAISED SEAL OF THE FLORIDA LICENSED LAND SURVEYOR WHOSE NAME IS PRINTED HEREON