630 SHERRY DR RFNC24-0043 J Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department **ALL INFORMATION
Var 800 Seminole Road, Atlantic Beach, FL 32233
HIGHLIGHTED IN GRAY
PLP
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: rp3Us(Sr� ' ` -: Permit Number: RF(;C Z4 v `'4 3
Legal Description 10-1(0 /(7 '2S`,19e 54;c770,-)03 ((J i RE# 17000/- U OUv
Valuation of Work(Replacement Cost) $ `/�S d Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial ❑Residential
• If an 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) ❑No
Describe in detail the type of work to be performed: I C gyp h Fe!-�cc� RAC- A I T NSi9 y',C
471rAwN.-0F-D o~-1 ;-nlam.
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name 1I1I /ham HA I - ` Z t C �i Address (4 ‘) .514-c-e '/ P 'Z
City NT-L 4" — CC ----1(3C,4-4- State Zip 2Z33 Phone cASW 3e2 I 79 U>'.99
E-Mail f,l
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company 33 Ci4t S ^)cc-VCt19i1 Qualifying Agent JO',1.n-rM -" Yetat,'
Address -1a fr1ALE5 i' - C City4acT( 3 va//t.LG State Zip 3z-z-'3
Office Phone c>i 73 s `1-5" 19 Job Site Contact Number
State Certification/Registration# —3- 1 7L E-Mail 73C�c/ E> P-b f r-..4iA/Lt(1171'
Architect Name& Phone#
Engineer's Name&Phone# // /
Workers Compensation Insurer �(���� OR Exempt❑ Expiration Date "( r ! Z<
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 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 YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
XE5O ,QGO ICE OF COMMENCEMENT. g ti
(Signature ofr-1. -r-&Agent) Signature of Contractor)s��r z
Signed and sworn to(or affirmed)before me this c49• day of Signed and sworn to(or affirmed) before me this a 9- day of
FEAe..UP ', , by ess'i -J ' 0( Drat- Rata -21 , det3.4. b Testf' �St�y�5
Qui�>t� / ct,•�
Notary Public State or Florida �y,, ,mNotaryica y PuW1c State of Florida
Jessica A Ddquist `r(. A Dolgwst
• My Commission HH 142217 My Commission HH 147217
[ ]Personally Known OR ‘,...dr Expires Oet14/2025 pi Personally Known OR Expires 420Y5
QrjProduced Identification [ ] Produced Identification "�
Type of Identification: DL, Type of Identification:
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:
Property Type: Lot Type/ Features:
Residential ,4:5 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):
2-Wood ❑ Four Foot (4ft)
❑ Chain Link ,WfSix 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)
, No
Will tree(s) be removed in association with proposed project?
❑ Yes (must submit separate Tree Removal Permit)
7No
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.
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r- SURVEYORS CERT'FICATIONI
'SONE VISIBLE
I hereby certify that this Survey of the lands
atlnl�tt:l ��II tx F described hereon was made under my direct
�'.``�, .ttk� supervision,and to the best of my knowledge •
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;c...-÷ and belief is a true and accurate representation
of said lands and meets the Standards of
Practice set forth in Chapter 5J-15.050 through
4ts,. _.1/ c -.._ 53-15.053,Honda Administrative Code, AFFILIATE
pursuant to section 472.027,Florida Statutes.
PThis survey is not valid without the signature and . 1 MEMBERS
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original raised seal of a Florida licensed surveyor �:
til Ali 01
�RJ't' FI UPA t,�� and mapper,except when the electronic
Cff4 It aURV1`pP signature and seal of a Florida licensed surveyor
and mapper is affixed hereto.
RAYMOND J.SCHAEFER �AXACTA
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DATI OP SURVEY! 11/23/20
FIILO WORK DATIt 71/19/2020 SU PAOI 2 OF 2 FOR LEGAL DESCRIPTION
PAGE 1 OF 2-NOT VALID WITHOUT ALL PAGES
AMMONBAUM REMO 11/23/2020)