151 SEMINOLE RD RFNC24-0044 ►i' BUILDING PERMIT APPLICATION FOR INTERNAL OFFICE USE ONLY
• s City of Atlantic Beach Building Department PERMIT#�F���"� !�(l-t�"'
c+�,. 800 Seminole Road,Atlantic Beach, FL 32233
"ALL ALL information required to process
-.if,i Phone:(904) 247-5826 Email:Building-Deptpcoab.us
Job Address /F/ cY 'r')lA'QZ — RE# I70609-0006
Legal Description
Valuation of Work(Replacement Cost) V7/ Heated/Cooled SF Non-Heated/Cooled SF
- Class of Work:fNew ❑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 pe rned ,
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Florida Product Approval# (For multiple products use product Approval Information Sheet)
Property Owner Information Name ,/ / s Tye c)E.L I Phone ?L ?SE (5OX--
Address /37 � �)7 ., ifi/c/�
,� � �' �dL>✓ City State-1Z—-Zip
Email Owner or Agent(If Agent,Power of Attorn or Agency Letter Required)
Contractor lnformatio Name f Company ( N,g j[.1D� Phone W7�-7p1D�Address JV/y- /J ) P�`G /[/ City J State -1-1--Zip j 2G
Qualifying Agent y6 Zo /3 �i State Certification/Registration#
Email / i)06 "15.7/ /7/ 4R) oz., 7/yt lob Site Contact Number W/ 7 ? eco /
Worker's Compensation Insurer 8 Q1)6 lf-i,-1 0 (1f-5(7.451)feq0R Exempt El 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 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.IF YOU INTEND TO OBTAIN FINANCING,,CONSULT WITH YOUR LEND OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. -"
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�� (Signature of Owner or Agent) c..., 6.#1.XA---- 4 ,7
(Si ure of Contracto
Si ed and sw n to(or a med)b•.ore me this L O day of Signed and Tom to(or affirm-I)before me this l day of
Z 4-by el, .A _ LISOL A iv, rck_ . , by
Signature of Notary e a \ Signature of Notary 0 4,d 0
[ ]Personally Known OR [ ]Produced Identification 19ersonally Known OR [ Produced Identification
Type of Identification: 1 _ L Type of Identification:
��t AMANDA DO'+YNS 1)
:T "94 -' • • •- MY COMMISSION q HH 022311
'' t':. TONT GINDLESPERGER
II �= MY COMMISSION#HH 407122 ;�5` • EXPIRES:November 16,2024
,;r: o?:Y EXPIRES:October 6,2027Notary
)F F� •o• •'!�`,oF���'•• Bonded ThN Public Underwriters
7;:::'--:'',,,,,; Fence Addendum Updated 1/14/2021
� �.x... j' City of Atlantic Beach Building Department
f--
% 800 Seminole Road, Atlantic Beach, FL 32233 PERMIT#
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: Date:
n
,, is)/ ,___(<-91-11 t10( .) P-Ci-- --E3 •_) 0 2.0 :7 LI
Property Type: Lot Type/ Features:
esidential / 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):
�od &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)Ye
Will tree(s) be removed in association with proposed project?
❑ Yes (must submit separate Tree Removal Permit)es
ge
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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