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125 8th St RSO24-0034 �c-y BUILDING PERMIT APPLICATION FOR INTERNAL OFFICE USE ONLY /3 I, City of Atlantic Beach Building Department p r) PERMIT# RCS©Z4 - 0034 �-1;1800 Seminole Road, Atlantic Beach, FL 32233 **ALL information required to process Phone: (904) 247-5826 Email: Building-Dept@coab.us Job Address /d g 1" S - Alleo lt- 4c.C' Fl RE# 170 3 Z Z - 0000 Legal Description /11vvC 4 l eplcr(c e rrs'f <v/CfC'/e d-pivs X Valuation of Work(R lacement Cost) C y o J Heated/Cooled SF Non-Heated/Cooled SF •Class of Work: [r New ❑Addition ID Alteration ❑Repair EMove ❑Demo ❑Pool ❑Window/Door • Use of existing/proposed structure(s): ❑Commercial ❑Residential • 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) ❑ No Describe/�� in detail the type of work to be performed: (Drn° d- IeP>cet 0) . Co(^cre-e a- /,'a-V1uctCJ--) j0,4,.- $ v--i-. Ajc,_/ freA►i(u^ ✓Vie i c)^ d)ee, e [a e (d 4,4., vA^ PA-1-k/.'1 o„ti 1, ('"lyn..t.e-1c StA^Z- Florida Product Approval# (For multiple products use Product Approval Information Sheet) Property Owner Information Name C In(le, Eisj o.,' Phone 7o1 _ i•P7ay Address )3,S" --/`^ 5+rPe.1 City ,4,t ,1.].i /'cG(i State Fl Zip Email F,'Gts p,1,Lhr,5 2T/14,/,Cpvvner or Agent(If Agent,Power of Attorney or Agency Letter Required) Contractor Information Name of Company pp,/t Th C ut)/4, Lo,�cre 4�-Prwrr i I le. Phone ,%O - oo-/6G a Address 3 5.9,. ept... )c) C J icl e 5 City -5,..,),Prat, State i Zip 3 s--U Qualifying Agent '5,60,1 t'jv_c'-- State Certification/Registration# Email pAuc c ✓..,7/16 @, t ktloo. C&,,.,, Job Site Contact Number 7e1- jou-/�G /- Worker's Worker's Compensation Insurer Jc jJ l 14-1-, A-\ 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 ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. �L-7 cij-,' vt-,-----(Signature of Owner or Agent) i _Ignature of Contractor) 4,". Signed and sworn to(or affirmed)befor me thhii� day of Sign nd sworn to(or . irmed)b-fore me this d of //�i'��" 2 ' Y L �l�S� /I't/krc'^ iL by L.��1 ��._ .\ Signature of Notary' .�-A .�o,� Signature of Notary _ _a_ ,�— [�Personally Known OR [ ] Produced Identification [ ] Personally Known OR [ ] Produced I.-n'•fication Type of Identification: Type of Ident - _10.............-..—...................................i i,.....--,,, ,,, PYP 70NIGINDLESPERGER 1 Notary Public State of Florida I �: i. MY COMMISSION#HH 407122 _ Kimberly A Murphy 1 --.'c .- y F y6.-.CS . EXPIRES:October 6,2027 1 1111 My Commission HH 469827 I 1 Expires 12/3/2027 MAP SHOWING BOUNDARY SURVEY OF LOT 7. CLUB MANOR, AS RECORDED IN PLAT BOOK 25, PAGE 62. OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA. i CERTIFIED TO: WILLIAM C. EIDSON AND VELVET EIDSON A. VERNON BRINSON MERS (MORTGAGE ELECTRONIC REGISTRATION SYSTEMS, INC.), SOLELY AS NOMINEE FOR TD BANK, N.A. OSBORNE & SHEFFIELD TITLE SERVICES, LLC FIRST AMERICAN TITLE INSURANCE COMPANY I I LOT 4 LOT 3N 85'32'15" E 70.00' (PLAT) b LOT 5 1 - - - 0.5� 03•N 8506'13' E T 69.63' (MEASURED) NAIL IILEGIBDI K — ��0_54_ EASEMENT X0.0. 03 I C 1 LOT 7 r 12_1- 0 O O Jr < I- Q D Of..7ri:/::: cc vi ° v a < 4•, , \\ \ Os oJ LV }-7j_ 5• ° O 1 •••..m 55.3' \ 0 O O o O o \ O O 3_� - A/C LOT 6 1- PAD ONE STORY C fFRAME ° 0.3•, a n POSTED # 125 c, _ W W n . e w LOT 8 - R— ° n Z 0L a $ 3 \ Lig T N Qo I '� in u) 12.0' O O =W N1 p COVERED--"..-c, Vo 20.5' a ENTRY a 22.9' - N Q`? '4- 0 - 4 \0 25 BUILDING7.99 Lil O '� 12.0' RESTRICTION LINE 7 CO Z O .. Z 4' n if a N C.. a • ' 60.09' (PLAT) ^• 60.48' (MEASURED) 14 S 8512'31" W 70.16' (MEASURED) PC BLOCK S 85'32'15" W 70.00' (PLAT; CORNER 8TH STREET (50' RIGHT OF WAY) LEGEND: PVC FENCE --D-- = W000 FENCE —A— . CHAIN UNK FENCE O = CONCRETE o = SET 1/2' REBAR STAMPED PSM#6146 • = FOUND I/2'IRON PIPE NO IDENTIFICATION (UNLESS OTHERWISE NOTED)