Loading...
Permit Fence 2010 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 Application Number . . . . . 10-00000974 Date 8/13/10 Property Address . . . . . . 315 12TH ST Application type description FENCE PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc Oft fence ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ RUEGER, THOMAS & LAUREN BEST FENCE CO OF JAX INC 28 17TH ST 886 AIA NORTH SUITE 5 ATLANTIC BEACH PONTE VEDRA BCH FL 32082 ATLANTIC BEACH FL 32233 (904) 543-7743 (904) 806-2749 ---------------------------------------------------------------------------- Permit . . . . . . FENCE PERMIT Additional desc . . Permit Fee . . . . 35 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 2/09/11 ---------------------------------------------------------------------------- Special Notes and Comments Roll off container company must be on City approved list and container cannot be placed on City right-of-way. ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 35 . 00 35 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 35 . 00 35 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. t" �3 `t CITY OF ATLANTIC BEACH _.L,..,.. .L...._..�_ I,.....__..I ,' J BOO SEMINOLE ROAD,ATLANTIC BEACH,FL 32233 09- Q n OFFICE:(904)247-5826•FAX NO.:(904)247-5845 BUILDING-DEPT@COAB.US Ftv , BUILDING PERMIT APPLICATION DUVAL COUNTY 1.'JOB ADDRESS: . ?- 2:VALUATION OF.WORK: 3.SQ.FT.UNDER ROOF 3iL4 .4.LEGAL 5.CLASS OF WORK 6.USE OF STRUCTURE: ❑NEW BUILDING ❑DEMOLITION ESIDENTIAL LOT_BLOCK_SUB DIVISION ❑ADDITION ❑CONVERTING USE ❑COMMERCIAL 7,DESCRIPTION OF WORK: ❑ALTERATION ❑ACCESSORY BLDG. B:FIRE SPRINKLER: ❑REPAIR 11 POOL/SPA ❑YES NlA ❑MOVE NtOTHER ❑NO PROPERTY OWNER: CONTRACTOR: ARCHITECT I ENGINEER: 9.NAME: 15,CO PANY NAME: 23.COMPANY NAME: �d 't L oen (2ud- .�' ✓I o. cF x U 16.N�ME�� �r r�t 24.LICENSEE NAME: 10.ADDRESS: 17.STATE OF FLORIDA LICENSE NO.: 25.STATE OF FLORIDA LICENSE NO.: 315 1 Vj s-I n r ` � 23' 18 ADDRESS' 26.ADDRESS: e- ( �I }0<1 g-o,c-2"f,r (2,4 Jac�sn�,Ile I Ft 3ZZS�i 11.OFFICE PHONE: 12.FAX NO.: 19.OFFICE PHONE: 20.FAX NO.: 27.OFFICE PHONE: 28.FAX NO.: Gr'x�-v- T-1,445\ tom.2�f3- I to3 9u�1.7 3t1.2, $c 13.CELL PHONE: 21.CELL PHONE: 29.CELL PHONE: 1 Bio+ Zi"). 14.EMAIL ADDRESS: 22.EMAIL ADDRESS: 30.EMAIL ADDRESS: �&L*vi-rvtc•�ask .C'oY►� InfvQi�tstknt e �k. net FEE SIM TITLE HOLDER: (IOTHERRTHAN OWNER) BONDING COMPANY: MORTGAGE LENDER: , ... .. ...: '>fF . .'.�. s 31.NAME: 33.NAME: 35.NAME: 32.ADDRESS: 34.ADDRESS: 36.ADDRESS: 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 laws regulating construction in this jurisdiction. This permit becomes null and void if work is not commenced within six(6) months, or if construction or work is suspended or abandoned for a period of six (6) months at any time after work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs,Wells,Pools,Furnaces,Boilers,Heaters,Tanks, Air Conditioners,etc. OWNER'S AFFIDAVIT-I certify that all the foregoing information is accurate and that all work will be done inc pliance with all applicable laws regulating construction and zoning.1 will not occupy or use the referenced building or any part therof, until cti are finaled and prior to obtaining a certificate of occupancy or completion issued by the building official,as required by law. *** WARNING TO OWNER: *** --w 46 &UPY YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION, IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTa OF COMMENCEMENT. r k r;' OWNER or AGENT NTRAC70R �`.,','r�'a)(If�Agant,Powe[of Atlomey of Agency Letter Required) (Qualifier Only), Signed: / Date: 6 1l7 Signed: Date: Before me this 4--day of 2009 in the county of Before this _day of 200 in the county of Duval,State of Florida,has personally appeared Duval,State of Florida,has personally appeared herin by himself I herself and affirms that all statements and declarations are herin by himself/herself and affirms that all statements and declarations are true and accurate. true and accurate. N�ry Public at Large,State of FL County of A 4 Notary Public at Large,State of_ - County of PersonallKn y own 13,96rsonally Known {� ❑Produced Identifcati/qnOe►��� Produced Identifcation Notary Signature: 1 J/ N �t"� Notary Signature: DONNA MY COMMISSION#DD675145 M DOANE BLDGO1 Permit Application Bldg:REVISED:12/18/2008 * *. ". EXPIRES May 16,2011 407)398-0153 FloridalloteryService.com F W p W Y U W w W Q Q OJ N W F m O O� � zn � F- UQO 00 � Opp Ln C/)� W U z --� O J O _ QpwF- Q D: z F CjNQrQ OOQ � Ww wZ WJ W (n F- W OZi ��O mOQQw _Z O �z z Z F W O W BYO W JNA Q Q F - �cr t1 C) J � wcnNwp0 �. D =m o W z z 0 "E 135.00' a-0o } ,"',DoQo0Wo"' S06'1a00 = UJ p cO `L c d W wU _z _ Y d p O U - Q w z p rn O F zzQ cn0wt-N d ` p Q = S� Q O W m F Z 5.9 r m� O >F m 3 z U w Q p o F-O m Q p Z O w F- �; M 39.3 QW JzpQ0O �Qpp 19.5 d- WJ LLI d O_m O m Z W O W'W S W p z rq w O _ 7, `� J � N r -O = U F- c) z p vvy"-----����- J n Q N > 0 J � Z W::) W' Q W Q W O O W 0 0 C) L:J W O Q ZD � N � Z 7 0 p�- Z m W � S d �. p J NO > -j Q W p F F W> 3. � O(npW:DZDf (n U- W Li > :-jry 2 Q mUpZ -QO C U W W Z ^� W O U p LW E � 0.7� F- D Y Qm U � ZQ Q Q OZ pZ O D L, m0 _U W (n (n S W Z F- F- Q Z Z WO m Q L,J 0C) pz Z O N 00 wQ z Q1) w- M 13.5' O d�`- V J _Z F- MO F- F- M Z w d O p Zr S � Z QJm n 13.0' F w Z < < f 7 W a- O z- 0 L, Z O cv O O� � Jzt,W_ OQO< �0 35.7' ~ z FU-- (n ED n- c �; Q O O C >© Qf - :E CN - W _NJ z9 ;l � - - N01*08'54"W 107.40 ' > oo N F- Qpz O NN01'09'30"W 107.51' FELDoz O a Q CO r` WJ z � 00 ;o �mcoop - LJ Szdam Q 0FSp � zp �jN�m zOw0O Q� I ZQ N -�Q Z zOF-- -C W 0' O F- p N Z U Q W m <z0 = Q W (_ c n Z �w� J Opp J0Z F- p -T 00 Ln � mN ~ Q ._0�Z o N <> u- (n �pQ W N pcO d Q F- O W Q� W W O Z O} M 0 ZQ SQ p LLJ o 0, �� �� z Y U ZZ Ln z N w OJ O � Z = ^ coF UOp -j< <Q > C7 FAQ QO F- m j r =af w 0 Z J U uic� J Q CL� oz - CA ;I NwL`� �pi� s � >� Smw p O d o Q �r p Q C) ~af w 9L'C�s3,.8b,�ti.SON ObOHO p w � > U ° Z J Z L W O - -- — S8l snlQy� J O F- Q Z p OOc ZpWOG' oo = Wp Jz0 �o = a=� D ~ vQizgo� ),VM �01HOI�I 0 m ~ L` j o ; Wow cn> (IV l8 �N al 1S d8)i�Ibn p� -3,,66,6O 1 L LL- N l O _ N z \�� z 0Lv J J `t O N p z V LL w O W 1m C) W w D Z z m 0 DL Z �j n , LLJ Ljjw w tF- ,jwLjj F- LIJ = Z Q � o LU m N L' � 'a z '61p a oa Q_ oa- 1 39 2' p p - 1� o w o w L<i Q Q }O '� O ¢ U') � / 00 C/,) � >- J D W vi U r V o } � 06 U) w cV z Lf J a N �� -tea � Q o ¢ - 'z 0) *03 V) < zELD O o r- o O O o li Ln Q U U rn q 46.9 m ` 1 ^t W V, � Q 5 Zo Z 35.05 W �:� o < 23„ N z w 0 �� X06-16 31 35.07' FIELD ;am N I� U o� N' 1 �U 0 w Li> .d. W �a ui Z ¢ W > � r II o � � ` Q z �� o ¢ i i6' o mw z oU (n �I N D C,Q J p w w ,rn p za n Zom zw �_ W L� 0, ¢V F Q00 F Z Q m C] 0 Q z J U) p U r. z V O w y o <t LL o Of JOQ QJ 1 C!f 0. 0 w � 0 - O _ > oa a a 0 L - ¢ � L Q U1 C-1 Cl- Qw = mL, Dor- D ¢ �� > wp (n o� Q zo m z � Ln U :�j r m o w C,c L" v (-) ¢ UQ z LiC� Li -i �- 2' �` J i 2 www SUC' S C!1 LJ Z ~ J N n ¢ p r z Q r Q U JLj j U o � o Q In w ODN ' � wwta-) O_ mwQ o Cl- zv i w ~ CffC) � Nz o GZO�J�D� v' o�z z �XzC)— > ¢� a Z Q Y -w" 0 L C) W U Wz W QZ O z �Ww Q m zL(i UOpN N C,U U 0 F Q� 15 U Q � N O O wU � zQ0- _ o Z C> w Q U Q I- W W L, W J (n I- W OZo - wzzoOww 1 �W w -JWQ g a W� cnQ JwNLiO g'00"E 135.00' __- �n _ o Z z S06`1 a� QwC)0 Qp0 a-cn- �- r r � � OO -' F- t a `iZ zwa � Qo i NUCi O � VO Z QL� 0Orn = 0 F ZZQ V) 0 - F- Lo5.9 Q w >- Li Z >"m� Ojam ZUoLJ< 393 0 QV) - z 19.5' d QG` } UOW O > f- QOU ) Ln W J J z wa Q C_n OU _q1 TAW t� Z W CD O W = WD Z �W O J n Q V _jPOO � aJ a' zWmE J a- t-`- <Q � H � Z L)0 LLJ o o W Q(n O W z p p a . z m LJ Li Li O(n p wJZ > �Q Wp ( NQ YJ W Q > Z T W Z O Z W Z p W afar -� m V Z O 0.7� D JV W D 0U 0 , 5 M O �� m0 � tnd] U QZ� > �Cj a C) � J o <E W � ZQ QZ Z Z 0 C N �w � o�0O 0Qz 13.5' CL p 0 LWQ Z QO -C7 M Z t- mcn H (n Z t w co 13.0 O Z ? _ ly Z Q J Z Q5UZ N r Z x Q `EE LLJ C) 0 °' 35.7' F J Q FD-- }. z LL 0 Q Q �.. QU uo CEON Fzo > Z O C X o Seto W ~ (n > Q� oi LLJ UJ o CD Q WLi o CN Z O 10 o p o __ ) N01'08 54 W 107.40 �o Z p O w� O Q c O 0 a, N01'09'30"W 107.51' FIELD W� zw�U - rt Nln Z O Nm, V) O >L- Z * ri ;tW QQ J .ten (7Q Q OOino �m Wo,z—, ovwv = .zW -Z a nCL m U) p twi a � C) _j ¢ U O 0 ¢ I Z< C-4 W z OZ O IQ m " Q �o0LJ�QW � Z � WN �� s� � � � L-w = oWN_ o o oO p JUz Q -r p O� JJ �w m=J ~ --�Z o1 VO FQ - } W H J cnr NOQ W Ln p to Qi- O wQ� W w oZ o}- � �� o 0 w � zQ =< z, �NrbGY 0 Q 0 0 ~ ~ V Y V 7 Z U Y OF n O OO O d 0 0 z S o O (n H Q > Q CD J w> Q� z v= nG -j Q = N G_ p LjLd S = Q Q W �`S F o F Z > CC � V) � J3,.8b, ,S Un Q O Q 6 > z u v - J- — 'LS'S3l S01gv 8 ObOHO Q W JU Ja N=0 _r--'---'- - rl Z wO < = W a 0 0 0 0 -_ O� HW F = QW `�- �- w O 3:a F-- Co z_ Q Q .IHM 30 1HO16 H1alM 3-eVj' jb/1 �Z -__ Of L,T o D o0 �w -' Lo>w (idld AO 3NHl 1Sd3) 0� a m Z 0 w 0 W � V oil \ L L!._ N ^ p i 0 O Z �s M N 1 F" Z g' 'S otf w - m O z 1=m O W s wLLJ Z z m { a m CIO z Lij V) ' LTJ W z F-- °- W LLJ+ic w Q m a t= 0 < c NO � oQ p vc� 39 2' O o w o N oz 'Z � - n � � Q0 � Z) w U 1 \ 3; p > t , \ (I1 go .arJ o Z 0 0 p r (n z 0 J \o NOv) z1 000 � p a � � ti O � Loi > _ U 1 X6.9CC m U) W IJ Z C 5 om Q U' W100 3Noo.15 2o W 35.07' FIFLD Q\� -4::lull Z W N' O ?- = Q J Q Q J p a ' �- --� U O 3 W > w [Ifrn z Of 0O0 Z Z o,- o = a ��N Z mF- w Q : Q h LC) O ZO _! z Op m wLLJ 0 � tL = c/> LtJ Q v O 0 a p U F z < m 1 i O �O, w z � > zn aW ¢ W Q to O v` � OQ DQ D Q C7 � � �Li F- O r Q Q Z m 0 Z Cf) CjID ' Sr 1w W ` � O0 � cUn Q Q `nL'f LV CL L � �-= 2 z -i - W i w O / F L z Z Ul W Z r w a r O � r ZQ Qa- QLLJ V Q cr> . U � O � �j O C) 0 <Q u g~a0 u o�OD �� a � F�- moo � o � o, pb-Q� CL ZnN cn �LLJ � oZ �� � ��z Q ,/ V' y z Q w�,� :) Q ¢ m N GPO�� ooz z oXmo � j ¢o Q m zw Y 7- HUU-4-2010 16:12 FROM:CLERK OF COURTS 904 270 1512 TO:92475845 P:1,11 at�03:20 2010181580, OR IM IS327 page Ft=.BR 0ARK CIRCUIT O1COURTOWALpCCOUR 7[1 RECORDTNGeck$10VYfcvr• OO NOTICE OF COMMZNCEMZNT Permit W. Tax Folio No. State ofFludda,County of Duval TM UNDERSIGNEI)hereby give nuke that tho improvement will be wede to eerWo real property in accordance with Chapter 713,Plorids,St ties,the following information is gwvided in this Notice of Commencement. I. Descripaont f� potty(lege d enrApn of rropetry and address if available). Zr !t3 i•l& Ruck 1r1L, _5"3 2. General Description of improvements: 1L pf 4'fru 11 g 1 goto um &11a da kM- ,ns�(11 of 44 bJ92trafttI Asrmt r� 4-af4bgXa�- 3. Owner information: a)Nara sad Address.-ro-A t L4Ltwftn RveqA--r Ain [Z"''k 5+. ��t 13e�•, .3ZZ3� b)Interest in property c)Name and addmeas of simple tMehoidcr(Vother than owner): 4 Contractor Information: a)Name and Addtcss: 09W RAU tb 0(jkg I A t- 54>4 44A_-rra r-OW J&x f'L.3225.4 4 b)Pbone Number:_ 1,J �dlt�ll+ S. Surety Information: a)Name and Address: b)Phone Number. c)Amount of Bond:S 6. Lender Infarmationl: a)Name and Address: b)Phone Numbs; 7. Persm within the State of Florida dosignsted by owner upon whom Notices or other documents may be served as ptovided by 713.13(Ixa)7.Florida Statutes: a)Name and Addroa9: b)Phonc Numbers of0csignated Fenian- 8. In addition to Wunselti'berself,Owner designster Of to receive a copy of tele Licnm's Notice as pnsvkkd in Section 713.13(1)(b),Florida Smtl,tca. a)Name and Address: b)Phone Number of pel w ora oily detigatad by owv1Q: 9 Egna ion data of Notice of Commence neat(The expiration data is one(1)yeas final the date of Rocordiag usam a different date is specified: WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER TUB EXPIRATION OF THE NOTICE OF CohQaNCEbMNf AIM CONSIDM MV DePOPER PAYMI3NTS UNDER CHAPTER 713,PART b SECTION Mil, FLORIDA STATLRE4, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY.A VOTIC>v OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE 108 SITZ;BEFORE THE FIRST INSPECTION IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCiNO WORK OR RECORDING YOURNOTIC.1'OF COMMEN O Signature of Owner or Owner's PrMad Mamd&Titlel0flice DONNA M DUANE +5 MY CAlia�tlSaltau t<ODarar�a Tho fore artAgti6)'1li�cd fore me this 4 day of u s .20 by for • Paean) (&R;ifiy Type,Fc, u-rAaemoy ane a""1nsuuiint was Rxaeuled tor) City of Atlantic Beach APPLICATION NUMBER �' t+ Building Department (To be assigned by the Building Department. r 800 Seminole Road _ Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 - Fax(904)247-5845 "?oln9' E-mail: building-dept@coob.us Date routed: City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: TRY Department review required Yes No Applicant: C (_r6 61 � nning &Zonin Tree Administrator Project: '0 ublic\qqo n lic.Utilitie ub iT c5afie�ji Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified B Florida Dept.of Environmental Protection Florida Dept. of Transportation St.Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: [Approved. ❑Denied. (Circle one.) Comments: BUILDING / PLANNING &ZONING Reviewed by: Date: TREE ADMIN. Second Review: QApproved as revised. ❑Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: []Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05/14/09 City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) r 800 Seminole Road jJ Atlantic Beach, Florida 32233-5445 / y Phone(904)247-5826 - Fax(904)247-5845 ^�5$3 E-mail: building-dept@coab.us Date routed: �r City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 1� lz d��.e� Department review required Yes No Applicant: C Lr6 0 . nning &Zonin JTree Administrator Project: TZk22 ublic Wor Crk Lic Utilitie u is aey Fire Services Other Agency Review or Permit Required Review or Receipt Date of Permit Verified B Florida Dept. of Environmental Protection Florida Dept. of Transportation St.Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: Approved. []Denied.(Circle one.) Comments: BUILDING LANNING &ZONIN � �aO Reviewed by:_o�l,l� �,� �Date: TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: QApproved as revised. []Denied. Comments: Reviewed by: Date: Revised araK4tQ3 City of Atlantic Beach APPLICATION NUMBER �• ;� Building Department (To be assigned by the Building Department.) `v 800 Seminole Road 9 Atlantic Beach, Florida 32233-5445 J Phone(904)247-5826 - Fax(904)247-5845 Date routed: E-mail: building-dept@coab.us City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: A,5�- 12 T� Jerk Ct, Jannn artment review required Yes No Applicant: �6 �9- g &Zonin Tree Administrator Project: I ublic Works--�� u Iic Utilitie ul tic S-a el Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified B Florida Dept.of Environmental Protection Florida Dept.of Transportation St.Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: Approved. ❑Denied. (Circle one.) Comments: BUILDING PLANNING&ZONING Reviewed by: Date:�D TREE ADMIN. Second Review: QApproved as revised. ❑Denied. P WAFETY Comments: PU LIReviewed by: Date: FIRE SERVICES Third Review: [—]Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05/14/09 Public Utilities Plan Review Comments Date: g�s(� Initials: Project Name/Address: 3 15 /�- ► Application Permit#: :Check Boge Application Tracking Comments to Add .Comment Avoid damage to underground water/sewer utilities. Verify vertical and horizontal location of utilities. Hand dig if necessary. If field coordination is needed, call ❑ 247-5834. Ensure all meter boxes, sewer cleanouts and valve covers are set to grade and ❑ visible. A sewer cleanout must be installed at the property line. Cleanout must be covered with an RTI concrete box with metal lid. Cleanout to be set to grade and visible. A reduced pressure zone backflow preventer must be installed if irrigation will be provided or if there is a private well on the property. Backflow preventer must be ❑ tested by a certified tester and a copy of the results sent to Public Utilities. Plans note the building will be unsprinkled. If plans change, any fire line installed must be metered with a Sensus touch-read meter in a properly sized vault and an ❑ appropriate backflow preventer installed. Backflow preventer must be tested by a certified tester and-a copy of the results sent to Public Utilities. If fire sprinkler system is provided, contact Malcolm Clemons at 247-5 83 9 for backflow requirements. At a minimum,will require double check backflow ❑ preventer. Fire lines must be metered with a Sensus touch-read meter. Meters larger than 2" ❑ must be installed in a vault as noted in JEA specifications. CITY OF ATLANTIC BEACH ~- 800 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233 09- I � ` I .I n OFFICE:(904)247-5826•FAX NO,:(904)247-5845 J " BUILDING-DEPT@COAB.US t,v BUILDING PERMIT APPLICATION DUVAL COUNTY 1:`JOB ADDRESS: 2t.VALUATION OF WORK: 3.SQ.FT.UNDER ROOF Ad P LEGAL DESCRIPTION: �� < 5..CLASS OF WORK'` 6.USE OF STRUCTURE: ❑NEW BUILDING El DEMOLITION RESIDENTIAL LOT-BLOCK_SUB DIVISION ❑ADDITION El CONVERTING USE El COMMERCIAL 7;'DESCRIPTION OFWORK: " ❑ALTERATION ❑ACCESSORY BLDG. 8r.FIRE SPRINKLER. !t Z�` i `1 Cv � ✓ -^u ❑REPAIR ❑POOL/SPA ❑YES NIA ❑MOVE OTHER ❑NO PROPERTY OWNER: -`CONTRACTOR: "; ARCHITECT!ENGINEER::' 9.NAME: 15.CO PANY NAME: 23.COMPANY NAME: U 16. AME: 24.LICENSEE NAME: 10.ADDRESS: 17,STATE OF FLORIDA LICENSE NO.: 25.STATE OF FLORIDA LICENSE NO.: 315 IZ-r"k 5+ h+ _ fi.G 6c-4p1. 3Z-7-333 � 18 ADDRESS 26.ADDRESS: 3a I,,Il p I�Z-, 3LZS`► .C11.OFFICE PHONE: 12.FAX NO.: 19.OFFICE PHONE: 20.FAX NO.: 27.OFFICE PHONE: 28.FAX NO.: Ev PHONE: 13.CELL PHONE: 1 21.EELLL PHONE`� 29.CELL PHONE: 14.EMAIL ADDRESS: 22.EMAIL ADDRESS: 30.EMAIL ADDRESS: �aatn_f vt CSX .C�aYY► cnQst4nc� �k, nit = HOLDER: s FEE. IF OTHERTHAN TITLEowNeR) BONDING COMPANY; MORTGAGE LENDER 31.NAME: 33.NAME: 35.NAME: 32.ADDRESS: 34.ADDRESS: 36.ADDRESS: 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 laws regulating construction in this jurisdiction. This permit becomes null and void if work is not commenced within six (6) months, or if construction or work is suspended or abandoned for a period of six (6) months at any time after work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs,Wells,Pools,Furnaces,Boilers,Heaters,Tanks, Air Conditioners,etc. 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. I will not occupy or use the referenced building or any part therof, until all inspections are finaled and prior to obtaining a certificate of occupancy or completion issued by the building official,as required by law. * WARNING TO OWNER: * * YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTI E OF COMMENCEMENT. ,, � ;;u,.�r���.� WNERorAGENT , •. `,„ NTRACTOR:�; �1 6. a °(If Agapt,Power of AHomey'o�Agency Letter Required) ! ?' "'° (Qualifier Only) I..i Signed: / C; Date: � �V Signed• Date. �b Before me this�day of k 2009 in the county of Before this day of 200 in the county of Duval,State of Florida,has personally appeared Duval,State of Florida,has personally appeared herin by himself I herself and affirms that all statements and declarations are herin by himself/herself and affirms that all statements and declarations are true and accurate, true and accurate. _/ NVry Public at Large,State of Fl County of A Notary Public at Large,State of�,County of personally Known rsonally Known E,Produced Identificat BeProdumd Identification- Notary Signature: �r_� �C./�-� Notary Signature: OANE * *_ MY COMMISSION t DD675145 %-Mbl Permit Application Bldg:REVlSE0.12f18(2008 EXPIRES May 16,2011 (407)398-0153 FlorldallotaryService.com