Permit Fence 1750 Selva Marina Dr 2012 'ra a L " :14* --0r1
``ry CITY OF ATLANTIC BEACH
A ';' 800 800 SEMINOLE ROAD
.. ATLANTIC BEACH, FL 32233
0 �� INSPECTION PHONE LINE 247 -5814
Application Number 12- 00000519 Date 5/08/12
Property Address 1750 SELVA MARINA DR
Application type description FENCE PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
4 ft fence install
Owner Contractor
ONDREJICKA, JOHN A BEST FENCE CO OF JAX INC
1750 SELVA MARINA DR. 886 AIA NORTH SUITE 5
ATLANTIC BEACH FL 322335618 PONTE VEDRA BCH FL 32082
(904) 543 -7743
Permit FENCE PERMIT
Additional desc . NEW FENCE 4'
Permit Fee . . 35.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 11/04/12
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.
A
" ;
City of Atlantic Beach APPLICATION NUMBER
''�r
fl be by the Building artment.)
Building Department (To e assigned y g De p
800 Seminole Road 410 4? _ /
- -3 Atlantic Beach, Florida 32233 - 5445 x , �
Phone (904) 247 -5826 • Fax (904) 24 -; _: • 5 1d /
E-mail: buildin dept @coab.us Date routed: /2_
'. .�f 9
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND T " ACKING FORM
Property Address: /752 fT/i/L- ' 2774 rtha,- r Department review required Yes No
p Y Buildin
Applicant: , ff.-776,f. tanning & Zonin
�/ ee ministraforr
Project: i/ t � j (', / 716-7)3// - Crublic Work`s)
u is Uti i ie
Public Safety
Fire Services
6 Review fee $ Dept Signature .7.-- . ! ..n ,
Review or Receipt Date
Other Agency Review or Permit Required of Permit Verified By
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: -r 1/ Z
TREE ADMIN. Second Review: ❑Approved 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 05114109
7 :,..5. ,r CITY OF ATLANTIC BEACH D ���; (� I
Cl #" 800 SEMINOLE ROAD. ATLANTIC BEACH, FL 32233 (f
n OFFICE: (904)247 -5826 • FAX NO.:(904)247-5845
�E } M BUILDING- DEPT@COAB.US
• Ti >~ BUILDING PERMIT APPLICATIO MAY 0 ` ; Z®FA S $UNTY
1. JOB ADDRESS: 2. VALUATION OF WORK: B _ ROOF Y
I rf5o & \o Ilf�,►-i ri� VI 7 'e, 14(e00 y --
5. CLASS OF WORK: --......,-- ORK: TURF:
4. LEGAL DESCRIPTION:
0 NEW BUILDING 0 DEMOLITION RESIDENTIAL
LOT BLOCK 9 SUB DIVISION 0 ADDITION 0 CONVERTING USE 0 COMMERCIAL
7. DESCRIPTION OF WORK: ' A L - 0 ALTERATION 0 ACCESSORY BLDG. 8. FIRE SPRINKLER:
l vtSkatl I 1 (/� ( Af r [141 Q� ITl (ilW��u M , (C C ❑ REPAIR ❑ POOL / ❑ YES
J ❑ REPAIR ER r eVICQ/ ❑ NO 0 NM MOVE
PROPERTY OWNER: CONTRACTOR: ARCHITECT I ENGINEER:
9. NAME Y�J
15. COMPANAME: /y��-,',,�`y' / 23. COMPANY NAME:
*Lci-e,t1 tve v � S- r e 630 l O � a 24. LICENSEE NAME:
iI C y^ 16 0 i l•
e 1 .- u S
10. ADDRESS: say l0 17. STATE FLORIDA LICENSE NO.: 25. STATE OF FLORIDA LICENSE NO.:
1 750 l'Y ►�(/�' ►✓(�
31 18. ADDRESSSL�.0)1 I l .-/. /_ll d , 26. ADDRESS:
- A ` �(a , ve c • 322_33 -TT J
11. OFFICE PHONE: 12. FAX NO.: 19. OFFICE P H NE: 2 2 X N 2 T 27. OFFICE PHONE: 28. FAX NO.:
13. C -HONE: 21. CELL CV •J V EELLLL PHONE: 29. CELL PHONE:
'14. EMAIL ADDRESS: . 22. EMAIL ADDRESS: , , A 30. EMAIL ADDRESS:
joa k - h Oat t- e � o� o e b-es eeia.tie
FEE SIMPLE TITLE HOLDER: BONDING COMPANY: MORTGAGE LENDER:
F OTHER THAN OWNER).:
31. NAME: 2 / �, z O O b 33. NAME: 35. NAME:
X 52. AD f / v 34. ADDRESS: 36. ADDRESS:
Vi z- �� i q
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 NOTICE OF COMMENCEMENT.
OWNER or AGENT CONTRACTOR .
If Agent, P • = of Attomey or Agency Letter Required) . (Qualifier Only) .
// 1
_
Signe■i/ 11 .r. a�.,i
.. (/.. 4A Date: , 12 Signed / At., / Date: a ' / - / Z
me this 1
Before day of • 1 . ,-2049 in th county of Bef - a this / day of ii , 2e89.in the county of
Duval, Staid of Flo( a, has personally al). -ared 2.0/ Duval, State of Florida, has personally a speared 2. 1 2--.
�
6.4--k � tht I e_ c. MI*, G k U,b 1 S
hefin by himself / herself and affrns that 1 statements and declarations are herin by himself 1 herself and affirms that all statements and dedarations are
true and accurate. _� true and accurate. � L �1
Notary Public at Large, State of , County o& Io kiS Notary Public at Large, State of'+ L , County of 1. II (J0(1 S
0 Personally Known O ,, ersonally Known
it Produced "'o,- '` I[J' , 0 /� •, 0ProducedIde ' - �_
Notary Signa p . J. t' ,AY/ AMIS Notary Signatuej4Jf J. / 'iINIM " P��
I • v • NDE M EBURN • BRANDB M LBURN
.j
'% ; 1149 MY COMMISSION* EE031149
- re E S 30, 2014
- • „ t EXPIRES september 30, 2014 •
407 398-0153 l`T.on� 07 39 -0153 Florida tvloe.t
BEST FENCE COMPANY OF JACKSONVILLE, INC.
5404 Race Track Road
Jacksonville, FL 32259
904- 268 -1638 OFFICE
904 - 230 -2780 FAX
Enclosed please find, a Notice of Commencement, the Building Permit Application along with (2) copies
of your marked survey, and a copy of your proposal.
Please take your permit application, with your notarized signature and the marked surveys to The City of
Atlantic Beach, 800 Seminole Road, Atlantic Beach, FL. 32233 for processing. Application process
typically takes one week.
Once completed please take the permit and survey copies along with the Notice of Commencement,
signed and notarized to the Clerk of Court office location listed after filing your permit application to file
the Notice of Commencement.
Duval Co. Clerk Of Court Office, 1543 Atlantic Blvd. Atlantic Beach, FL. 32233 904 -1
Upon approval and receipt of your Permit and NOC, please fax /email /drop off copies of the permit
and notice of commencement for our file, so that we may move forward with your installation process.
Thank you. If you have any questions or concerns, please don't hesitate to call us.
Sincerely,
9 341/HILICA / 24 ' 2 " ----
Brande M. Eburn
ARB /Permit Coordinator
Best Fence Company
Phone: 268 -1638
Fax: 23o -278o
beburn@bestfencejax.net
01 3O -
. . tit /v I'M'/
5404 Race Track Rd ........ .......... ... .0ilice (904) 260
D -. Jacksonville. PL,32259 .Fax (904) 230-=27,80
i D E$: [A, LT, L PTCLE St., Augustine. Office (904) 827-9088
......., JACK'S'v.V 1 L L E ! Lifetime Warr,anty on Vinyl & Aluminum Fence .
Vin: 3041c (,)p. La cliainlink Dyin -Atulhinum 3 Wc;od ' RES IDENTI61, CONTRACT
FNCE. 1 lEICAIT: 4 3 r 7(-1' ;,,.1 4W B5 0 6' t. ...1 ic CITransitions • Customer: JOb.11 0 n reil icaco
''.
WALK QATF-s isztOMPilammizatik 0 .m. ' Address: 1750 Salvo Marin Dr
ItSTS: -: .'" ' ''' 8- Atlantic BeacIi, ft. 32233
TERRAIN: :.3.15.ven '.Hen 0 Sip. 1
Community:
CLEARING: 0 Hest Pence 3 Customar N \ft
nom:
OLD FENCE: Aleg fence rj Customer
'GRADE: rzt Top 1,41v0 a•Vollow Grmie (H) (W)
1,10A:ARB: 3 Rest Pence C.)Customer 1 V (0)904-9824552 (e)
0 APPROVAL RF.CEIVISI) DATE:: (E) . oaraco ' LIN ail.com
v46
Lilo:Aims Materials 1 rranty ,.
3 Year.Labor Wet .nty
c oe ,,,,,■ i i , ,
4 -
.t i 01 .V v i00, ..e.. .. :: . T ' ' k' tip 1 •*?.
• ' t.9 o ikr
1 CM
\ (.*
1- ft) , .
• 4
‘ a\NeS 4 sell* c.t0s% el.
::..._
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. ‘4‘
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8 e.kr . ir,,- .c..‹) J crt, • • ' .• ' 11 ,,--- 1 A ke, \ _ l f
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.:"...- ---.2.... - ,.,. -, . , ..,. .. • ,.,,,, - 2: , v ' ' • ' - ' . ' • - - • "----• - . --- • •--'• ---- --
!..... . „ro-41 c ess A. 0 i , Ac, rc, i,
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t‘ ( ) L • 1 .- 1 '
.:..• . ,...,, v4 , L.,\,-, (0 ) ‘-‘ *c 0 1 ‘o_ do..iove., l GA 'N't, ,, f\ S.,:to %.4"ir% t S 4 (1 SA' Cv . .
- c.t
.. $ \ i
:.-
k 1 \6 . 4 \ ' - 19Nirth'ea' '.- VC4 - -60 1 t i eMt• ; ' ' ' ci ''.:- '
% r \ S I V' Ck ; V -CAA ..-V!!' =0..trrs S. —t :44—.:__:. - .--,.
''' : r 1 1.....o.0.1.. 1 0 c■-- ' '''''' .'"`' ' - - - . • '
• --...me..- . ....: c b , " ' 4C.1
di' mrmrvnrlAlllikLumINIII1lMMIINEnllIllMPOIMIIIIIIIIIIIIII ' 0
:,, % . v. 6
•'? 1 ei
.Cettelnarrnlist as.sunat responsibility' for placeinent of (once unlets all Total Feet See ,O•StogJer Total Price I 11
appropriate SUrV4, Pins (metal PIPOO or Concrete monumentsare
uncoveted.prior to leslallatio.n. Best Fence Co, inc. will assist owner in Sub Total . 'N t i i i■ Deposit Amount
foceting pins if provided copy of survey. All materials will remain
property of Best Fence Co, Inci until paid in ftiii. AR8 rce Date
sysktiblacustomot agtecs16 woposal inikodiitg mammals. Imo. tormi & lopanidiu 0 s Bal
hp-6nm
Due
Caitklma abC AA1 allirooss or sivvian from obey° spCcithzitiOns inVotvusg ar.M Costs lt OP TI ' ' ' • - ance ....
• t4 o only gpvit■Iglen swept am Iva tecareaan extra tharge aV.er an0 abgrm,the c 4/11161.4
wig:gate-Alf asteemants 0:1840fOnt =a ctidoss.arsid am. or 4 Mays berm! ISL:t =Of . Proposals goo(' for Z Vb days
Sig Fence C41. thc, }gnat nomad* foraarnage so erscerereurovestrutriens sacs s I 1
ua re t . s ,sytteeef.sees,cipes,csc.,- ligtunica cheats are soon in a Mop service teb. Pas/tient Ter os: 4 , 1 1M,...,..4 Ff. i a 4pc.,a ......i b
''--
Cancelled orders trill! embject to a .50% restoeRing fee, Best Fenco: wig Date Igil 'la
1203054 f Cu'stotnert WADI Date:
iliVi r'''' II or/rPireP- Al 7,
..,,,,,
:LIN i .1...,. :ii
..., I ..s,.. .— A .= i-
4')/
...
5 ,,,,y ;y �� City of Atlantic Beac APPLICATION NUMBER
' s Buildi Department (To be assigned by the Building Department.)
J ,q
r � - ?``' ,. 4‘v ` 800 Seminole Road a.•? — ,6
Atlantic Beach, Florida 32233 -5445
• / Phone (904) 247 -5826 • Fax (904) 247 -5845
x Jil9r E-mail: building-dept@coab.us
Date routed: ..i /
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: Z Saill.- ' fh&. Department review required Yes No
p y Building __
tanning & Zonin
Applicant: �C ree minis ra or
Project: f if / �61 C P-ublic - �'
urUtiiie
Public Safety
Fire Services
Review fee $ Dept Signature j ' . _ -.
Review or Receipt Date
Other Agency Review or Permit Required of Permit Verified By
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: p roved. ❑Denied.
(Circle one.) Comments:
BUILDING_
t • NNING & ZONING Reviewed by: q_Altle_J it-._-Sate: 62/2p'i7
• IN. Second Review: nApproved as revised. (Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: Approved as revised. nDenied.
Comments:
Reviewed by: Date:
Revised 05/14/09
N 14 W 150.00'
11111111 ' PROVIDE TEMPORARY SILTATION Rp r SWALE�DEEP 'N/
BARRIER UNTIL CONSTRUCTION w, SIDES • "ES TO KEEP
U IS COMPLETED (SEE DETAIL) INTO CANAL, RET rIN NG CF
•
I-
I EXISTING CANAL
ID • . - • —
ASCOT 2- CHANNEL w -
i vi s ( r - - -
t it)i J. 4 L F TOP OF BANK _ 1
,34_ -------. 1 0
t (' ` �� - -- NEW POOL BATH - - - -- — I N
b Vl ' ( /// 8 1 & STORAGE
VO
e
/ - -w( 4s Co 4 g
- 1 h O C' -7 "SE 'BACK - "DECK = �A 0 ko N kW! _ e&L. ° 32
G ' IPA° EXISTING i
a-kl I I , n _ ' � P OOL NE PORCHES i ° ,n
�...i . OCAT
REL
) 0 ' L F - e ( CZ) N • . / " — Ar,�� POOL EQUIP z �• ` I. 'it 28.2'
PI' 144";211111 EXIST •E =ACK
n A.f r i 1 IRRIGAT N _ 1 � 4 � �� - ∎ - i r _ . . 0
�—C S 1 / PUMP �" .. i + 0�� � '
eikt-te,F-1,u. RELOCATED � , . .Nc*� IL•= lima ' f (' 1,..4 1 AC CONDSR f ti:'4� r i
12 R- t anr a1. �G�� _ i
�� tit 27.9'
p /� ' �, 41 t 01 - EXIST = E 'BACK I ` ' C (�� N ,1� 10 NEW CONC WA �8 �F1
-- :� f�i`t 4t1, ��- EXIST GONG WALK ltEIOVED
�4 @ -Q Lq' ' , - - DUMPSTER _ �.•
/ 14' RAll � t , ∎ -.111 -1il
C. • e
32' o"�.gr„ ..
.. - BACK '�( XIS TR TO REMA EXIST TREES TO REMAIN
,i�l,i,li i,tl, - - ,, J
N • -- EkiTT�EiAt tS %oIVE - e lifr ,
REMOVED & REPLACED
I- I- W/ NEW 4" CONC DRIVE NEW CDNC DRIVE
N • (1382 9F)
II • 56' RAD
CANTERBURY N
_____ 6 1, •"
1
City of Atlantic Beach S 14 54'50" E 150.00' new'
,
Punning and Zoning Department LOT 8 BLOCK 9 AS SHOWN ON MAP
SELVA MARINA DRIVE OF SELVA MARINA UNIT N0. 5, AS
100' R/W RECORDED IN PLAT BOOK 50, PAGES
This approval verifies compliant* with apptbabte 29 - 29A OF THE PUBLIC RECORDS OF
zoning, subdivision and other local land SITE PLAN DUVAL COUNTY, FLORIDA.
development regulations, but does c.•a ,. 1 -. �
approval for the issuance of perm - - • • :. • , nigi 1" = 30' -0"
with Florida Building Code and all - FLOOD ZONES X & AE
local, State and Federal permitting PCEe{lttf ORAGE VOLUME:
must be verified by signature of the Vic 41 ,250 SF
Beach Building Officio' to the `b� a
Building Permd. �P - DEVELO: MENT RUNOFF VOLUME POSTDEVELOPMENT RUNOFF VOLUME
� e• 5456 SF/41250 SFx1.00 =.13 IMPERVIOUS 11467 SF/41250 SFx1.00 .28
Approved By:. _ - �!
�, , } � -j'- 35814 SF/41250 SFx.20= .17 PERVIOUS 29785 SF/41250 SFx.20 4
Date: G -� i ;,,
• . 0 FFICIENT .31 RUNOFF COEFFICIENT 0.42
Ru,'..rr VC) :.31x412508Fx9.3/12 =9,784 CF RUNOFF VOL:.42x41250SFx9.5/12 =13,427 CF
-ixC- 12_ Lrq
REQUIRED STORAGE VOLUME: 13,427 CF - 9,784 CF = 3,645 CF
PROVIDED STORAGE. VOLUME: 37 92SF 15'; D P SWALE W/ 1:4.25 SIDES = 3,693 CF
ONDREJTCKA GARAGE ADD'N
Fisher & Simmons Architects, Inc. 1750 SELVA MARINA DRIVE
1310B Second Street south Jacksonville Seawall. Florida
ATLANTIC BEACH, FLORIDA
C *Ted ZTOZ /DO /CZ Wd ZS:DT Wd /HW3 951,10MreoTurme g2no.zg4 quaS
0...Ai r City of Atlantic Beach APPLICATION NUMBER
t��
J (To be assigned by the Build Department.)
Building Department
r . v 800 Seminole Road v �� /
s� Atl Beach, Florida 32233 5445.: (� 2 /
, ✓
Phone (904) 247 -5826 • Fax (904) 2;4 ; 5845
E-mail: 2012 Date routed: f�
mo o, t� mail: building-dept@coab.us
City web -site: http://www.coab.us ----------
REVIEW AND T ACKING FORM
SaG � 4 r ,) 7a ,, Department review required Yes No
Property Address: / ldin
D Bui
i' / 7?e Applicant: fanning & Zon ree minis rraforr
Project: y-7 if-77 ei, / 77c9'1l ( ublic Wor
c is Uti i ie
Public Safety
Fire Services
Review fee $ Dept Signature', a .
Review or Receipt Date
Other Agency Review or Permit Required of Permit Verified By
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. f Denied.
(Circle one.) Comments:
BUILDING
PLANNING & ZONING Reviewed by: (4----)7 Date: , !3 ��
TREE ADMIN. , Second Review: nApproved as revised. nDenied.
p ,c A • " KS CorrJments:
f BLIC UTILITI .
PUBLIC A Reviewed by: Date:
FIRE SERVICES Third Review: nApproved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
( 5
7 tS'�r� . CITY OF ATLANTIC BEACH D � 1ti F , a t . r
a V U
n ' \t, 800 SEMINOLE ROAD, ATLANTIC BEACH, FL 322 33
;r f " - .f OFFICE: (904)247 -5826 • FAX NO.:(904)247 -58
�Ej BUILDING- DEPT @COAB.US
�y�'
-u,��� BUILDING PERMIT APPLICATIO MA YO NINA 2. LINTY
2. V OF WORK: 1 3. S �
ROOF NN
_ 1.
JOB ADDRESS: 2.
//�� /� , p � By L / y J�
1 1 5 V 6 V 0 fr l (ri w� v 1 Y / C/ * ' - ��...� a : CTURE:
4. LEGAL DESCRIPTION: 5. CLASS OF WORK
❑ NEW BUILDING 0 DEMOLITION RESIDENTIAL
C i
LOT x BLOCK SUB DIVISION ❑ADDITION
0 CONVERTING USE ❑COMMERCIAL
7. DESCRIPTION OF WORK: ❑ ALTERATION ❑ ACCESSORY BLDG. 8. FIRE SPRINKLER:
1 ,/ _ �( r �❑ POOL -OTHER / S . ❑ YES ❑ N/A
t 117tQ�, I 1 I (/T T �I 1 � f R �ll'1��u 1`� IC L ❑ MOVE ❑ REPAIR OTHER + eviCe.1 ❑ NO
PROPERTY OWNER: CONTRACTOR: ARCHITECT! ENGINEER:
9. NAME: 15. COMPANYrNAME: / 23. COMPANY NAME:
A K(1-6 Q� ��,eii C � e� rCrtCe � oMQartlo F J a k
16 NA E: 24. LICENSEE NAME:
mt C I-LU S
/� Va 1 STATE F FLORIDA LICENSE NO.: 25. STATE OF FLORIDA LICENSE NO.:
10. ADDRESS:' 7$0 .(� / 0 �_ /
3 1-1 [C , l 18. ADDRESS: a' C)C � 1- td , 26. ADDRESS:
11`46■14.4 C . ,32233 T 1 'I z zSS
LAccANsovOi Ile ; .. 3
11. OFFICE PHONE 112. FAX NO.: 19.
9. OF� OFFICE I ONE 12 0 FAX NO.: a 27. OFFICE PHONE: 128. FAX NO.:
. 41 HC'NE:
21. CELL PHONE: ✓ 29. CELL PHONE:
a'��' r...rorwisoli■ 30. EMAIL ADDRESS:
J
I EMAIL ADDRESS: 22. EM ILADDRESS: ,f
ba P rat (• e.o 0 I� o e (9-eS` i"' i ce k •ie MORTGAGE LENDER
FEE S PLE TITLE HOLDER: BONDING COMP Y:
b2 .5".... 9F OTHER THAN OWNER) 31. NAME: 33. NAME: 35. NAME: e//////������,,,,,, // / / 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.
*Irk 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 NOTICE OF COMMENCEMENT.
OWNER or AGENT CONTRACTOR
(If Agent, P • of Attorney or Agency Letter Required) (Qualifier Only) /
Signe• 1 A /.. s!r /i�[� GI Date: , '57/7 Signed , / / Date: °4 - Z-
_ , - 9G08incounty of Bef - e this / day of Ai , 2989'in the county of
Before me this day o f • Z i 2-6 ! 2_2
Duval, Sta a of Flo( a, has personally ap•eared Duva State of Florida, has personally a.peared
a 4-& �1 d I- 4e a - M1 GkI,.bhs
herin by himself / herself and Oft that 1 statements and declarations are herin by himself / herself and affirms that all statements and declarations are
true and accurate. _...--- I' true and accurate. � ��
Notary Public at Large, State of , County of O LAS Notary Public at Large, State of L , County of l 71" Li e►'t ti 8
❑ Personally Known le, - Personally Known /
-Produced Id -- ffic- •o - /` i I{ /�'*t y � ❑ Produced Ide ti• - �j_
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