2209 Alicia Ln 2013 deck CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 13-00002677 Date 6/04/13
Property Address . . . . . . 2209 ALICIA LN
Application type description DECK/PATIO
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 15000
----------------------------------------------------------------------------
Application desc
NEW DECK
----------------------------------------------------------------------------
Owner Contractor
------------------------ ------------------------
MARSHALL DUANE F & LYNN L. MATHIEU BUILDERS
500 CHERRY POINT RD 15899 SHELLCRACKER RD
WOOLFORD MD 216771311 675 ATLANTIC BLVD (SIGN)
JACKSONVILLE FL 32226
(904) 813-3661
----------------------------------------------------------------------------
Permit ' * . . . . BUILDING PERMIT
Additional desc . -
Permit Fee . . . . 125 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 15000
Expiration Date . . 12/01/13
----------------------------------------------------------------------------
Special Notes and Comments
Roll off container company must be on City approved list
and container cannot be placed on City Right-of-Way.
(Approved: Advanced Disposal, Realco, Shappelle ' s and Waste
Management . )
Full erosion control measures must be installed and
approved prior to beginning any earth disturbing
activities . Contact Public Works (247-5834) for Erosion
and Sediment Control Inspection prior to start of
construction.
2010 FLORIDA BUILDING CODE, 2008 NATIONAl ELECTRIC CODE
*REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING
DEPARTMENT IMMEDIATELY.
Full erosion control measures must be installed and
approved prior to beginning any earth disturbing
activities . Contact Public Works (247-5834) for Erosion
and Sediment Control Inspection prior to start of
construction.
Roll off container company must be on City approved list
and container cannot be placed on City Right-of-Way.
(Approved: Advanced Disposal, Realco, Shappelle ' s and Waste
management . )
-------------------------------------------------------------
PERMIT (%t4veRDVFEt OBLY IN ACCORDANCE WITM ALLXIT)SWULARIU�B.$VJW-&AWACES AND THE FLORIiA 0 0
BUILDING CODES.
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
C
Page 2
Application Number . . . . . 13-00002677 Date 6/04/13
----------------------------------------------------------------------------
Other Fees . . . . . . . . . ENG REV BLDG MOD OR ROW 25 . 00
STATE DBPR SURCHARGE 2 . 00
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 125 . 00 125 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 29 . 00 29 . 00 . 00 . 00
Grand Total 154 . 00 154 . 00 . 00 . 00
PERMIT IS APPROVED ONLV IN ACCORDANCE WITH ALL CITV OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
mAy 31 2013
By
May
so. 3o13 4: p7rm rwa i v OcM Sary ic-aa tnc
vlFlF,^r4v ev lits O%sbc-C-
W-L &I mra
O"r.—O_ 05
plbcwwt itvmmmp 2dow-amme. Ak F.... 4-&n4p ;A4;x-lbft 79b ......
PAWY 50, 2al 3
ubwa sawaaMban " Fldbmc*bm%mw
aAa*AP 4& —SLAOO�4UUA& Lgbavm
'Tc-,2,
C:3,n OAMV 7, 201-A, tfUft -rgffm-MV t3,V 9ft4a S-Oak *,tW3b%&Rdb=2&AVJbl R~1*1W 6—d
oppec,wma Vc3.ur ffvbcjLbma* 6ga. ed��Im.CM ttbdll CIMMndh*jdMd ddOMr-&41'kj@L -T-Ok-
4savintl4�rb 24�eftm woructLarml rckagpd;nt Al%a gt%db AbppdbftM&nC-�S O"C:00 W"O
#A A*j-Cbftr.*ini^A wb�. .-,44wv. P.(%"VwO*dl Ph&a>,&
:01comwv�darkp*w7na" ta, aftiA dbfnc�w Aaa V��&Ar "low. 046%bow.Opoew wh,*ir wo*"4vepworwwod Ow WW#Aoqrc-q 04P 4NAP
"*Y, 4camumody, Abefto Alfimsw�AkAFw~j, mbpobwwpb�� Air—
'Irttle J�ftMr %,V611 13.0 PgdbC:dWJ Irb -eCl"l ClilO t-Q-
.,ka rrL&r%&Mmra cwr Terwk"v Jav To,=SO^&4c3u--wc:>%Pvwm4m'L
jrcw C^4p Almmujw cW jolawmorm
-vc- Oao,,d of Ar--Aed�cmata
City of Atlantic Beach
CE
Building Department
8W Seminole Road
Atlantic Beach,Florida 32233-5445 1 2013
Phone(9"247-SM6 - Fax(904))2
E-mail., buffdrq<W1@c0abus
ft:1A~coab.u9
APPLICATION REWEW AN� TRACKING F RM
Property Address: Z77 Uepartment review roquired Yes No
Applicant: MPIrarqning&ZjoW
pt
-FreaAammistrator
Project:
P Pu ic
u - safety
Fire Services
Other Agency Review or Permit Riquired R*vkm or Receipt Date
of Oermit Verified By
Florida Dept.of Enviror-mental fttection
Florida DepL of Transportation
SL Johns River Water LUnagement Distrid
Army Caps of Engneers,
Division of Hotels and Restaurants
rosion of Alcoholic Beverages and Tobacco
Other
APPLICATION STATUS
i Reviewing Department First Review: E]Approved. Denied.
(Cirde one.) Comments:
BUILDING
PLANNING&ZONING
Reviewed by: Date:
TREE ADMIN.
Second Review. P��ed ass re0sed. E] ed.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Revjew�ed
FIRE SERNACES Third Review. []Approved as raVised. []Denied.
Comments:
Reviewe.d b�- Dab.-
Revlwd 07WI10
mAy 3 2013
4#4�,%p4v few 10 Or 'or-Ak "C*mvrvwv-4t as ^%scjb",%Ir IC3,P.4
IWIL J%j jjhl6%"97VIVA,OP":-
-%-kp4"0 & Owimploo-naL nwovft#L AAA4616
a 0. ao 1 31
PW 3 14,bnAtftdbn
i 4&V 0 & — j%Ij.Wo A d
VVI PC�-A I'l MAV C:CA'-4t-1 MI-6-
Cc,Ova f.*.2Spd;#bl -,-A 8"�
10.,r jd 463,A
I &kA- F&AV 90 is
j~",jr4 r� &j..A fol.- ooa�ow-*&$*,ft
.ffp,, C7dNkWS#p', '00*60 P. Aboo-O ff S.P.
A. cvwzwp%�dg�rw �ff T WrAmle IXs- tl 4w
vc Auol��.d�f
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: CZ0!r 94c. Permit Number:
4e,11- y L Parcel#
Legal Description 71
t7loorZeCao q. t. on-he# 1�1 d
de. Proposed ork eated/cooled fed
Valuation of Work S
Addition Alteration Repair Move Demolitio l/s W1 w' oor
Class of Work(circle one): cze:w)
Use of existing/proposeel structure(s)(circle one): Commercial �[W s Zid e�n t i�al
If an existing structure,is a fire sprinkler system installeV (Circle.one): 0 N
Florida Product Approval 4
For multiple products use Vro—duct ap rm
Describe in detail the type of work to be performed:
Property Owner Information:
Name: Address:
ip.�,�3� Phone f-Ot (3- /067
city 4 State
E-Mail or Fax 4(optional)
Contractor-Information: uall ent: 5114
ceY A (45 olt
Company Name: 9 le Zip
Address: _City*VX1, State
Office P ne Job Site/Contact Number 916P!V"I le',4__Fax
State Ce i ication/Registration
Architect Name&Phone# AK IG 4t ex
Engineer's Name&Phone 4
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and 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 iTwork is not commenced within six(6)months, or if construction or work is suspended or abandonedfor a period qfsixP6)months at any time after
work is commenced. I understand that separate permits must be securedfor Electricar Work,Plumbing,Siqns, Wells,Pools, urnaees,Boilers,Heaters,
Tanks and Air Conditioners,etc.
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 FINANCING9 CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
I hereby certify that I have read and axamined this application and know the same to be true and correct. All provisions of laws and ordinances governing this
type pJ work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any otherfederal,state, or local law regulating construction or the peFformance of construction
Signature of Contractor
Signature of Own�
& w(.1-4 ................................................................
Print Name _Aqn((" ar-c4i o-e�-111*111,11*11, Print Name
....................................;;;e"*"",*"""""*,1*11,111,111,11*1111*111,111*11,111,11,*11,111,111,11,l**"I
Belo*,!97e-
Befor thi of 20
this y of 20
1 11,
1P PAOLA GIL
lorida
Notary b ic Notai y Vublic-State of F 2015 fAyCOMMI ION DD957760
my Comm.Expires Jun 23, 0.24.12
",,OF f , commission#EE 105915
FLORIDA DEPARTMENT OF ENVIURONMENTAL PROTECTION
Bureau of Beaches and Coastal Systems
3900 Commonwealth Blvd-MS 300 -
FL Tallahassee,FL 32399-3000 Powif Number.-
- - - - - - - 850)488-7708
No.ofPaSmAdacked:
F1!ELD PERMIT PURSUANT TO SECTION 161.053 or 161.052,FLORIDA STATUTES
FINDINGS OF FACT AND CONCLUSIONS OF LAW: The request for a perinit wa considered by the staff designee of the Department of
Environmental Protection mW found to be in compfiRim vAth Ow mqvimrr�mts nf Chspb-62B-31 Florida Administritfive Code(F.A.C.). Approval is
specifically linu�todic activity in the stated location and by the prcoa d=jjWn,appmtod a C
*i if any),aftschad xWxlud conditions,and any special
conditions stated below pursuant to Paragraph 161.053(5),Florida Statutes. This permit may be suspended or revoked in accordance with Section 62-
4.100,F�kC. J
PROJEC`r LOCAI�1111-.
+
PROJECr DESCRIPTION:,:-
7" J-
17�
r yl
SPECIAL PgRhffi CONDITIONS: This pmnit a vaW only saw aN applicable federal,date,and local permits we obtained and does not authorize
contraventmm of local setback requirementi;or zonmg or buildmi;eades. This perind and pubic notice shall be posted on the aft unmediately upon
I ssuance and mW remain pooled alorig with local appvW md#A of any ud*n*mned by this permit Other special omfitions of this
pp-ruait include:
e-ri-I iL It.I--,'
A L
XrAMARD FEW r COND11TIONS: The parmifte dM comply with the aftwhad standard field parnit condifiomL
APPLICANT INFORMATION: I hereby certify that I am either. (I&)the owner of the subject property_q (1b)I have the owner's consent to some
Ob permit on the ownces beh4 and dot(2)1"obtain any applicable beams or peiTnits which may be requited by federal,Ask,county,or municipal
low prior to commencement of the authorized work (3)1 acknowledge that the authorized work is what I requested;and(4)1 accept responaWk for
sompliance with all permit conditions.
Applioaft Signatim 7/ 113 T `50.('�W ) J1140i'll-1p<
Applicant's Printed N�me Adilsass
If applicant is an agent
printed nanie ofpropff ty owner pvpa*bww propffly mow's telephone no.
DEPARTMENT FINAL ACTION AND FILING AND ACKNOVAUgDGMENT: This fold permit is approved on behalf of the Departinerit of
Envkonmental Protection by the undersigned staff designee,and filed on this date,pursuant to section 120-52,F.S,with the uridmiped designated
13eputy Clerk.receipt of which is hereby acknowledgW.
StqffDesi�eeTiepvry Cierk P7*ifed Name qfDon", p 09- CJW* Date
PUBLIC NOTICE IS ON Tit E MCK OF THIS FERWl'. RX11`11RATUNDAT&
(Emargency permits issued PUT=t to Section 6213-33.014,F.A.C.,are valid for no mom than nindy&p wd~am pennits are valid for no more
dian 12 months. The staff Gesignee may specify a shorter time limit.)
EMERGENCY PERMffT:0 YESO NO Approved plans are aftched: 13M' ONO
AND PUBLIC NOTICE CONSPICUOUSLY ON THE SITE
DEP form 73-122(Updated 01/06) MileCopy-Tall-haswe Office] ffello-Copy-Applicant] [P;nkCqpv-SAqffD=gneej
FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION
Bureau of Beaches and Coastal Systems
3900 Commonwealth Blvd—MS 300 -
Pew*Num*er.
s FL Tallahassee,Fl,32399-3000
488-7708 No.ofPagesAvoched:
F1 i ELD PERMIT PURSUANT TO SECTION 161.053 or 161.052,FLORIDA STATUTES
FINDINGS OF FACT AND CONCLUSIONS OF LAW: The request for a permit was considered by the staff designee of the Department of
Envionmental Protection and found to be in compliancewith the requirements of Chapter 6211-33,Florida Administrative Code(F.A.C.). Approval is
specifically limited to Ithe activity in the stated location and by the project description,approved plims(if 011Y),attached abumiard conditions,and any special
conditions stated below pursuant to Paragraph 161.053(5),Flofida Stiltutes. This permit may be suspended or revoked in accordance with Section 62-
4.100,F.A.C.
CT"PROJZ
'2,
PRCkJXCT DESCRIPTION :f'
f-76
ky
fi
L"J
SPECIAL PERMIT CONDITIONS: This permit is v@W a*sfkw 81 applicoNe federaL state,and local pemutB we obtained and does not authorize
contravention of local setback requirements or zoning or buil&g cockL This permit and public notice shaU be pooled on the site immediately upon
issuance and sW remain poolled along wirth local approval until the 00111100bw of any aclivity auffmaod by do pm& Other special condifions Of dkig
mmit include.
STANI)ARDP9RM1ff COND11TIONS
APPLICANT INFORMATION: I hereby certify that I am cftw. (Is)the owner of the suticet property (1b)I have the ownes cwWW to
this permit on the ownees bch4 mW that(2)1 slid ablain any ap0beable beam or parnits which may be required 6yC6A..d dd16 sounty,or munxqm
law pnor to commmeement of the aulhorized waft (3)1 ackwmAodge that the aulhormad wark is what 1 4110* for
compliance with all parrut conditions.
Applicanfe Signature Twq
4'r
Applicanfs Printed Name
If appficant is an
agent:
prbfkd name ofpropirty pvpw*y bwxorls address pwpaly owner's Ickphow na
DEPARTMENT FINAL ACTION AND FILING AND ACKNOVIIAMMSM: 71tis field permit is approved an behalf of the Dopecloned of
Enwronmental Protection by the undcogned staff designee, arid filed on Stis dab,pursuam so mcbon 120.52,F-S.,with lhc urAcn*W dmknW
Deputy Ckik,mccipt�' fiwhich hereby wkww6i*.
&ffDesigneelDeputy Ckrk Primaled Name ofDasifflwaVepiary CFa�-- Dase
PUBLIC NOTICE IS ON THE BACK OF THE PERROT. EXPULATION DATE:
(Emergency permits issued PU!Mw to Section 62B-33.014,F.A.C.,we vallid for no more than ninely dar and other field permits are valid no more
thm 12 months. ;!;staff oemgnee'ruy specify a shorter time limit)
EMMGENCY PSWT:13 YES 13 NO Approved plans are atlached: E�ES 0 NO
A" PUBLIC NOTICE CONSPICUOUSLY ON TM SITE
DEP form 73-122(Updated 01/06) Phile Cqp-),,7o1h*a=e Office] [YeflowCopy-Applicmal [Pink Copy-StaffDesignee]
FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION
Bureau of Beaches and Coastal Systems
3900 Commonwealth Blvd-MS 300 -
FL A t Tallahassee, FL 32399-3000 Perrmil Nuniber.
i 21 wat ON a 1%21%ft ON ON~-%. (850)488-7708 No.ofPages A nached.-
FIELD PERMIT PURSUANT TO SEC'FION 161.053 or 161.052,FLORIDA STATUTES
FINDINGS OF FACT AND CONCLUSIONS OF LAW: The request for a permit was considered by the staff despee of the Department of
Environmental Protection and found to be in compliance with the requirements of Chapter 62B-33,Florida Administrative Code(F.A.C.). Approval is
specifically limited to the activity in the stated location and by the project description,approved plans(if any),attached standard conditions,and any special
conditions stated below pursuant to Paragraph 161.053(5),Florida Statutes. This permit may be suspended or revoked in accordance with Section 62-
4.100,F-A.C.
PROJECT LOCATION:
PROJECT DESCRIPTION:
SPECIAL PERMff CONDITIONS- This perrnit is valid only after all applicable federal,state,wid local permits am obtained and does not audxxizc
contravention of local setback requirements or zoning or building codes. This permit and public notice shall be posted on the aft immediately upon
issuance and shall remain posted along with local approval until the completion of any activity authorized by this permit Other special conditions of this
permit include:
STANDARD PERM11T COND][TIONS: The permittee shall comply with the attached standard field permit conditims.
APPLICANT INFORMATION: I hereby certify that I am either (la)the owner of the subject property 2[ (lb)I have the ownct's consent to secure
this permit on the owner's behalf,and that(2)1 shall obtain any applicable lk=ws or permits which may be required by federal,state,county,or municipal
law prior to commencement of the authorized worlc� (3)1 acknowledge that the authorizzd work is what I requested;and(4)1 accept responsibility for
compliance with all permit conditions.
A,le
Appficanfs Signature Date Telephone No.
Applicant's Printed Naim Address
If applicant is an agent
ptwed narne ofproperty owner property owner's addiness property owner's telephone no.
DEPARTMENT FINAL AMON AND FILING AND ACKNOWLEDGMENT: This field permit is approved on behalf of the Departinent of
Environmental Protection by the undersigned staff designee, and filed on this date, pursuant to section 120.52,F.S.,with the undcraigned designated
Deputy Clerk,receipt of which is hereby wknowledged.
StaffDesig"ee,T)eputy Clerk Printed Name ofDesigneelDeputy Cler* Date
PUBLIC NOTICE IS ON THE BACK OF THIS PERMIT. EXPIRATION DATE:
(Emergency permits issued pursuant to Section 62B-33.014,F.A.C.,arc valid for no more than ninety days and other field permits arc valid for no
than 12 months. The staff designee may specify a shorter time limit.)
Em[ERGENcy PEkmrr:0 YES 13 No Approved plans are attached: OM ONO
AND PUBLIC NOTICE CONSPICUOUSLY ON ME SITE
DEP form 73-122(Updated 01/06) Vhile Copy-Tallahassee Office] [Yellow Copy-Applicant] [Pink Copy-StaffDesigneel
DATE: 5/23/13 PLAN REVIEW CORRECTIONS REPORT PAGE
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH FL 32233
------------------------------------------------------------------------------
APPLICATION NBR . . : 13-00002677
ADDRESS . . . . . . 2209 ALICIA LN
APPLICATION DATE 5/15/13
APPLICATION TYPE DECK/PATIO
------------------------------------------------------------------------------
OWNER . . . . . . . MARSHALL DUANE F & LYNN L.
500 CHERRY POINT RD
WOOLFORD MD 216771311
CONTRACTOR . . . . . MATHIEU BUILDERS
15899 SHELLCRACKER RD
675 ATLANTIC BLVD (SIGN)
JACKSONVILLE FL 32226
------------------------------------------------------------------------------
AGENCY NAME: PUBLIC WORKS
DATE ACTION ACTION BY
------------------------------------------------------------------------------
5/23/13 DISAPPROVED DEBBIE WHITE
Full erosion control measures must be installed and
approved prior to beginning any earth disturbing
activities . Contact Public Works (247-5834) for Erosion
and Sediment Control Inspection prior to start of
construction.
Roll off container company must be on City approved list
and container cannot be placed on City Right-of-Way.
(Approved: Advanced Disposal, Realco, Shappelle ' s and Waste
Management . )
Provide copy of Homeowner' s Association approval .
City of Atlantic Beach
Building Department
800 Seminole Road
Atlantic Beach,Rodda 322-33-5445
Phone(904)247-5826 - Fax(904)247-584�
E-mail: buiIdlng-dept@coab.Us
City web-site-- hftp://www.coab.us
APPLICATION REVIEEM AND TRACKING Fq'RM
Property Add partment review roquired Y No
Applicant: PI—arIning&Zonind
r
Project:
P bF_
u ic Safety
Fire Services
Other Agency Review or Permit R6quired Review or Receipt Date
of Oermit Verified By
Florida Dept of EnvirotImental 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: gleApproved. FIDenied.
(Cirde one.) Comments:
(��DING)
PLANNING&ZONING
Reviewed by: /22 Date:
TREE ADMIN. Second Review- DAppmed as revised, [31)Aed.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by- Date:
FIRE SER\ACES Third Review: [:]Approved as revised. MDenied.
Comments:
Reviewed by: Date:
Revised 071Z7110
City of Atlantic Beach
Building Department
800 Seminole Road
Atlantic Beach,Florida 32233-5445
Phone(904)247-5826 - Fax(904)247,-64�
E-rnail: bui1d1n"ept@coab.us
City web-sitw hftJhvww coab us
APPLICATION REVIEW AN� TRACKING F 'RM
Property Add A,L- 4 �L- Oapar#nent review roquired Yes No
Pkinne & Rind
Applicant- I gy"
Project
lic UfiffW I
PHb�l c:�Safety
Fire Services
Review or Receipt
Other Agency Review or Permit Riquired lo Date
of Oermit Verified By
ent r4
jr
'g
P'
_b
.1�
-i1c
--J�
fPublic Saf v
Florida Dept of Enviror-Mental Protection
Florida Dept:of Transportation
St Johns River Water Management Mstft
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
odw.
APPLICATION STATUS
1 Reviewing Department Firtt Review: E�A�pproved. F—]Denied.
(Circle one.) Comments:
P PLANNING&ZONI Reviewed by: -Date:
TREE ADMIN. Second Review- DAppmved as re0sed. ODenled.
PUBLIC WORKS Comments:
PUBLIC UTILMES;
PUBLIC SAFETY Reviewed by: Date:
FIRE SER%4CES Third Review-. OApproved as Wised. ElDenied.
Comments:
ReWawd Date:
Revlwd 07WI10
BUILDING PERMIT APPLICATION
MAY
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845 FR I=5 �_ 3
Job Address: Ime'lld? Z9 ne Permit Numbe
el
Legal Description Y, ithlw�ldf �Parc_ Sq
pV FloorAreaot —S
g.Ft.
of Work Sj/, Proposed Work eated/cooled n�n"-heated/cooled
Valuation
Class of Work(circle one): (��_ew Addition Alteration Repair Move Demolition
Commercial Ge s Zid e n:ti a�l
Use of existing/proposed structure(s)(circle one):
If an existing structure,is a fire sprinkler system installed9 (Circle.one): 0 N rFILE COPY
Florida Product Approval#
For multiple products use produ t approval form
Describe in detail the type of work to be performed:
Property Owner Information:
-re_42e, ,4Ad�dress: —2.210 4? 4111,4
Name: Zipj Phone�
city
E-Mail or Fax#(Optional-
Contractor information:
Company Name: 9 le
Quali A nt,
State 4,
Address: city Zip
Job Site/Contact Number 4?dP a le Fax#
Office P ne
State Ce ica ionfRegistration
Architect Name&Phone# AK q OYA-dr. 3
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and 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 commencedprior to the
fa permit and that all work will be pedbrmed to meet the standards of all laws regulating construction in thisjurisdiction. This permit becomes null
issuance o, or work is suspended or abandonedfor aWeriod ofsixfi months at any time after
and void ffwork is not commenced within six(6)months, or ifconstruction i
work is commenced I understand that separate permits must be securedfor Electricar work Plumbing,Signs, ems,Pools, urnaces,Boilers,Heaters,
Tanks and Air Conditioners,etc
WARNING TO OViFNER: 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 YOUi NOTICE OF
COMMENCEMENT.
flaws and ordinances governing this
I hereby certify that I have read and examined this a lication and know the same to be true and correct. Allprovisionso 0,cance,the
f . ty to violate
p
,p
type p�work will be coTplield with whether i ied herein or not The granting of a permit does not presume to give authori
sfg f construction.
provisions of any otherfederal,state, or local regulating construction or the peTformance o
Signattire of Own Signature of Contractor___4
a..
Print Name —42 rt t-L ac,ch v)-e� Print Name (.................................................................
......................I.............9...............................................................................................
Befo*-
gle-
2
Befor t t,
20
this of 120 th
it,
P
PAOLA GIL
Notary ic Notary Public-State oTTI rids otary
s Jun 23, 015 mycoMMI I DD957760
my Comm.Expire
#fi& 10.24.12
EXPIRES�::,tery
Commission*EE 105915 ubkA
I OFF" Bonded Thru t
WOTECM1
FLORIDA DEP fffff-ep- PROTECTION
Bureau of Beaches I
3900 Commonweal Pkv Number:
FL A Tallahassee,FL 32
%&* (850)488-7708 C PY
u0Z
_MOW
No.ofPages A nached.
FIELD PERMIT PURSUANT TO M �ORIDA STATUTES
i
FINDINGS OF FACT AND CONCLUSIONS OF JAW: The requed for a permit wu considered by the staff designee of the Department of
Environmental Protection and found to be in compliance with the requirtanents of Chaptzr 62B-33,Florida AdminWrative Code(F.A.C.). Approval is
specifically limited tolthe activity in the stated location and by the project description,approved plans(if any),attached standard conditions,and any special
conditions stated below pursuant to Paragraph 161.053(5),Florida Statutes. This permit may be suspended or revoked in accordance with Section 62-
4.100,F.A.C.
FROJECI LAP%-j%IION-
MOJECT DZSC1tWrION:
A 7
>)
SP&CIAL PERMIT CONDITIONS: This permit is vrM only after all applic"fedcraL statc,and local pennits m obtained and does not authoriza
sontravention of local setback requu=ncntB or zonft or building codes. This permit and public notice sha be poded on Ac site immediately upon
innnee and shall remain posW along with hxW app a =6*a cornpletion of my wtivily a0mizad by this pmk Odw opMW emblions of this
permit include:
A *A,--
i7�4-t
'A
STAMA"FERW CONDITIONS: The parnitice shall cmply%th the a#wUd staklard fieW pamd conditions.
i
ApPtiCAW INP16PMATION: I hernby certify that I on either. (1a)the owner qf the wjl*d propar�,,VX (1b)I bove the owna-'s rwriont h;w=r
this permit on the ownces belolt and U'W(41)1 dall obtain any - Il I -----a or pamits vfth aq be requirwl byfedwiL d1k county,or municipal
law prior to commenament of the airthorized work (3)1 aciu�Sat Go m*mized wook is v4W I requesick mW(4)1 nospit responsibibly for
sow4ijance with aH permit conditions.
AppBeffints Signature Date
Applicanfs Printed Name
Addrws
Ifapplicant is an agent: ' ZiLt
P*W mme ofpropffty ownff PVPWiY wnws ad*vw POPWOO 0"W& I-1 A no.
DEPARTMENT FINAL ACTION AND FILING AND ACW40WLZDGPAWr.- This field perind is approved an behalf of the Depwisnant of
Environmental Protection by the undersigned daff"pun,and filed on this dde6 punniant lo section 120.52,F.S.,with the undersigned den4oded
Deputy Clerk,roccipt of which is hereby acknowledged.
StaffDesigneelLkepuly Cla* Prmsed Name ofDosifflevoTArpaq Ckrk Date
?UBLIC NOTICE IS ON THE BACK OF THIS PERMIT. EXPBLATION DATR: —ts am QW or no MGM
(Emergency pWmts issued pursuant to Section 62B-33.014,F.A.C.,am valid for no mom than ninety doys and odier fidd Fwnu f
thin 12 months. The kaff designee nay spm*a shorter time fimit.)
EWERGENCY PERM:13 YF—S 0 NO Approved pians am aftiched: 11M ONO
AND PIJBIJC NOTICE CONSPICUOUSLY ON TM SITE
DEP form 73-122(Updated 01/06) Mile Copy-TalkAmme Office] [Yeflow Copy-ApplicaWl Pink Copy-StaffDosigneel
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Permit u e
Job Address:
Legal Description Parcel 4
Floor e�a o /c
40orZ
Valuation of Work ,' Prnnowf�T no
$14�0_dd 1,;�' Proposed Work heated/cooled
Class of Work(circle one): cie:w:) Addition Alteration Repair Move Demolition pool/spa o /door
Use of existing/proposed structure(s) circle one): Commercial 1[,'e s Zid en:ti a�l
If an existing structure,is a fire sprinMr system installed? (Circle.one): 0 N/A
Florida Product Approval#
For multiple products use�roduct approval form
Describe in detail the type of work to be performed:
Property Owner Information:
41 41;
1"(`6
Address:
Name:
'—hone
city State ipTLO
�Phone
E-Mail or Fax 9(optional,
Contractor Information:
Company Name: uali g A ent: 4544
Address: city L, State 4-- �Zip ��
Office P ne Job Site/Contact Number !?_VV 9J_? 74 '(-.4-_Fax#
State Ce ication/Registration
,,�; -
Architect Name&Phone#
Engineer's Name &Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and 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 be performed to meet the standards of all laws regulating construction in thisjurisdiction. This permit becomes null
ofa permit and that all work wdl or work is s ended or abandonedfor a eriod ofsix(6)months at any time after
and void ffwork is not commenced within six(6)months, or if construction If
work is commenced I understand that separate permits must be securedfor ElectricylWork Plumbing,signs, ens,Pools, Airnaces,Boilers,Heaters,
Tanks and Air Conditionery,etc.
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 YOV1k NOTICE OF
COMMENCEMENT.
I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this
type pj work will be coTplied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the
Ff ns ru
provisions of any otherfederal,state, or local law regulating construction or the pe ormance of co t ction.
Signatdreofownm Signature of Contractor
ntj��AAW --
Print Name 04--c—Ohl V) ',� Print Namee .............................................................
..............................................................................................
B
t�efopjge
Befor t i, Rr-of 20
this of 220 L
ky PAOLA GIL
o ary
lorida ;6
C
EXPIR' U
Notary b ic Jun 23,2015 14: w MMI
My Comm.Expires ES-. 10.24.12
Commission#EE 105915 ....... BmdedThruNo,tsryPuNcU%Q
I OFV, 1�
P.
T'-T-
City of Atlantic Beach
f
Building Department
8DO Seminole Road
Atlantic Beach,Florida 32233ZW
X)
Phone(904)247-5M6 - Fax(V
E-mail: bui1dng-dept@cwb.us EN �R
City mmb-s& htIpJAww co2b us
APPLICATION R ND TRACKING FqRM
Property Address: /I _711 Department review roquired Yes No
Dee,---
Applicant: A P antning 8.;
ishlator
Project:
FP__1J_b_ric 3 ge t y
I [-Fire Se
Review or Receipt
Other Agency Review or Pennit Required of Oermit Verifl6d B Date
_y
Florida Dept of Environmental Protection
Florida DepL of Transportation
St.Johns Mver Water Management DisM
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
APPLICATION STATUS
�JApproved.
Reviewing'Department First Review. [3Denled.
(Circle one.) Comments:
BUILDING
PLANNING&ZONING Reviewed by: Da*te: 43 .
TREEADMIN. Second Review: ElApproved as re0sed. DDenled.
nt
Comments,
S
3
15- _/ i I Reviewed by- Date:
PUBLIC SAFETY
FIRE SERMCES Third Review: DApproved as revised. DDenled.
Comments:
Reviewed by Date:
Ravised 07WI10