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342 6TH ST CLOSED OUT SHED PERMIT City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) - yilt ' 800 Seminole Road ' 0 Atlantic Beach, Florida 32233-5445 Phone(904) 247-5826 Fax(904)247-5845 E-mail: building-dept@coab.us Date routed: 271 City web-site: http://w\&w.coab.us APOLICATION REVIEW AND TRACKING FORM Property Address: �-1 Z- (z7n- ." DqepArLment review required Yes No Build Applicant: t1i iw 1 anning &Zoning &dministrator Project: h Workti i ie Public Safety Fire Services Review fee $ Dept Signature Othe Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept. of Environmental Protection Florida Dept. of Transp^h^«, - St. Johns River Water Army Corps of Enginee1-4 Division of Hotels and F an i Division of Alcoholic Be Other: Reviewing Department First Revii (Circle one.) Comment: BUILDING PLANNING &ZONING Date: TREE ADMIN. Second REZ PUBLIC WORKS Comments. PUBLIC UTILITIES I PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. [-]Denied. Comments: Reviewed by: Date: Revised 07/27/10 rfs Lr y City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road Atlantic Beach, Florida 32233-5445 Phone(904) 247-5826 - Fax(904)247-5845 x ,319 > E-mail: building-dept@coab.us Date routed: 7113 Cityiweb-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: �`T Z &77t Sl_ De ment review required Yes No �anning & Applicant: /- dministrator Project: 69 LGf ublic Work is ti i ies Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Date 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 Divisio of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: R-A-poroved. ❑Denied. (Circle one.) Comments: � �B U I �ee/J �Ze Is*h1� o�- NNING &ZONI Reviewed by: � Date: 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 07/27/10 BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Q Office (904) 247-5826 Fax (904) 247-5845 , 94 0 U Job Address: FV rmit Nu Legal Description Parcel# Floor Area of Sq.Ft. Sq. t Valuation of Work$ 522-0, 0a Proposed Work heated/cooled non-heated/cooled � . f Class of Work(circle one): New Additi Alteration Repair Move Demolition pool/spa window/door Use of existing/proposed structure(s) (circle one): Commercial esidentia 11 If an existing structure,is a fire sprinkler system installed? (Circle one)' -, N/A Florida Product Approval# For multiple products use product approval orm Describe in detail the type of work to be performed: v� v� Gs,-FT Property Owner Information: Name: Address: City t-rl-tyT/L A, State%Zip 22-3 7 Phone i-- 9 / E-Mail or Fax#(Optional)_9 I e L 5 c Ole 44, 'k//G!� , Contractor Information: Company Name: Qualifying Agent: Address: City State Zip Office Phone Job Site/Contact Number Fax# State Certification/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 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 zs not commenced within six(6)months, or if construction or work is suspended or abandoned far a period of six6)months at any time after work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs, Wells,Pools, urnaces,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 FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. I hereb 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 o1 certify 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 other federal,state, or local law regulating construction or the performance of construction. Signature of OwnerSignature of Contractor Print Name �J1 .. ... .......... .-........... .� ..1 ............................. Print Name Befog --yy / Before me this Day f / ' ' 1t-- 20 0� this Day of . 20 Ati:.�lA.h4na: .g:Kx*� .�'::�, �C i.L i;�hrt+ii" r7 Notary Public Notary Public :° �: .� , n , ` Revised 10.24.12 of�y?c 9ooded 7hro Notary•Pubic U�t(e-�-t -, ars alit ,7.1111(1:1.) :1 IJ.L. 111111 l-"I.r.ry✓v lu ..a..✓.r .......v.. cul Oz pui? 2uiptin .w....Y,,..�.,,, 1402GS 31;uellb ;O to 6616 Z t►it CPO ARD � l .P A :• Tom. - (�1 r �ti t 1 71 Ove -SLOOZT ON 'i3NYd xiwnw00,,'l' f 'va1H0'I3 I x7.Nn00 'IVAna Iyanoui.. SII fSr K 'ilOV38 OI.Mli'V'A0 1110 'dVW ;��C S� S 1��✓, 3ZVH 3DNVHnSN1 wou in wovk' , /7 Td a3NIWH313a SV (NIV'Id a00'Id Hb3]<` 00S 3HZ 3aismo) x 3NOZ Hid• c i S3I1 NOMH NN0HS.?J6LH3d0XI iHVZ 61P 41. �'JdQ'� ,:•tea .�A t 7-,; o-� S ® 02 a u C' Atl g s� Planni a Z partment Th p approval verifies compliance with applicable zo ting, subdivision and other local. land g� de elopment regulations, but does not constitute w ap roval for the issuance of permits. Compliance v✓i Florida Building Code and all other applicadl d► to I, State and Federal permitting requiremerTl m t be verified by signature of the City of Atlantic CA B %uilding Official prior to the issuance of:a J B Permit. ove lc..� lc�� of ,mo••y y A. ivy�®��o1 --I%.tjJL S �19a• 1Mr,law •y� S� L /e va1Hou 'x1NnoO -IVAna 40 SQ 1003H OI'iqu 1.N3111in0 3H3. 30 69 30Vd S 'A009 IV'id NT a3GHOMN S`J IVId 01 ONIaH000V HOV3G 0I1NV'i,EV 1,V,, NOISIAMMIS t -ON �Vid L A3018 61 10q Jct JU .g AHVUIIOEI -DNIK®HS __ C ]��T MAR 2 8 2013 ray 1' i, City of Atlantic Beach APPLICATION NUMBER Building Department BY: (To be assigned by the Building Department.) r 800 Seminole Road Atlantic Beach, Florida 32233-5445 Phone(904) 247-5826 • Fax(904)247-5845 E-mail: building-dept@coab.us Date routed: j,12 7 ZZ 3 City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: `T Z 6,1,7?f De ment review required Yes No Build' Applicant: arming &Zoning dministrator Project: inzat-4k' �j ublic Works is ti i Public Safety Fire Services Review fee Dept Signa Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept. of Environmental Protection Florida Dept. of Transportation St. Johns River Water Management District Army 9orps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLI ION STATUS Reviewing Department First Review: Approved. DDenied. (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: ( Date: ATREEDMIN. Second Review: ❑Approved as revised. ❑Denied. ORK Comments: T I PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. Comments: Reviewed by: _ Date: Revised 07/27/10 BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 �S M Office (904) 247-5826 Fax (904) 247-5845 O U Job Address: f h S-7- #1 L #X/r�C 4e Fr rmit Nu r: ?413 Legal Description Parcel# Floor Area of Sq.Ft. Sq.Ft Valuation of Work$ 5 2219, oo Proposed Work heated/cooled non-heated/cooled 5-5 . F Class of Work(circle one): New Additi Alteration Repair Move Demolition pooUspa window/door Use of existing/proposed structure(s) (circle one): Commercial C"Reside- nt- i�1 If an existing structure,is a fire sprinkler system installed? (Circle one): es N/A Florida Product Approval# For multiple products use product approva orm Describe in detail the type of work to be performed: I41 sem 461) 6N �� 5^s�.F� ��FF G2#g£Z��V F t e lSy/t/itf). Property Owner Information/:: ` _ Name: 0y5 I? 1 C - 1�� Address: 2V- b-4 City Ira-CYT f& 8C � State%Zip 4t} nPhone vel i�, k o i E-Mail or Fax#(Optional) Ig 19 �,���T( Contractor Information: Company Name: Qualifying Agent: Address: City State Zip Office Phone Job Site/Contact Number Fax# State Certification/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 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 tf work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a_period o�six16)nsonths at any time after work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs, Wells,Pools, urnaces,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 FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. I hereb 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 ofYwork 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 other federal,state, or local law regulating construction or the performance of construction. Signature of Owner `` Signature of Contractor Print Namef7J .. 1��. .......4-..-........... .���.. ............................. Print Name Befor �yy�I� �` Before me this Day f / ' ' 20/3- this Day of 20 �= ���. l -�, ;,,, ! Notary Notary Public Public - ' - i eo t t4 .ora Revised 10.24.12 9ondod That Notary Public Unr;e­v,7s:n _-%- CI'T`Y OF ATLANTIC BEACH OWNER BIDER AFFH)AVIT I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION CONTRACTING" REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW: DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTES: STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMI?ROVE A ONE—OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000.00 OR LESS. THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE. IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THE CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE,WHICH IS IN VIOLATION OF TI-IIS EXEMPTION. YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR YOUR CONSTRUCTION MUST BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES. II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASE III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY OIC THEIR IMPROVEMENT TRADES. IV. PENH TY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(1). AN"OCCUPATIONAL LICENSE" IS NOT ADEQUATE, THE OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPETENCY' OR THE FLORIDA "CONTRACTORS CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE BUILDING DEPARTMENT(247-5826) IF IN DOUBT. V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. ADDRESS PHONE NUMBER PRI�NA -3-2 -2- 1 1 3 -- SIGN URE DATE Before me this day of Q C K 200 in the county of Duval,State of Florida,has personally appeared herin by himself/herselfd affirms that all statements and declarations are true and accurate. Notary Public at Large,State of�,County of fW ❑Pers ally Known duce dd Identfcation- I 'rr?;•,c[y s3+@--L:c.-rte,'__ 5i(;l1i N DD 9577(0 Notary Signature. "' s FFI!rcary 14,2014 n Upliry Poblir,U^rIc rumit¢rs — F:BLDG/Owner- ilder AftadaviY,REVISED:4/7 h009 i 'Al1 )1011%(1[1) :l IJ,tJ. Vln. 1 l.l­......a..v..0 ..aovu . .....vv.. ful oZ pue guip)in8 6616 ZQ A13D 1 tj T" 4.4.� 4 IN Al ko 71 {. '68/Li/ya33,Vfl 'aTE100;::, -SLOOZI 'ON 13NVd AIIMWHOW� �- va ' no I3 '7LiNn00 3.'IVAna 'vanao j. ? . '113V39 3I3,Nv'93.v:do .LLIO 'dvW i3 ( aaaIAa3NWH3iaSV NlVIdoolV ,, Ou5 3N33aIS3dl0) X 3NOZ NIA -{ s LCO�O a\�o�a��aad S3I1 N034l3H Nt10NS AtIi3d021d 3 HJ • .; \1 0 SIP °f ' t•sa , s= ® N ; . � � P D � r� if w • 15..) !.4 '/ of .00•.!5.+ V4 JL X vaY oia °xj,NnoO '9VAna d0 SC�21033L1 3I't8nd INTUR3 3493. d0 69 30Vd S NOOK 1V'ld NT a3a49OD9"I SV . Vl! l 03. 3NIQi21033V 113v3f1 3I3NV'I3.V o,V,, NOISIAIaunS i -ON 3.v-ld L NiDOI4d 61 101 DIUKOHS dVW RECEI'� . City of Atlantic Beach MAR 2 8 2013 APPLICATION NUMBER a' Building Department (To be assigned by the Building Department.) 800 Seminole Road Bim' -----_-_ Q ra Atlantic Beach, Florida 32233-5445 0�su Phone(904) 247-5826 Fax(904)247-5845 T ;nq�' v E-mail: building-dept@coab.us Date routed: S12 7 Z 3 Cityweb-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address az ST-2- �TW � Department review required Yes No Build' Applicant: anning &Zoning /- gdmi,,nistrator Project: hLGt j orkti ies Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept. of Environmental Protection Florida Dept. of Transportation St. Johns River Water Management District Army Corps of Engineers Divisioi 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: l�3 TREE ADMIN. ❑App Second Review: roved 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 07/27/10 r-`1 UOP to r• � � 20 �? F F a; BAS a; L"o F P S� 342 6TH ST Atlantic Beach FL 32233 Building Type 0103 - SFR SPLIT-LEVEL SOH Year Built 1950 Building Value $139,059.00 Type Gross Area Heated Area Effective Area Finished upper story 1 56_ 0 560 532 Addition 560 560 504 Unfin Det Utility 144 0 79 Base Area 1410 1410 1410 Unfin Open Porch 192 0 38 Unfin Open Porch 18 0 4 Finished Open Porch 144 0 43 Total 3028 2530 2610 Front 50.00 Depth 150.00 BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247-5826 Fax (904) 247-5845 O Job Address: F-f rmit Nu r: 2413 Legal Description Parcel# Floor Area of Sq.Ft. sq.Ft Valuation of Work$ 5 Z�-�� too Proposed Work heated/cooled non-heated/cooled 55 f Class of Work(circle one): New CA—dditi Alteration Repair Move Demolition pool/spa window/door Use of existing/proposed structure(s) (circle one): Commercialesident- i� If an existing structure,is a fire sprinkler system installed? (Circle one� Yes N/A Florida Product Approval# Por multiple products use product approva orm / Describe in detail the type of work to be performed: i',11&1k12 vv R� l q% 6d Property Owner Information: Name:&4� �, Ir, e ' I� Address: City L >3 f State%Zip 4 2-3 7 Phone 04 L E-Mail or Fax#(Optional) /d2 ,� C dPe �L /We-1v le Contractor Information: Company Name: Qualifying Agent: Address: City State Zip Office Phone Job Site/Contact Number Fax# State Certification/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. 1 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 jzzrisdiction. This permit becomes null and void if work is not commenced within six(6)months, or if construction or work is sus ended or abandoned for a period of six 16)months at any time ajter work is commenced. I understand that separate permits must be secured for Electric Work,Plumbing,Signs, Wells,Pools, urnaces,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 FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. I hereb 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 o'Vwork will be complied with whetherspeci zed herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other federal,state, or local law regulating construction or the performance of construction. Signature of Owner Signature of Contractor PrintName .. ............................. Befor --yy� p /3 Before me 20 this Day f / ' ' /L—� this Day of .20 4 -.'✓P�. � �-i �.. = 1 '' Notary Public Notary Public } < Revised 10.24.12 Bonded"thro Notary Pub'rr,Unr:e�•<.^i:;rs �l 4 } , CITY OF ATLANTIC BEACH �> 1 ®DINER / BUILDER AFFIDAVIT I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION CONTRACTING" REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW: DISC SURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTES: STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY.TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE—OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR IMPROVE A COMMERCIAL BUILDING AT A COST OF$25.000.00 OR LESS. THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE. IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THE CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE.WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR YOUR CONSTRUCTION MUST BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES. It. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. 111. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES. IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(1). AN"OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE BUILDING DEPARTMENT(247-5826) IF IN DOUBT. V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. ADDRESS PHONE NUMBER PR2NA DATE 2 2 � L:! SIG RE Before me this �7 day of / +a 201ain the county of Duval,State of Florida,has personally appeared herin by himself I herselfd affirms that all statements and declarations are true and accurate. Notary Public La rge,State of County of fdw ❑Pe ally d d Identfcation- _ e ' si ear f_.rflAHAi�9 Sli,id#r�0 35770 Notary SignatUra. rc";!7r a v 14,2014 y iIry F'i h(is UnrAarumiers i F:/6LDG/0---r-Builder Afrada�i�P.*109 MAP SHOWING BOUNDARY SURVEY OF LOT 19 BLOCK 1 PLAT NO. 1 SUBDIVISION $SAO° ATLANTIC [LEACH ACCORDING TO PIAT AS RECORDED 1N PLAT BOOK 5 PAGE 69 OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA Y !d C�•' n�iwWT ao w�1� `, 1rx..>srF—aT rj��oo/.,ar P 4.5..o0r To Lagj c.�4T � V .F' N �•.,.� r0.7 _ k8 LoT ZI ® ►� LGf '1 .. ,' r. ?HF PROPERTY SHOWN HEREON t.IES Q G 1IN ,ZONE X (O11TS1DE THE 500 G\�y��e��� Oj� 'YEAR FLOOD PLAIN) AS DETERMINED ���I Q� •�� .}i, 1 / ,;FRQM':THE FLOUR INSURANCE RATE 3S KAP, CITY OF'ATLANTIC BEACH, ORIDA, DUVAL COUNTY, FLORIDA, �1/S 1"COKKUNITY PANEL NO. 120015- FLQLs ±' °0001D, DATED:k/17/89. 31 o 00A, 3 wf�y� 1z n ,( v i/ k 4 ----REGEI V t? � ®o' 02,4 11 �..�•.errv,��> .ii 11 2 9 199 City of Atlantic B ach Building and Zor ing ........... ...,..,.. ..,....... . rnsat , wuw mlml L' c•Clrifil`L`C TAI/`