294 POINSETTA ST FENCE j�LJr�r,
CITY OF ATLANTIC BEACH
_ 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
FENCE PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-FNCE-963
Job Type: FENCE PERMIT
Description: 6FT-4FT FENCE
Estimated Value:
Issue Date: 5/14/2015
Expiration Date: 12/5/2015
PROPERTY ADDRESS:
Address: 294 POINSETTIA ST
RE Number: 170567-0010
PROPERTY OWNER:
Name: Fry, Carla A
Address: 294 Poinsettia ST
PERMIT INFORMATION:
FEES:
Fence/ROW $35.00
Total Payments: $35.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach,FL 32233
r� \� Office(904)247-5826 Fax(904)247-5845
Job Address: Permit Number:
Legal Description Parcel#
oor ea o q. t, t
Valuation of Work$:,I:QX� Proposed Work heated/cooled 11 SO non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structum(a)(circle one): Commercial est G�
If an existing structure,is a fire spnn er system installed? (Circle one): es No N/A
Florida Product Approval#
For multiple products use pro uct approve orm �N!
Describe in detail the type of work to be performed: a-1 z- vc d
Provertv Owner 11, tion: _
Name: /- Ad p/ — <
City I Stat Zip one
E-Mail or Fax#(Optional'
Contractor Information: CONTRACTOR EMAIL ADDRESS:
Company Name: Qualifying Agent:
Address:
Office PhoneJob Site/Contact Numbcity Fax#cath Z
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 ofa permit and that all work will be performed to meet the standards ofall laws regulating construction in Ihts jurisdiction. This permit becomes null
and void fwork is not commenced within six(6)months,or ifeammuction or work is susPeMed or abandonedfor a period ofsix/6)months at any fixe aper
work is commenced 7 understand that separate permits must be secared far Electrics( Work,Plumbing,Signs, Wells,Pools,Furnaces,Boilers,Healers,
Tanks andAhr Conditioners,eta
COMMENCEMENT NG MAY OWNER: IN YOUR PAYING TTO WICE 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 hereby cert*Mat Ihave readand examined this a plication and know the same to be true andcorrect. A/lprovuioru oflaws and ordinances governing this
type of work will be complied with whether spect ted herein or not. The granting ofa permit does not presume to give authority to violate or cancel the
provisions ofsny other federal,slate, or local law regulating construction or the performance ofcomtruction.
Signature of Owner Signature of Contractor
Print Name
................. .. .bl...... ......................._........_...._............... Print Name
........ ................._.....__..........................................................._........_...........................
Befo s Before me
this Day 20 this _Day of .2p
Notary Public Shin LCarahem
s01
y a uy commawnrr oeaaa Notary Pu tc
Ym,y e.qA.oxn.rsas Revised 01.26.10
CM OF ATLANTIC BEACH
OWNER / BUMDERAFFMAVIT
I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART i `CONSTRUCTION
CONTRACTING"REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW;
DISCLOSURE STATEMENTFOR SECTION 489.103(7),FLORIDA STATUTES;
STATE LAW REQUTERS CONSTRUCTION TO BE DONE By LICENSED
CONTRACTORS. YOU NAVB APPLIED FOR A PERMIT UNDER AN MWMPTION TO"CHAT
LAW. THE E)WATTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY.TO ACT AS
YOUR. OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST
1UPERVISIP.'IHE CONS I'RIICT70N � yOU MAY DUII,D OR IMPROVE A ONE-OR
[WU PAbII�,Y RESIDENCE OR A FARM OUTBUILDMG. YOU MAY ALSO BUILD OR
IMPROVE A COMMERCLIL BUILDING AT A COST OF$25.000.00 OR LESS THE B m D1NC
MDST BE FOR YO UCE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE.
IF YOU SHLL OR LEASE A BUH,DING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR
AFTER THE CONSTRUCTION IS COMPLET73, ITE/.LAW WCLL PRESUME THAT YOU BUILT
IT FOR SALE OR LEASIi WHICH IS IN VIOLATION OF THIS EXEFITT70N. TOU MAY NOT
HIRE AN IMLICENSED PERSON AS YOB CONTRACT02 YOUR CONSTRUCTION MUST
BE llONE ACCllONE .1CCORD]NO TO THE EUII.DING CODE.$ AND ZONIIJG REGULATIONS. IT IS
YOUR REEPC1NSlBE.I'Il' 7"O MAKE SI1RE THAT PEOPLE EWLOYED RY YOU H VF
LICENSES REOUIRCD JY SPATE LAW AND BY COI 'ry OR MUNICIPA'E7.�g1NG
ORDINANCES_
It. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCIIASED
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 ON THEIR IMPROVEMENT TRADES,
TV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE E P OVED UNDER ANY
CIRCUMSTANCES OWNERS 9EING 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' Oft THE FLORIDA 'CONTRACTORS
CERTIFICATE' TO ASCERTAIN IFA PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE
-5826)IF IN DOUBT.
BUILDING DEPARTMENT(247
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.
ADDR SS� i?01n a -5+,- T04 - `I85-0-71g
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SIGNATURE 77 '// DATE
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Duret,Slag MFlanda,haz penonall dhenn by lof�mel(PP„/Irgry J(entle pal
all araremenrs and eaaarripns
Nobry Public of Laige,State o( _f County of
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