708 SELVA LAKES CIR -DECK/PATIO rII�L/ri,�
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
RESIDENTIAL ALT/OTHER
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-DECK-1387
Job Type: DECK/PATIO
Description: patio approved on 15-DECK-1041
Estimated Value: $2,000.00
Issue Date: 6/12/2015
Expiration Date: 12/9/2015
PROPERTY ADDRESS:
Address: 708 SELVA LAKES CIR
RE Number: 172027-5836
PROPERTY OWNER:
Name: BELLOIT, WHITNEY E
Address: 708 SELVA LAKES CIR
PERMIT INFORMATION:
FEES:
BUILDING PERMIT FEE $35.00
Total Payments: $35.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
City of Atlantic Beach =RECEJ�V�IEIDD' APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road AAtlantic Beach, Florida 32233-5445Phone(904)247-5826 Fax(904)2449 E-mail: builtling-dept@coab.usDale routed:
City"b-site. hHp:H . coabms
APPLICATION REVIEW AND TRACKING FORM
/QA iy
Property Address: Ji*t, LQ E.S d1z ment review rewired Yes No
Applicant: �/if/ Li/L. , annmg&tomin'gN9
Pe or
Project: �9 T1 ublic Wo s
I u is i
� UUOA IT Public-Safety
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
Flonda Dept.of Transportation
St.Johns River Water Management District
Amy Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: ❑Approved. Efl5emed.
(Circle one.) Comments:
BUILDING
PLANNING 8 ZONING
Reviewed by: C4�_ Date: �
TREE ADMIN. Second Review: Approved as revised. Eyened.
PUBLIC WORKS Comments:
PUBLIC UTILITIES 5
PUBLIC SAFETY Reviewed
FIRE SERVICES Third Review: ❑Approved as revised. igDenied.
Comments:
Reviewed by: Date:
Revised 071VII0
A-4° CITY OF ATLANTIC BEACH
A' -
®9'YINER / BUILDER AUI'FMAVUT
L FLORIDA STATUTES; CHAPTER. 489, FLORIDA STATUTES, PART I "CONSTRUCTION
CONTRACTING"REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW:
DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTES:
SLATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED
CONITACTORS. YOU LEAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT
LAW, THE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO.ACT A9
YONR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. Sulam MIJS
}_UI'Eli VISE 7]IF Ci lN1 l I<I IC'71UN Y(41 RAS i YOU MAY BUILD OR IMPROVE A ONE—OR
IWO FAMILY RESID.LNCE OR AOR A FARM OUTBUILDING YOU MAY ALSO BUILD OR
IMPROVE A COM YTERCL-L BUILDING AT A COST OF$25.000.00 OR LESS. TIM BUILDING
MUST BE FOR YOUR US'E AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALF OR LEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WTLiILI ONE YEAR
AFTER THE CONSTRUM- ON IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUILTH[PE AN IOR SALE OR LEAStf. WfI[CH IS IN VIOLATION OF THIS EA'EMPTION. 1'011 MAY N(
HIVINUC-1-NSEP,. PCBSON AA v�LR CONTRACTOR YOUR CONSTRUCTION MUST
BE NONE ACCORDINO TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS
VOIIIR RESPONSIBILN 4' TO MAKE SURE THAT PEOPLE EMPLOYED HY )`P HAVEII[ N.$GA IREOD/REU �1_SI_171 LAW AND BY COUNTY OR MfINICII'A LIi LNSI MO
(IRD. INANCES.
If. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION IN6LIRANCF BB
PURCHASED
Ill. 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; UNLICENSi:U CONTRACTORS CANNOT BE EMPLOYED 11NDER ANY
_IROLIMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO
455-225(1). AN "OCCUPATIONAL LICENSE"IS NOT ADEQUATE THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY"CERTIFICATEOF COMPETENCY" OR THE FLORIDA 'CONTRACTORS
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR_ TELEPHONE THE
BUILDING DEPARTMENT(2475826)IF IN DOUBT.
V.ACKNOWLEDGEMENT;I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT. -
Ace St.1v0. "% CIL14. -- 1Rd1�41o4-ilia
ADDRE55
Lo1 .` ,T PNONE NUMBER
\
NAM
SIGNATU
DATE
Before me Nladay of /�� R 20__,�.n Ne county of
Duval,SAWM�M1as parsonely,fF=+ d -rdfry I(/M1erselfaM ef(m¢Ilial
all stalertrenfs and decy2ibna ere Mca nccurafe.
Notary Publical Lalge,Siafa of _,Ccunq of Vrsr�
OP do,w,un�
FA. Habry Putllc stab Banda
Fwa
ShIdey L Graham
Notary S,in.tu My Cbnbiae.FF 088980
�Ia,Fy swil..oaunol6
Y tl3LUfyUmv-HuiI2aAIfiMvi5ltFVla'FL; 41o'Cy
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
cc-- , ,,L Office (904)247,-_58126 Fax(904)247-5845
Job Address:�'� SAW- v-a6S C dt& j1� 4C Rd, Permit Number:
Legal Description Parcel#
oor ea o q. t. q. [
Valuation of Work$ ^'e?DDOL 00 Proposed Work heated/cooled non-heated/cooled O�
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial Residential
If an existing structure,is a fire spnnkler system installed?(Circle one : es o N/A
Florida ProductApproval#
For multiple products use product approval form 'C r
Describe in detail the Type of work to be performed: �PAVF� JPA-1110 O� 4i A_ �c',t�C, C
SDO
Property Owner Owner Information:
NameA(r Address:�8 V6L LAb u
City klt
Stateffzip S3-X Phone -1 8-
E-Mail or Fax#(Optional) W 7MIe'1 94 t';Mk 1 C [L1M
Contractor Information: CONTRACTOR EMAFL ADDRESS:
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 Fou made to obtain a permit to do the work and installations as indicated. f certify that no work or installation has commenced prior to the
issuance o a permit and that all work win!be performed to meet the standards ofall laws regulating construction in this jurisdiction. This permit becomes null
and void t work is not commenced within six(6J months, or ifemstruction or work is suspended or abandanedfor a period ofsis/6)months at any time after
work is commenced. f understand that separate permit/must be secured for Electrical Mork,Plumbing,Slgns, /s,Pools,Furnace, Boilers,Heaters,
Tionks 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.
[-No
reby certify that/have read and examined this location and know the same to be true and correct Allprovisions oflaws and ordinances governin,¢this
o)work will be cora lied with whether sped ted herein or at. The grunting of a permit does not presume to gyre authority to violate or cancel the
vtmons ofany other era, ore, or local aw regulating construction or the performance ofcanstruction.
nature of Owner um of Contractor
NWry u Ob otFbrl g
`, s .ley l Grahwn
nt Name �lT� mg.cw iwion FF ovu*rin ame
....E»o..e eviddote ..........
fo one me
ay o 20 this -Day of 20
u NotaryPublic
6 63 .0-0
1ry_0 Revised 01.26.10
7o 8 va, Lok" C1 oe —
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U � �D� MAY 7 _. ._
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City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach, Florida 32233-5445 C Q
Phone(904)247-5826 Fax(904)247-5845 '
E-mail: building-dept@wab.us Dalerouted.
City web-site: http://vwwwab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: -Q 4 s&L,&_5 CieMent review required Yes No
Buil
Applicant: 0� �/r„ .,Planning&Zonin
re or
Project: J�I`W Public Works
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified
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:.i
TREE ADMIN. Second Review:
❑Approved as revised. ❑Denietl.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 071V110
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach, FL 32233
Office (904)247-5826 Fax(904) 247-5845
Job Address:g'� .7��110� �c tLa� CAJ& Mbli%c- 84h. Permit Number:
Legal Description Parcel#
Floor Area o q. q, t
Valuation of Work$^'tr�l)DO.00 Proposed Work heatea d/cooled non-heated/cooled 500
Class of Work(circle one): New Addition Alteration Repair Move Demolition poollspa window/door
Use of existing/proposed structure(s)(circle one): Commercial Residential
If an existing structure,is a fire sprinkler system installed?(Circle one : es 0 N/A
Florida ProductApproval#
For multiple products use pro uct approva orm
Describe in detail the type of work to be performed: %129— PA-110 OW ' L& 'bak,
6j,sj-- %U0 s . -V-
Prouerty Owner Information:
Name: CD40 IrAi-orr Address: 3OS Va IAkA5 Cagr�
City A�C1.+ Sr t Z D.$m3phone 8OY-10U3-
E-Mail or Fax#(Optional) W '7MItl 9ef g Gi1'Ik I L t UM
Contractor Information: CONTRACTOR EMAD.ADDRESS-
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
Applicafion is hereby made to obtain a permit to do the work and installations as indicated. I cert fy that no work or installation hat commenced prior to the
issuance ofaperma and that all work will bepe armed to meet the standards ofall laws regulating construction in lhisjurisdiction Thispermitbemmes null
and void fwork is not commenced within. (6 months or ifconstruction or work is susyended or abandoned for a period ofsiu/6J months at any time aper
work is commenced. I understand that separate permits most be secured for Electrical Work,Plumbing,Signs Wclls,Pools,Furnaces,Boilers,Healers,
Tanks and Air Condilioners,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 hereby certify that l have read and examined this plication and know,the same to be true and correct All provisions oflaws andordinances governing this
type , work will be cam lied with whether sPeci ted herein or not. The granting of a permit does not presume to give authority to violate or carscel the
provisions ofany,other er ,s ate,or localli regulating corutruction or the performance ofconstruction.
Signature of Ownerre of Contractor
rmuty a nsura row g
Print Name �1c}Qll SnuleylGreMm
......... ........... ... . .. ..MsQWmiuw FFomgWrin me
a Fr otii7Yame ... ......
.- ..................Befo a ore me
th' ay o 20 this _Day of .20
No u t Notary Public
76 - 6S .0-0 Revised 01.26.10
R CITY OF ATLANTIC BEACH
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 I AVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TOT IL
LAV✓. THE ESTNIPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY. TO ACT ALC
YOUR OWN CONTRACTOR EVF,N THOUGH YOU DO NOT HAVE A LICENSE. YUU AIU'.l
�I V4,t Yl=1118 kU •IkUf_�IION 1'OIIRSFLh' YOU M.WY GUILD OR IIv)PROVEA OM;
—OR
1WO FkNRll ' REaTENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR
IMFROVP.A COMMS CLUL BUILDING AT A COST OF S2A000.00 OR LESS, T' SOL,UM,
MUSTBEFQ&A2Q AND OCCUPANCY_ ITry1AYN01'BE BUILT FORSALC ORI LA,SP
IF YOU SELL OR LEASE A BUILDING YOU HAVC BUILT YOURSEL, WITIIDJ OIYE YEAR
ASTER THE CONSTRU!�fON IS COMPLETE THE LAW WILL PRESUME THAT YOU BUT,P
TT FOR SALE OR LFA WHICH IS IN VIOLATION OF THIS EXEVIPTLON. 1( 1 i _I k 1 Nt l I
t NSI I f S 1N kS ) ?CONIRACI' - YOUR COTISTRUC ION MAST
8 IN TO TT-IL BUILDING CODFS AND YOUR
tEGULATI-ONS I I I
`il IJR RLSIanNJllol I ITr N1 khJ SURE THAI PrOPLE I NII'1 01 EU 131 1 Il kA f
I h I NCI RI=oLlh t 1 S�_I'm L kkk ANCA(3) I IIUN'fY OR MIMICII'AL I I I " S lur
� PII H I ti
it IOJURY LIASU ITV; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORI:ERF MFY�i gRV
III EUILOIN3 DEPARTMENT SUGGESTS WORKER'S O
l -'r.11f..4LII OMPEN$ATJUN Ib�,i n:aFlr'F RF-
Oil. IRS Wli'HHOLDING; 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,
ONLCENu6u CONTRACTORS CANNOT BE EMPLOYED 11N�ER q�R
S. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER. FLORIDA STATUTE NO.
'OCCUPATIONAL LICENSE" IS NOI PDEQUATE 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(2475826)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.
-ao a sv va "s c4all,
PH NE NUMBER
u rr
NrVA
Before meibis day of /�� �y�/L� 20a�a Ne county of
anal, Stem of Fb ,has personaM af9a'l/tl herrn ly M/ryarseHam afimrrrs met
all YaRmenlg an tlede20ona ere Luea `rcvrre�.
Notary Publkal Large,State of_ f County of VC��
�_ P�rearraEY Kmmr G� ��
IVf u11ymW6uXan- r
NMary PuNic Stara 0 FloMa
Shl L Graham
Notary Sonaiura: _ E Cd11OW14MIS066690
-- Ermiro OL14TII016 Y
.<—.�.._—wu-.=�Nul✓a nNuenr:RGVI\aU;urn `._— --.`. J
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MAP SHOWING BOUNDARY SURVEY OF
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rico
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Atlantic Beach
m - a Planning at I Zoning Department
rp
of This approval veno s compliance with applicable
r�C coning, subdiviel n and other local lend
•tea development jFaml
ut does nal wnahtule
approval for Mf bangs. Campiiance
u, 5 lMaa E vnt5 Florida Bnd e5 oftr applicable
` ` Se rµ.�' ��jq W.I.Stale eermitting requirements
must be vendre of the City ofAtlarlgc
� ^ Beach Buildinr ho We m 5
•w Ljl ,e Building Perm
i�;,f1a" gi. f Aa Rua
Nu:srtew-/Le9 '•a'+. SE( R Approreaer:
,•sr.w:m,.rAw';w.vtAr Data:
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City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned b the Buildin
800 Seminole Road Y g Depanment)
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 Fax(904)247-5845
E-mail: building-dept@ca b.us Date routed: ,'s
City web-aite: hdp://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: :7-,Of
�ffUSyrL rtment review required Yes No
Buil
Applicant: anning&Zarin
r or
Project: .O Public Works
bVi s
06 `� Public Safety
/VI 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
Reviewing Department First Review: QApproved. N QffG(`)(. YC i1/I B w%
(Circle one.) Comments:
BUILDING
PLANNING 8 ZONING
Reviewe
TREE ADMIN. Second Review:
QApproved as rev
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewe
FIRE SERVICES Third Review: QApproved as revi
Comments:
Reviewed by: Date:
Revised 07/27/10
ISUILDING YERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach, FL 32233
Office (904)247-5826 Fax (904)247-5845
�
Job Address:IW WUp- Lis di�AL S& Permit Number:
Legal Description Parcel#
Valuation of Work$ or
^�ZDDO.00 Proposed Work heated/cooled 9
non-heated/cooled__:0 0
Class of Work(circle one): New (Addition Alteration Repair Move Demolition pool/spa window/door
Use of
If an existing�pructuoredis a fie sprinkler sysle tem installed
?(Circle one ;Residential o N/A
Florida ProductApproval#
For multiple products use pro act approve orm
Describe in detail the type of work to be performed: DA5V , PA110 794- '60A MV
6mi- — too t ,C.►
Property Owner Informatio
Name: (740 'Z.I.Orr Address:
c;Ty AFla..a.c Stat 4'r DjiX Phone_[fj��luj 0.
E-Mail or Fax#(Optional) W 'IMId 94 EWA 1 L f OM
Contractor Information: CONTRACTOR EMAIL,ADDRESS:
Company Name: Qualifying Agent:
Address:
Office Phone Job Site/Contact Number tTy Faxtate Zip
State Certification/Registration#
Architect Name&Phone#
Enginer'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 o(a permit and that all work will be performed to meet the standards ofall laws regulating construction in thisjurisdiction This permit becomes null
and void(work is not commenced within six(6)months, or ifconsouction or work is suspended or abandenedfor a period of six/6)months at any time A ter
work is commenced. I understand that separate permits must be secured for Elecoh, Work,Plumbing,Signa We(/s,poo/s,F7trmtces,Ba7lers,He es,
Tanks andAir 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 YOVIi NOTICE OF
COMMENCEMENT.
I hereb certh that I have read and emmined this plication and know the same to be true and correct. All provisions oflaws and ordinances governing this
type oI ark will be complied with whether sppeci ted herein or not. The granting of a permit does not presume to give authority to violate or cancel the
Pro
ofarty other ra, ate,Or local trw regulating construction or the performance ofconstruction.
Signature of Owner
waren a m of of Contractor
Print Name11, .w1 ShoreyL6tehsm
{am u~. .- ..-...m,C,mm!sioe FF om*rin ame
. ........ v .$ Ewlrea Otit1A01e ............... ......
Befor x� .............
th' ay 020 one me
this _Day of 20
No u Notary Public
`76 . /, )! /Y_ 7 Revised 01.26.10
CITY OF ATLANTIC 15L1 ACI$
L FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 'CONSTRUCTION
CONTRACTING"REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW
DISCLOSURE STATEMENTPGR SECTION 489.103(7),FLORIDA STATUTES:
STATE LAW REQUIRES CONSTRUCTION TO BE DONE LICENSED
L
By IC
CONTRACTORS. YOU HAVE APPLIED FOR A PERMUNDER AN EXHMPTIC THAT
LAW. THE EXEMPTIONT ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY.TO A/T AS
YOUR OWN CONTRACTOR EVEN T HOTTGH YOU DO NOT HAVE A LICENSE. TL, p{
'"'IRVIY IHFfIN',II LIfTIlTN 1' ll1R' YOU MAYB
1WV PAN9B,Y RESIDENCE OR CARMFA UTBUILDING. U OU MAY ORaeRALSO BUILD OR
DIIPROVE A COMvMRCIAL BUILDING AT A COST OF$25.000.00 OR LESS. T �B w
IP,I LOT BEFOR YOUR USE AND OCCUPANCY. IT MAYNOT BE BUILT FOR SAL F OR L GASP.
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WTlHBJ ONE YEAR
NAFTER THE CONSTRUCNON IS Co LETE, THE AW{;H L PRESUME THAT YOU BURT
IT FOR SALE OR LEA., WRIICH IS IN VIOLATION OF THIS EXEMPTION. 1"U11 I NIA, Nu I_
HI19 U lul W Pf)I I _LI—N �A 1'nLK�N CTOK YOUR CONSTRUCTION MUST
}3E DUNE .iLUURDIIJ�. PO THE BUILDING CODES AND ZONING REGULATIONS. If 1,
71-11V VfI VOHSIIALI1 f0 MARE SURE THA"IPEOPLE TAS lO '
iv'I NSI L, _l— 1 ED BY 1' JI II,AL
L'—LIED_ 1 'I47LAVV AND BY IOUNfY OR M1IUNIC7PAL 1 LL NS
NO
RUN 1NLI S
II INJURY' LIABILITY;Y; S119CE OWNERS MAY BE LIABLE FOR INJURIES TO WORKFRS THEY HIRL
Hit SIIILDINt'- OEPARTMLNT SUGGESTS WORKER'S COMPENSATION INSURANCE SE
'JR( I'ASE0
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.
hIV. PENALTY` UNLICEN18hO CONTRACTORS CANNOT RF EMPLOYED UI
_IRCUIIOSTANCFS. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO
SEC T E AN-OCCUPATIONAL LICENSE' IS NOTADEQUATE 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(2475826)IF IN DOUBT.
V.ACKN0WLEDGEMENT;I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
i
OWNER-BUILDER PERMIT,
Aooc saa .1�w�81o4-�CKSa
PHONE NDMBER
LO M
ZGNAZUd
DATE
Before methis. ] tlxy Df /, / 30JIa Ne munty of
aural,SbfeGFlon�/�a hea personellY FPf�h�Try rreare/neneHantl effimmlhal
Il statements entl tleGarSJone aretmex acivnle. vol
Notary Pubticat Large,Safeof Coolly of VV/L,
�.Pmdiwtlid Y Ylnn.
Notary Public Stats of F101
Nors slgeame:_ / Shitley L Graham
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/ ,Nd This approval verif compliance with applicable
zoning, subdivisi n and other local land
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�� approval for the i¢¢ rete of P.O. Compllonce
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