544 PLAZA - SHED PERMIT . i rL��:rjv,..
°S, CITY OF ATLANTIC BEACH
A ` 'S 800 SEMINOLE ROAD
.. ._. ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
SHED PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-SHED-1716
Job Type: SHED PERMIT
Description: MOVING EXISTING SHED
Estimated Value: $1,000.00
Issue Date: 7/17/2015
Expiration Date: 1/13/2016
PROPERTY ADDRESS:
Address: 544 Plaza
RE Number: 170703-0206
PROPERTY OWNER:
Name: MCLENDON, KEITH
Address: 544 PLAZA
PERMIT INFORMATION:
FEES:
BUILDING PERMIT FEE $55.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $59.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL (IlY OF A"1'I.ANTIC BEACH ORDINANCES AND 711E FLORIDA
BUILDING CODES.
iir
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904)247-5826 Fax (904) 247-5845
Job Address: SIN 9 az. Permit Number:
Legal Description Parcel #
Valuation of Work$/$0 ea. Od Proposed Work he ted/cooled S .Ft
non-heated/cooled
Class of Work(circle one): New t sdifoi , Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial 4'esidentia
If an existing structure,is a fire sprinkler system installed? (Circle one): •es go N/A
Florida Product Approval #
For multiple products use product approvaTform
Describe in detail the type of work to be performed: Mou«
' txis�`n Qhe 4)1 to bcir k
edle ■ec o4 ]ewer`d • ' he. s ►ty' w%skt for Si* p back Cat ur.J �i d
c �e.iiec
Property Owner Information:
Name: '(4 i4* AA.ek it.r v� Address: Sky co lqz t t
City wlko c ��� State {Zip 3 '13 Phone 904- G 31-32.410
E-Mail or Fax#(Optional) Kci.‘, 1ks4n1 eabliz .okaa. cow,,`
Contractor Information: CONTRACTOR EMAIL ADDRESS:
Company Name: Qualifying Agent:
Address: City State
Office Phone Job Site/Contact Number Zxp
State Certification/Registration# Fax#
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
andApplication is hereby made to obtain a permit to do the work and installations as indicated. I cert that no work or installation has commenced prior to the
void�wo k isinot commenced within six(6)�months,t omeet construction or of all is sus ended or abandoned for a this period of si 6)This months t any time after is commenced. I understand that separate permits must be secured for Electrical IFork,Plumbing,Signs, Wells,Pools, Furnaces, 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 cert that I have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this
type ofwork will be complied with whether speci red 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
?rint Name e:\A y� M e 4�o ion Name
3e me Before me
l 's 17 gay o' 1 u0 ,20 if- t i No •.
--� 20
illita.
I iota" �r 04 Sary. Public State m of Florida 111 y•r. Li toy'tit', 9�id N1 990
po,atl'
Expires 02/14/2018
Revised 01.26.10
s ' "d\ CITY OF ATLANTIC BEACH
, OWNER / BUILDER AFFIDAVIT
.4.--•r;s„r/
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 TI-TAT
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 TILE 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
1 TIRE 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
PURCHASED.
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.
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.
54 Li 4luZH c4GL-I- C,31 - n1,610
ADDRESS PHONE NUMBER
I.ce;-k\\ Ak Lc.note,n
PRINT NAME
c. .2 "I-1- 1C
SI ATURE DATE
Before me this day of ,20_ in the county of
Duval,State of Florida,has personally appeared herin b elf/herself and ffirms that
all statements and declarations are true an accurate.
Notary Public at Large,State of r County of
,,,111...❑,,,111......,,,,,,Personally Known V
ced den•, -tion- _ / A - /2 6 ,P%� Shirley Public State of Florida
�� a19f., ci Expires 02/14/2018 086990
Notary Sign- . *AL t
E.BLIX;/Owner-!;Odder Afladarh.REVISED. 4i1•'2009 lo