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610 TIMBER BRIDGE POOL 1 " ' v CITY OF ATLANTIC BEACH \\,,,..._ ..„ s 800 SEMINOLE ROAD 1 ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5814 P t 0111 SWIMMING POOL MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247 -5814 JOB INFORMATION: Job ID: 16- POOL -919 Job Type: SWIMMING POOL /SPA Description: POOL Estimated Value: $40,000.00 Issue Date: 4/29/2016 Expiration Date: 10/26/2016 PROPERTY ADDRESS: Address: 610 TIMBER BRIDGE LN RE Number: None GENERAL CONTRACTOR INFORMATION: Name: POOLS BY JOHN GARNER, INC. Address: 4049 E BUCKSKIN TR QA Phone: 904 - 743 -2060 PERMIT INFORMATION: PUBLIC WORKS: 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. All silt must remain on -site during construction. POOL - Wellpoint (if used) must discharge into vegetated area 10' minimum from street or drainage feature (swale, structure or lagoon). A separate pool permit is required. Roll off container company must be on City approved list and container cannot be placed on City Right - of -Way. (Approved: Advanced Disposal, Realco, Republic Services, Shapell's, Sunshine Recycling and Waste Pro). Full right -of -way restoration, including sod, is required. FEES: PLAN CHECK FEES $125.00 BUILDING PERMIT FEE $250.00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. CITY OF ATLANTIC BEACH A 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5814 STATE DCA SURCHARGE $3.75 STATE DBPR SURCHARGE $3.75 Total Payments: $382.50 1 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. ;Jiff; t'LA1V LOT 168 AS SHOWN ON PLAT OF ATLANTIC BEACH COUNTRY CLUB UNIT 2 _ AS RECORDED IN PLAT BOOK 67, PAGES 132 -137 OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FL. TIMBER BRIDGE LANE Fg�.E C o� (50' R /W) R. T/ _ CI -- T - _• -_ N___80 20.50' 1...k- 362. 66'(P) SIDEWALK ' �• 1.57, 1,68 . , � '� • � P. T. — ��� . . -- - C2 1 ,..• . Zl` f oN® GRAPHIC SCALI PARKING DUMPS7� 15 �� 30 0 siti_vil I am . ' DRIVEWAY:: 7.5. 15' B.R.L ,_ JEA -E. Z 2zs7' a 2 caR ivAIJ( --N. ( IN FEET ) o, GARAGE h p N N _ �, a 1 inch = 30 ft. 7.51' 5.00' I' I I' 2 2. + ' ...... ' O r7 11II .. i O 220o• , = �} In �� r, ,-• 9.09' { 10.O PRQPOSED : , ' ' m TRT STORY RESIDEN CE i DENOTES PROPOSED WOOD up F���v r Ni TYPE •A 1.30 '�� OD 777 " DENOTES PROPOSED CONCRETE 267' 49.6 8$.33' • 0 o° E. o -Pb0{_�1� ! m DENOTES CHEMICAL TOILET - W � , a, o �. g rn '; - DENOTES FUTURE 4" TREE ,� ca 0 .* j } - N o 1111 6 't� a nl 5 I o N a� I� � I II 6 0 i ED I 44-7-14, o I. - 8 � 8 7 ' � I' l l ' I I #7 - z . 0o . Z ► n - . a . 6.26' _.1 #4141411ANIPt 10' B.R.L. 10.7 L21 L3 107 —""— SILT FENCE GOLF COURSE HAVE A 3' SIDE /REAR SETBACK FROM FACE OF GARAGE TO BACK OF RIGHT OF WAY AND DING FACE OR PORCH TO BACK OF RIGHT OF WAY; 3UBLE- FRONTAGE LOTS. FOR WHICH THE NON- ADDRESS IM YARD SHALL BE 10 FEET FROM GARAGE OR BUILDING RIGHT OF WAY. Pool deck 573 sq ft Pool equipment pad 36 sq ft 20 ON THE C_NTERUNE OF TIMBER BRIDGE LANE AS BEING N80'24'17'W. SOD BREAKDOWN ¢nua� Ra' .NS SHOWN HEREON ARE BASED ON NASD 1988. TOTAL LOT AREA 8,370 Sc HEREON UE MTHIN FLOOD ZONE "X' AS DEPICTED ON THE FLOOD INSURANCE RATE MAP 4UMBER 120077. PANEL NUMBER 04084, DATED. JUNE 3. 2013. 11-10 FLOOD ZONES SHOWN ON TO CURB W 1,006 Sc :CALM OFF CF THE F.E.M.A. F.I.R.M. MAPS AND ARE FOR REFERENCE ONLY. 1HE F.I.R.M. R/ R/ GROSS SOD AREA 1,00 Sc INCLUDING THE DATE ERE n MAY H BEEN THIS O AVE I SUBSEQUENT REVISIONS AFTER THIS DATE TO THAT D YALL SUPERSEDE SAID DEDUCTIONS 5 SHOULD BE MADE TO THE COMMUNITY'S FLOOD PLANE MANAGEMENT REPOSITORY. FOUNDATION SLAB 3,433 Sc IC WORKS. HEREON OF ATLANTIC BEACH. DRIVEWAY 768 Sq. 'ENCED HEREON ARE BASED ON NAVO 1988. FOUNDATIONS OR UTIURES & NO IMPROVEMENTS. OTHER THAN 11 SHOWN WERE LOCATED LINE TABLE LEAD WALK 76 Sq. F THIS SITE PLAN. SIDEWALK AREA 208 Sq. NS AND /OR ANY WRITTEN INFORMATION ADDED TO THIS MAP AND /OR REPORT IS PROHIBITED UNE DIRECTION LENGTH A/C PAD(S) & GARAGE ED BY THE S'GNING SURVEYOR. Ll(P) N8D'24'17�W it 10 32 Sq. F 3E0 TO BE VIEWED AT A SCALE OF 1' =30' OR SMALLER. SERVICE COOR SLAB DEPICTED AS EXTENDING INTO THE BUILDING RESTRICTION UMIIS MUST REMAIN UNCOVERED & L2(P) N89 50.28 WATER /CONSERVATION 0 Sq. Ft . ,DJACENT TO WETLANDS ARE TO REMAIN NATURAL VEGETATIVE. AND UNDISTURBED. 4 FEET AND DECIMAL PARTS THEREOF. L3(P) N80'24 T07AI DEDUCTIONS 4,517 Sq '17 - W 2.30 ONLY FOR THE LANDS AS DESCRIBED. IT IS NOT A CERTIFICATE OF T1TLE. ZONING. NET SOD AREA 4250 sq ft: Doc # 2016081064, OR BK 17523 Page 1223, Number Pages: 1, Recorded 04/12/2016 at 09:28 AM, Ronnie Fussell CLERK CIRCUIT COURT DUVAL COUNTY RECORDING $10.00 DEED DOC ST $6348.30 ORIGINAL Prepared by: c opy .; Brent R. Newton, Esq. Newton & Newton, P. A., 10192 San Jose Boulevard Jacksonville, Florida 32257 File Number. 16 -0056 Consideration: $906,832.77 Corporate Warranty Deed This Indenture, made this 8th day of April, 2016, Between RIVERSIDE HOMES OF NORTH FLORIDA, INC., a Florida corporation, whose post office address is: 12276 San Jose Blvd., Suite 120, Jacksonville, Florida 32223, Grantor, and JEFFREY A. BROWN and KIMBERLY D. BROWN, husband and wife, whose post office address is 610 Timber Bridge Drive, Atlantic Beach, Florida 32233, Grantee; Witnesseth, that the said Grantor, for and in consideration of the sum of Ten Dollars ($10.00), and other valuable consideration, to it in hand paid by the said Grantee, the receipt whereof is hereby acknowledged, has granted, bargained and sold to the said Grantee forever, the following described land, situate, lying and being in the County of Duval, State of Florida, to wit Lot 168, Atlantic Beach Country Club Unit 2, according to the map or plat thereof, as recorded in Plat Book 67, Pages 132 through 137, of the Public Records of Duval County, Florida. Parcel Identification Number. 169505 -2100 Subject to covenants, restrictions and easements of record, if any, and taxes for the year 2016 and subsequent years. And the said Grantor does hereby fully warrant the title to said land, and will defend the same against the lawful claims of all persons whomsoever. In Witness Whereof, the said Grantor has caused this instrument to be executed in its name by its duly authorized officer and caused its corporate seal to be affixed the day and year first above written. RIVERSIDE HOMES OF NORTH FLORIDA, INC., a Florida corporation Signed and Sealed in Our Presence By MATTHEW A. ROBERTS President Wit... hint Name: QL` _._.__- .J legal► ' (Corporate Seal) -- DALLAS ATKINSON MusessMwNamm State of Florida County of Duval The foregoing instrument was acknowledged before me this 8th day of April, 2016, by Matthew A. Roberts, President of Riverside Homes of North Florida, Inc., on behalf of the corporation. He is personally known to me. �✓1 1 ; � ' o '• '"s�t BRENT R NEWTON 1 Notary Public } e Notary Public . State of Florida 9 Printed name: rtn 1 � Q; � My Comm. Expires Oct 19. 2018 t My commission expires: I ;! o,..;; , ' Commission N FF 142445 y .f t(antic Oeacfz Country C(u6 Owners' Association Inc. 414 Old Hard Road, Suite 502 FILE COPY • Fleming Island, Florida 32003 • Phone: 904 -592 -4090 * Fax: 904 - 269 -2729 wiVw. flori diallprOperl yIIIallag,elllellt.colll Jeff & Kimberley Brown March 11, 2016 610 Timber Bridge Lane Atlantic Beach, Florida 32266 Re: (Lot 11168; 610 Timber Bridge Lane) Pool, pool deck, pool equipment, and pool fence. Dear Mr. & Mrs. Brown: We thank you for your above referenced architectural submittal, and are pleased to inform you that same has been approved. You may proceed according to the information provided with your application made part of this approval, the Community Guidelines, and following conditions 1) In ground Pool, decking size, location, and layout (approved aS depicted within specifications provided by "Pools by Jo /m Garner, Inc." attached hereto and made part of this approval. 2) Pool and pool deck to substantially resemble in color and materials as pictorially depicted in representation provided by "Pools by John Garner, Inc." and nuufe part of this approval. 3) Pool equipment to be located within the BRL, and behind equipment screening wall. 4) Perimeter pool deck elevation to meet and snatch backyard elevation. 5) Any excess dirt to be removed front the premises. No alterations to existing grade elevations, lot wales, or lot drainage is allowed or approve(. 7) Four foot (4') high, flat top, two (2) rail black aluinilt(lin p00! code fencing allowed 8) Fencing shall continence at least eight feet (8') back front front corners of home, as depicted 011 site plan submitted herewith and made part of this approval. 9) If connecting t0 any existing fencing, please obtain your neighbor's permission prior to installation. 10) This approval is Aesthetic only, and does not grant, allow, or supersede County building codes, regulations or ordinances. This approval concerns only your submitted architectural plans. It is your responsibility to obtain any easements, permits, licenses and or approvals which may be necessary to improve the property in accordance with the approved plans. This approval must not be considered to be permission to encroach on another property owner's right to use and enjoy all possible property rights. Approval of this submittal does not constitute a warranty or representation by the ACC, or any developer or landowner, that the proposed improvements will be consistent with the development plans of any other landowner. Furthermore, this approval does no t in any way grant variances to, exceptions, or deviations from any y g setbacks or use restrictions unless a specific letter of variance request is submitted, and a specific letter of "variance approval" is issued by the party entitled to enforce such setbacks or restrictions. This approval also does not constitute approval of any typographical, clerical, or interpretative errors on the submitted plans. Compliance with all approved pool plans is the responsibility of the OWNER of legal record, and any change to the approved plans without prior ACC approval, subjects these changes to disapproval, and enforced compliance to the approved submitted plans. This approval should not be taken as any certification as to the construction worthiness or structural integrity of the change proposed. All local building codes must be met. If a Building Permit is required, one must be obtained from the appropriate governmental agency. Please refer to the County's building codes for requirements regarding fencing or other measures to control access to pools or spas. In addition, you as the property owner are responsible for positive drainage during and after construction. No water drainage is to be diverted to any adjoining lots/Also/ lease Yogi re - respo ib ble for contacting the appropriate Utility Companies prior to any;excavapon o c ►g ng• ; A ,, , By: I- Ierbert Boyett � f Floridian Property Management ' For: Atlantic Beach Country Club Owners' Association, 1„nc. Doc # 2016088042, OR BK 17532 Page 1394, Number Pages: 1, Recorded 04/19/2016 at 02:09 PM, Ronnie Fussell CLERK CIRCUIT COURT DUVAL COUNTY RECORDING $10.00 .... .... . FILE COPY NOTICE OF COMMENCEMENT State of Pi or i d ct. Tax Folio No. i (9q 56 - 21 CO - County of 111\10.1 To Whom It May Concern: The undersigned hereby informs you that improvements will be made to certain real property. and in accordance with Section 713 of the Florida Statutes, the following information is stated in this NO. ,TicE OF C MMENCElytENT. Legal Description of property being improved: L04 J2 A+tarth: LIMAN Qu-to Uli+ 2 Address of property being improved: if) I (.) Ii: (& tOer b( Af.,_ Lv) General description of improvements: 0.j&- ingclincl owl Owner: le...4 B1) (.i) n Address: Owner's interest in site of the itnprovement: 1. WISZIIC Fee Simple Titleholder (if other than owner): Y Name: 9f ContractoAddress:r: f) p 4_ AC- -": . z2-1 3:). s_eraL u\ 64 tI EMci 3 04 k 3U- Telephone No.: et D _43 z(coo Fax No: cioq Ng b LSI) _______ Surety (if any) 14 Address: Amount of Bond $ Telephone No: _ ________ _ Fax No: Name and address of any person making a loan for the construction of the improvements Name: Address: Phone No: Fax No: Name of person within the State of Florida. other than himself, designated by owner upon whom notices or other documents may be served: Name: Address: Telephone No: Fax No: In addition to himself. owner designates the following person to receive a copy of the Lienor's Notice as provided in Section 713,06(2)(b), Florida 'tatues. (Fill in at Owner's option) Name: l Address: Telephone No: Fax No: Expiration date of Notice of Commencement (the expiration date is one (I) year from the date of recording unless a different date is specified): THIS SPACE FOR RECORDER'S USE ONLY OWNER Date: 3 Before 1 ji day of 4 e e...e _ ill th,County of Duval, State Of d k1eFlorida, iuit,c appeared 4 AQ,PDP/- y eilik TONYA uniMICKLAND Notary Public at Large. State oS.Florida, Co ty o Duval. MY COMMISSION II FF072MII My commission expires: _ ..__ 5 . _...-- --. Vr EXPIRES: Jimmy 134011 Personally Known: . 164.! . or Produced ldentificati in. _v,kk--"" .------- z eyit. 5, c. I 4 l A e . 1— ,3--74-; Sy:v. Jar City of Atlantic Beach APPLICATION NUMBER r j s S Building Department (To be assii tied by the Building Department.) . 800 Seminole Road — y_p9 -. Atlantic Beach, Florida 32233 -5445 Phone (904) 247 -5826 • Fax (904) 247 -5845 x a E -mail: buildin de t coab.us Date routed: ' City web -site: http: / /www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: (O �d //A / , / a Department review required Yes No p Y � Applicant: / S 4 Sri /h/ , A i �Z _ Pla nning & Zonin� Tree Administrator Project: ♦ / ublic Work - Public Utilitie� 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 Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: Approved. ['Denied. (Circle one.) Comments: BUILDING PLANNING & ZONING Reviewed by: l ` Date: VI-7 /l` 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 05/14/09 ri ,;;Ly� fy City of Atlantic Beach APPLICATION NUMBER ;�s , � Building Department (To be assi ned by the Building Department.) / � < �w 800 Seminole Road — � Q a - 9i 9 E - Atlantic Beach, Florida 32233 - 5445 / ` / Ph one (904) 247 -5826 - Fax (904) 247 -5845 i/ /p 0 .t1J:- E -mail: building- dept @coa Date routed: 7 7 �� City web -site: http: / /www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: (L /d / /A / AO i'. Department review required Yes No p Y Applicant: , / 0 S ��i Zia , a o ,Cr Planning & Zoning Tree Administrator Project: ♦ / Public Work f/e Review fee $ Dept Signatur y Other Agency Review or Permit Required Review of Permi . i)V1/4)T° Florida Dept. of Environmental Protection Florida Dept. of Transportation St. Johns River Water Management District t f ) Army Corps of Engineers Z/20-/6 `f -' Division of Hotels and Restaurants \^ _ Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATL Reviewing Department First Review: [ proved. 1 'Denied. (Circle one.) Comments: BUILDING �/j� PLANNING & ZONING Reviewed by: - - i' / Date: It'd d 1 TREE ADMIN. Second Review: I 'Approved as revised. nDeti. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: 1 Approved as revised. 1 IDenied. Comments: Reviewed by: Date: Revised 05/14/09 1 j ty City of Atlantic Beach APPLICATION NUMBER if r te. - Building Department / 04) (To be assi ned by the Building Department_) 800 Seminole Road 2 — ?ea 9l Atlantic Beach, Florida 32233-5445 u/6' Phone (904) 247 -5826 • Fax (904) 247 -5845 E -mail: building- dept @coab.us Date routed: 7 / City web -site: http: / /www.coab.us \_ APPLICATION REVIEW AND TRACKING FORM Property Address: (O /d //A / r / . Department review required Yes No p Y in 9� Applicant: , / 0 S ,��� but 1 � � r' g & Zoning Treg Arim nistrator Project: ublic Work bIic Utilities Public Safety Fire Services Review fee $ Zr Dept Signature Review or Receipt Date Other Agency Review or Permit Required 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 Division of Alcoholic Beverages and Tobacco Other: APPL ATION STATUS Reviewing Department First Review: Approved. nDenied. (Circle one.) Comments: BUILDING /� PLANNING & ZONING (4 ? - Date: Y /� Reviewed by: TREE ADMIN. Second Review: Approved as revised. 'Denied. 4,19 IC WOWS Comments: AWi k--44 PUC UTILITI Zb Date: P BLIC SAFETY Reviewed by: FIRE SERVICES Third Review: I Approved as revised. nDenied. Comments: Reviewed by: Date: Revised 05/14/09 1 1 , 1 i 1 1(•.-CLIne _ 2Df ••••• am. ., 1/117 ... .._ , - _______ 1 • , • . .... ___ ___ _ _ _____ Y7 X/243 r ke 3 ____. ._ ____ _ _______ I 4 - /ft xeto 1 . 42 x1/42 y . 11,4e1 - -- - _ I -Vol° Allelf.__e004.k \ l__MA _4 , 41,_1(ao 0217 .4 r 4745 1 .41_7 K-10_ ---. 14 _ _ 11.:. i w ( l sit 442 lif 414 1 I Iv --- -- -- , ___4 _. _ - - - --------- . c g____6 sly .„.a..... . i . _______ _ .__________ i _ ___________ ....,,,, 4 - - _ _ _ ___.4 _____________ __ . , .. _______ ; t it , , . ______ ycpv • ....Pe.eLiga:#40t'.4411.2„ LOT 168 AS SHOWN ON PLAT OF . ATLANTIC BEACH COUNTRY CLUB UNIT 2 _ AS RECORDED IN PLAT BOOK 67, PAGES 132 -137 OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FL. (50' R/11) • — - PT C1 — 2D 50 - `�` C --- N SC 2 4'17 "�/ 36 SIDEWALK • ° f o .'. - 21.57' _ i. . . _ - �. . d " .., . `N • P f d • 1 � .. ' n . .- 2 1 . 33' 1 pm q't�`__ �,: G R AP H T C S C AL I �, PARKING DUM S7ER 1 t7 15 - oRivatvAY a . �— . ._I 30 I I_ F.. 7.5 JEA ! I i f ( I • _ L ;, - E. _�`;. . 2 21 5' aR G' B.R.I. + f J j . , • �< 27.67' � �, •� 2 CA R 3 LEAD t ( \ 0.. GARAGE 'rn L`�ALJC —. \ ) 0 _ : o N N Q 1 inch = 30 ft. 7.51' 1 r 1 r V. . l o 2zoo• — i i 9.09' 1,11s:',> N o: d^ J �: 2 )— � 10.0 �' 5 TYPE RES vCE m $ i ii DENOTES PROPOSED WOOD M (9- ) dW F.F dui 67 ELE ant. ON .-1 3D rte ' DENOTES PROPOSED CONCRETE 1 1 2. 67. V. a i :• I `� _ 49.67 X 8$.33' b 49.6 ! � w� � ( Y m DENOTES CHEIv11CAL TOILET • s l e w yJ 0� y"'; - DENOTES FUTURE 4" TREE fic\I 7 93 -- - • - I ro. T D � � co � 8 7 _ RirlittiATCA - - �- " a 51Y-/ N1� Oil' ' ��,�o;, , e M � � r ' I LArw III II a O y' ao• It� po ;7- ''ff 6.26 f 12 . 1 !i 10 B.R.L. R.L ;r! 10.7 L 2. ' ice —SjLT FENCE GOLF COURSE i �a> >> J City of Atlantic Beach i ` r APPLICATION NUMBER a ' ye Building Department Q , � ( To be assi ned by the Building Department.) P. > 800 Seminole Road / (; ... — X00 9 -,1 ' x Atlantic Beach, Florida 32233 -W ', 16 / Phone (904) 247 -5826 • Fax (90 5845 Z / p /_ 91 . 1 19' , = E -mail: building- dept @coab.us Date routed: / 7 ( City web -site: http: / /www.coab.us APPLICATION REVIEW AND TRACKING FORM Y Pro ert Address: (L /d //A / AO i • Department review required Yes No , / f..,..,)________ Property Applicant: / S ..„ /h/ i ¢ o £ ,e C., Planning & Zoning Tree Administrator Project: • / ublic Work.. blic Utilities 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 Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: /Approved. / � � 1 'Denied. T / (Circle one.) Comments: fee ��� elpfr - BUILDING PLANNING & ZONING ` / Reviewed by. ,i,eXi 910 &iry Date:l''.Z /16 TREE ADMIN. T Second Review: (Approved as revised. 1 (Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: I (Approved as revised. 1 (Denied. Comments: Reviewed by: Date: Revised 05/14/09 w BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 FILE COPS Office (904) 247 -5826 Fax (904) 247 -5845 Jots address: (o10 TtMAXI & I'a(g. Lr Permit Number: /( ,4 /— 9/9 Legal Description WI I IA ► } i E (lcuittyu Cat phi 4 2 Parcel # 1 b SOS - 2- I00 Valuation of Work $ 43 (°) 66 '-'° no ° I Proposed Work h ted/cooled .1 t n- heatedicooled class of Work (circle one): New Addition Alteration Repair Move Demolition o5/spa vindow /door Use of existing/proposed structure(s) (circle one): Commercial G I sii1 nt - If an existing structure, is a tire sprinkler system installed? (Circle one): Yes No N 'A Florida Product Approval 4 For multiple products use product approval form l) >scrioe in detail the type of work to be performed: 0,Ot1St id in la) p0 - Property Owner Information: - 1-ea 6cVWt\ Address: 601 71.v. a c" - o 6 g L. iv A . S Ct _ State( -Z Zip _ .Z. Z.33 Phone �'tl r -- 5 z e E- e�aii or Fax # (Optional) - -_ Contractor Information: Con ?pan Name: TOPS b it IOWA &t f Y ,f,,KG Qualifying Agent: - 3 . 0 hn 605 uc°es;• 10221 b B\1v�t � City TikiL State :_)tfice Phone _4o 143 ZU 4 ti , i it Fax # K Zip 3Z.24 6 � Job Site! Contact Number U ti RUy 7y5 btSD Stat�: Certification /Registration # CPG Q tag38y — ,.l:itec N t Name & Phone # - - - r JA- — iv 1 � L1,ineer's Name Phone # & rer Simple Title Holder Name and Address V — B.;ac ing Company Name and Address _ - N /Grgage Lender Name and Address oz . 1(2,r'icatioti rs 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 c uJ 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 n. t v,,till . work is not commenced within six (6i months or if construction or work is suspended or abandoned for aperiod of six (6) months at any time after wor, commenced. 1 understand that separate permits must be secured for Electrical Work. Plumbing. Signs, Wells. Pools, Furnaces, Boilers, Heaters. Tonics and ,4ir 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. crest z certify that 1 have read and examined this• a plication and know the same to be true and correct. All provisions of laws and ordinances governing this . 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 • •JVi..:.ns of am. other federal. state. or local lent regulating construction or the performance of construction. � n�teure of Owner AL--- IL i - - S ignature of Contractor 'r; r :Janie ` L. 4, .. Print Name i s, ",on 'and subscrib befo e use Swo rr� to nd subscribed before me hip / Day of -- 1Y/it/) 20 / 4' this J. 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