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871 Sherry Dr ROW pavers permit CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 RIGHT OF WAY PERMIT MUST CALL BY 4PM FOR NE)Cr DAY INSPECTION: 247-5814 JOBINFORMATION: Job ID: 16-ROW-1898 Job Type: RIGHT-OF-WAY PERMIT Description: replace existing concrete driveway with pavers Estimated Value: Issue Date: 8126/2016 Expiration Date: 2/22/2017 PROPERTY ADDRESS: Address: 871 SHERRY DR RE Number: 169982-0000 PROPERTYOWNER: Name: PALMER ET AL, CHRISTY L Address: 871 SHERRY DR PERMIT INFORMATION: PUBLIC WORKS: UTILITY DEPT.: 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 runoff must remain on-site during construction. Full right-of-way restoration, including sod, is required. Maximum driveway width within the City right-of-way is 20' (circular driveway width is 12'maximum). Ensure all meter boxes, sewer cleanouts and valve covers are set to grade and visible. A sewer cleanout must be installed at the property line.Cleanout must be covered with an RT1 concrete box with metal lid. Cleanout to be set to grade and visible. FEES: Fence/ROW $35.00 rk*UkREM*Ea%H)BWK[4(Rb@DANCE$afiaML CITY OF ATLANTIC REACH ORDINANCES AND THE FLORIDA BUILDING CODES. CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5814 Total Payments: $60.00 PERJAIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by1he Ruilding Department) 800 Seminole Road E-CEIVE Atlantic Beach,Florida 32233-541, X� I f—ow— Phone(904)247-5826 Fax(9(412 5 E-mail: building-dept@coab.us 6 22 2016 Date muted: Cityweb-site: http:/1www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 1 Shur, Department review required Yes No Building Applicant: kku Planning&Zoning free Administrator Project: L*jSN�Ah MUIA9 ublic Works ublic Utilities Public Safety F Sew ces ire 4 1 im Review fee $ Dept Signature, Other Agency Review or Permit Required Review of Penmit=PBty Date Florida Dept, of Environmental Protection Flonda Dept.of Transportation St.Johns River Water Management District Amy Corps of Engineers Division at Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: [OApproved. E]Denied. (Circle one.) Comments: BUILDING PLANNING&ZONING Reviewed by: Date: TREEADMIN. '01, ZZS7�-/ Second Review: ElApproved as revised. ElDenled. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date FIRE SERVICES Third Review: [DApproved as revised. F]Denied. Comments: Reviewed by: Date: Revised 05114109 City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road nECEIV w7j�'q'% Atlantic Beach,Florida 3223'-5 Phone(904)247-5826 FEd:(94(0445)247-58 AUG 2 2 Date routed: aa Of E-mail: building-dept@coab.us City welo-site: http:/Avww.coab.us n 2016 BY: APPLICATION REVIEW AND TRAGKING FORM Property Address: Department review required Yes No Building Applicant: Planning &Zoning Tree Administrator Project: _i*tiucti)� Lx�s'�N emufAil Irublic Lo U b J�t� 'e, <2ublic Utilities D Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Revi.ew it=P' Data of Pe By Florida Dept.of Environmental Protection Florida 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: APPL!GATION STATUS Reviewing Department First Review: ETApproved. ODenied. (Circle one.) Comments: BUILDING PLANNING&ZONING Reviewed by: Date: TREEADMIN. Second Review: ElApproved as revised. [-]Denied. C VORVS Comments: J.t�' '0"f_4__� PUBVP UTILITIES jr-7-2—I& PUBLIC SAFETY Reviewed by: Date, FIRE SERVICES Third Review: E]Appmved as revised. [:]Denied. Comments: Reviewed by: Date:— Revised 06114109 CITY OF ATLANTIC BEACH CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS 800 Seminole Road 90�247-5800 Atlimlle Beach,Florida 32233-5"5 F. 904-247-5B45 PLEASE SUBMIT(3)COMPLETE SETS OF PLANS WITH APPLICATION. Date I,A��4 A 0 Job BY THE Crry =# Address slil., `ts�Nu�' Permitee: 2W'2y%0� P�U*A-& U,�� - Telephone PermittmAddress: )D-qq Ay�o"Ay.,%S� 1�� Requestrig Pemnissionto Construct'. t;XMA;W1LACA-As' lvauywc. ^CAAIVS Location: (Reference to Crom-Street) I.,c!5 P, I Applicant declares that prior to filing this application he has ascertained the location of all existing utilities, both aerial and underground and the accurate locations am shown on the sketches. A Letter of Notification was mailed to the following Utilitles/Municipalitles: Jacksonville Electric Authority Yes( ) No Date: Bell South Telephone Company Yes( ) No Date". Ferrell Gas Yes No Date: Corti Yes No Date: 2. Whenever necessary for the construction, repair, improvement, maintenance, safe and efficient operation, alteration or relocation of all, or any portion of mid street or emement as determined by the Director of Public Works, any or all of mid poles, wires, pipes, cables or other facilitim and appurtenances authorized hereunder, shall be immediately removed from said street or easement or restat or relocated hereon as required by the Director of Public Works, and at the expense of the Perri unless reimbursement is authorized. 3. All work shall meet City of Atlantic Beac='da Deparmtment,,of Transportation Standards and be performed under the supervision L A N&*&% (Contractor's Project Superintendent) located at lag a Telephona* 4. All materials and equipment shall be subject to inspecti6n by the Director of Public Works or his designee. 5. Ail city property shall be restored!to its original condition as far as practical, In keeping with city specificartions and the manner satisfactory to the city. 6. A sketch of plans covering details of this installation, as well as, a Copy of a recent survey shall be made a part of this permit. Calculations showing any Increase in impervious area on owner's lot or in the city Rlqht of Way are to be Included with this application. 7. This permittee, shall commence actual construction in good faith with days. If the beginning date is mom than 60 days from date of permit approval, then permittee must review the pemit with the Director of Public Works to make sum no changes have occurred in the area that would affect the permitted construction. S. It is understood and agreed that the rights and privileges herein set out am granted only to the extent of the City's right, title and interest in the land to be entered upon and used by the holder, and the Holder will, at all times, assume all risk of and indemnify, defend, and Base harmless the City of Atlantic Beach from and against any and all loss, damage, and cost of expenses arising in any manner of the exercise or attempted exercises by the holder of the aforesaid rights and privileges. 9. The Director of Public Works shall be notified twenty-four (24) hours prior to starting work and again immediately upon complati n. OWNER Signed: Date: MAY A.ARVIN day lh Notary Public,State of Florida " , Ir . . 'rr Erly pp.. My Comm.Expires WIDrA20 =1t'.'0';F dli�',ins. . .11L M 4.4cr NotivyPublic. Stataofflo 4,tnl Zp�� MY M1.1 nww' Pereonatty Kn�: commission No.FF994922 E, Pd.cea mentlicawn: R.O.W.Permit Attachment—of for R.O.W.Permit#—issued 1200 Atlantic Beach,Fl, 32213 Owner's Name: (Y\_A�- �A as& PropertyAddress: R'71 S�-c=q L10 0� Subdivision: Lot#/Block R-E.#: REVOCABLE ENCROACHMENT PERMIT THIS REVOCABLE ENCROACHMENT PERMT, issued on this _ day of 200, by Atlantic Beach, Florida, a municipal corporation organized and existing under the laws of the State of Florida,hereinafter referred to as"CITY" and of Atlantic Beach,Florida,hereinafter referred to as"USER". NVITNESSETH: That the CITY does hereby giant the USER permission on a revocable basis as described herein the right to enter upon the property of the City of Atlantic Beach for the purpose w described in the City of Atlantic Beach Right-of-Way/Easement permit numbers noted above(copies attached). This work is generally described as: Any facility maintained, repaired, erected, and/or installed in the exercise of the privilege granted remains subject to relocation or removal on thirty (30) days notice by CITY to the USER, said notice to USER shall be given by certified mail, retain receipt requested, to the following address: The depositing of said notice of cancellation in the United States mail shall constitute the notice of cancellation and the burden is upon USER to keep the CITY informed of USER!s proper address. The USER shall promptly make my and all necessary repairs to any facility erected or maintained in the exercise of the privilege herein granted and shall at all times maintain said facility in good and safe condition. in the event it is necessary for the CITY or the City's approved representative or other franchised utility to enter upon the above-described property of the CITY, the USER shall replace at the USER's sole expense, any and all material necessarily displaced during the action of maintaining, repairing, operating,replacing,or adding to of the utilities and facilities of the CITY or franchise utility provider. The facilities allowed by the permit shall meet the current requirements of the City Code, Building Codes,Land Development Code,and all other land use and code requirements of the CrrY,including City Code Section 19-7 (b) which states "Driveways that cross sidewalks: City sidewalks may not be replaced with other materials, but must be replaced with smooth concrete left natural in color so that it matches the existing and adjoining sidewalks." Page I of 2 The USM prior to making any changes from the approved plans and/or method, must obtain written approval from the City of Atlantic Beach, Public Works Department, for said change. The USER shall, at the discretion of the CITY,be requested to submit as-built drawings showing the change within thirty(30)days after the day of completion. This permit shall inure to the benefit of, and be binding upon, the USER and their respective successors and assigns. USER shall meet the terms and conditions of this permit and to all of the applicable State and CITY laws and/or specifications, to include utilities locate requirements and use limitations/requirements of public rights-of-way and other public land. USER filarther agrees that the CITY and its officers and employees shall be saved harmless by the USER from any of the work herein under the terms of this permit and that all of said liabilities are hereby assumed by the USER. DATED and SIGNED this IfffNdayof As�av,,� 20P0 100�- — Property Owner (to be signed in presence of the Notary) STATE OF FLOREDA COUNTY(!MDUVAL 2 If On this I'X' day of 001 perso��y appeared before me, a Notary Public in and for said Col and- State, ��1 �r the property owner of -A-1 I Z4-ps-'-A I Atlami each, Fl�� known to me to be me person(s) described in and whal executed the foregoing instrument, who acknowledged to me that he or she executed the same fireely and voluntarily and for the uses and purposes therein mentioned. MAY A.ARVIN Notary Public,State of Honda Notary Public r surrCounty and State My Comm.Expires WIWA20 CITY OF A=C BEACK FLORIDA.a Commission No.FF994922 municipal corporation: Approved: -RW&jANR6wp&W-Public,Works Director sca"rit wltjim� cd� For Permits where city sidewalk is impacted, City Manager approval required: Jim Hanson,City Manager Page 2 of 2 -4so IL 1490_1� CITY OF 4)WNER CITY OF ATLANTIC BEACH OWNER/ BUILDER AFFIDAVIT 1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART I 'CONSTRUCTION FCON�TRACTING'REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW. DISCLOSURE STATEMENT FOR SECTION 489.103M FLOREDA STATUTES: TI1'' STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED AN E) CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER MMPTION TO THAT LAW.FTIMEXEWTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACT AS S YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST UPERVISE 16 QMTRUCTION YOURSELF YOUMAYBUILDORImPROVEAONE—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 FORYO&ME AND OCCUPANCY. IT MAY NOi BE BUILTFOR SALB 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 UNLrCENSE )PER2OAS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST BE DONE ACCORDING To THE BUILDING CODES AND ZONING REGULATIONS. IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE,��� LICEIISES REQUIRED BY STATE I AW 4ND BY COIUNT1 I .— IL INJURY LIABILITY; SINCE DOWNERS MAY BE LIABLE FOR INJ THE BUILDING DEPARTM —It�E �EM -L LFAULI, VUR INJURIES TO WORKERS THEY HIRE PURCHASED, ENT SUGGESTS WORKERS COMPENSATION INSURANCE B� 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 CIRCU ASTANCES. OWNERS BEING SUBJECT TO$5,000 PENALTY 455-228(l). AN-OCCUPATIONAL LICENSE'IS NOT ADEQUATE, THE UNGDER_FLORIDA STATUTE NO. SEE THE COLo, , It,1111"UAD, OF OWNER SHOULD PHYSICALLY CERTIFICATE' TO ASCERTAIN IF A PERS COMPETENCY' OR THE FLORIDA "CONTRACTORS -5826)IF IN DOUBT. BUILDING DEPARTMENT(247 ON IS A LICENSED CONTRACTOR. TELEPHONE THE 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. PRINTNAMVE SIGNATURE v Beforn,me it", it , Dunla"­c,R.Ond .4 2� 1,1:courl,0 a,Zl,_a'yo aVu. 'if-tatennamn.oddeUmomme;Nom u bboaii, nexandaffionstuat Notm,Public at Lor,e,Santa of F( County of_L_)fuvj Iz- y Note,Silin.tme FM�­wrauldffAfNda�,Ra�mm,�.nm Cl-Z OF ATLANTIC BEACH CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS 500 Seminole Road 90�247�8[10 a'o Atlantic Beach,Florida 32233-5445 Fat 904-247-5945 PLEASE SUBMIT(3)COMPLETE SETS OF PLANS MTH APPLICATION. Data 0 JobAddreess F�l ErUtDBY THE CITY_ Permitee: , G� U41th-S Telephone Permittee Address: I a_q q Ac>w I, ,�! -NZ Requesting Penmission to Construct lt�ul�' V.X MA 01AC"A� Location: (Reference to Cross-Stmet) P ii,,- 1. Applicant declares that prior to filing this application he has ascertained the location of all existing utilities, both aerial and underground and the accurate locations am shown on the sketches. A Letter of Notification was mailed to the following Utilities/Municipaiities: Jacksonville Electric Authority Yes( ) No Date, Bell South Telephone Company Yes( ) Noo Date: Ferrell Gas Yes No Date: Gonricast Yes No Date: 2. Whenever necessary for the Construction, repair, improvement maintenance, safe and efficient operation, alteration or relocation of all, or any portion of paid street or easement as cletennined by the Director of Public Works, any or all of said poles, wires, pipes, Cables or other facilities and appurtenances authorized hereunder, shall be immediately removed from said street or easement or reset or relocated hereon as required by the Director of Public Works, and at the expense of the Permittee unless reimbursement is authorized. 3. All work shall meet City of Atlantic eac or F orkla Department of Transportation Standards and be performed under the supervision (Contractor's Project Superintendent) located at Ja4tA Jiwg-JIeQVi OT�Irr4Q&L,_Telephone*._IDI-,L�q-�5-73 4. All materials and equipment shall be subject to inspection by the Director of Public Works or his designee. 5. AN city property shall be restored to fis original condition as far as practical, In keeping with city specifications and the manner satisfactory to the city. S. A sketch of plans covering details of this installation, as well as, a copy of a recent survey shall be made a part of this permit Calculations showing any Increase in Impervious am on owner's lot or In the city Rlaint of Way am to be Included with this application. 7. This permittee shall carnmence actual construction in good fafth with days. If the beginning date Is mom than 60 days from data of permit approval, then permittee must review the perinit with the Director of Public Works to make pure no changes have occurred in the area that would affect the permitted construction. 8. It is understood and agreed that the rights and privileges herein set out am granted only to the extent of the CWS rigt , nienest in the land to be entered upon and used by the holder, and the Holder will, at all times, assume all risk of and indemnify, defend, and save harmless the City of Atlantic Beach from and against any and all loss, damage, and cost of expenses arising in any manner of the exercise or attempted exercises by the holder of the aforesaid rights and privileges- 9. The Director of Public Works shall be notified twenty-four (24) hours prior to starting work and again immediately upon Completion. OWNER -1 signed IQ� / (4x MAY A.ARVIN Barbra mn,this day ofl]LLN'�L—Iin�t�h—e. of Duyal, Notary Public,State of Florida d has racnally appeared ,StateofFlo' my uomm.Expires 08111112020 m: arsonally Knoxm: Commission No.FIF994922 M . I Produced!Identification: R-O.W. Permit Attachment of for R.O.W.Permit# i sued '200 Atlantic Beach,FL 32233 _is — Owner's Name: mv,-e- Property Address: R'71 S�-ey" 6 ki 041. Subdivision: Lot#/Block#: R.E.#: REVOCABLE ENCROACHMENT PERMT THIS REVOCABLE ENCROACHWNT PERMT, issued on this _ day of , 200, by Atlantic Beach, Florida, a municipal corporation organized and existing under the laws of the State of Florida, hereinafter referred to as "C= and of Atlantic Beach,Flori4 hereinafter referred to as"USER!'. VVITNFSSETH: That the CITY does hereby grant the USER permission on a revocable basis as described herein the right to enter upon the property of the City of Atlantic Beach for the purpose as described in the City of Atlantic Beach Right-of-Way/Easement permit numbers noted above(copies attached). This work is generally described as: Any facility maintained, repaireA emoted, and/or installed in the exercise of the privilege granted remains subject to relocation or removal on thirty (30) days notice by CM to the USER, said notice to USER shall be given by certified mail, return receipt requested, to the following address: The depositing of said notice of cancellation in the United States mail shall constitute the notice of cancellation and the burden is upon USER to keep the CITY informed of USER!s proper address. The USER shall promptly make my and all necessary repairs to my facility emoted or maintained in the exercise of the privilege herein granted and shall at all times maintain said facility in good and safe condition. In the event it is necessary for the CITY or the City's approved representative or other franchised utility to enter upon the above-described property of the CITY, the USER shall replace at the USER's sole expense, my and all material.necessarily displaced during the action of maintaining, repairing, operating,replacing,or adding to of the utilities and facilities of the CITY or franchise utility provider. The facilities allowexi by the permit shall meet the current requirements of the City Code, Building Codes,Land Development Code,and all other land use and code requirements of the CITY,including City Code Section 19-7 (h) which states "Driveways that cross sidewalks: City sidewalks may not be replaced with other materials, but most be replaced with smooth concrete left natural in color so that it matches the existing and adjoining sidewalks." Page I of 2 - - - - - - - - - - - - - - - - - - - - - - - The USER, prior to making my changes from the approved plans and/or method, must obtain written approval from the City of Atlantic Beach, Public Works Department, for said change. The USER shall, at the discretion of the CITY,be requested to submit as-built drawings showing the change within thirty(30)days after the day of completion. This permit shall inure to the benefit of, and be binding upon, the USER and their respective successors and assigns. USER shall meet the terms and conditions;of this permit and to all of the applicable State and CITY laws and/or specifications, to include utilities locate requirements and me limitations/requirements of public rights-of-way and other public land. USER Rather agrees that the CITY and its officers and employees shall be saved harmless by the USER from any of the work hercin under the terms of this permit and that all of said liabilities are hereby matured by the USER. DATED and SIGNED this dayof . 20A� 4-By: A)�--—"— d--� Property Owner - (to be signed in presence of the Notary) STATE OF FLORH)A COUNTY VDUVAL On this of 20#1��persona Public J�= ftrysaid Co and State, fou tj� �y appeared before me, a Notary �ridaR� t' the property owner of Atlantic Beach, F1 o me to be the persou(s) described in and wW execifted the foregoing instrummt; who acknowledged to me that he or she executed the same fteely and voluntarily and for the uses and purposes therein mentioned. MAYA.ARVIN Notary Public,State of Hoffila Notary Public r said'County,and State My Comm.Expires 08/10/2020 'TaC BEACH,FLORII)A,a Commission No.FF994922 municipal corporation: Approved: rnex, A A�' "-PuKi Works Du' ector ra I - �Jxze' 46"itt�rt 11colao D. L.. 'If? For Permits where city sidewalk is impacted, 9r�p CA"\ City Manager approval required: Jim Hanson,City Manager Page 2 of 2 - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- I ce te:3 c;L I I ka cm �ha Sok 6c6:N,. %&.;z Z�� A CITY OF ATLANTIC BEACH OWNER/BUILDER AFFIDAVIT 1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES. PART I 'CONSTRUCTION CONTRACTING"REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW. DISCLOSURE STATEMENT cv��ZUIAUA 439.103(7),FLOREDA STATUTES: STATE LAW REQUIRES CONSTRUCTION TO BE DONE By LICENSED CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTIONTO THAT LAW. THE EXEMPTION ALLOWS YOU.AS THE OWNER OF YOUR PROPERTY,TO ACT As YOUR OWN CONTRACTOR EVEN THOUGH YOU Do Noy HAVE A LICENSE. YOU MUST DORIMPROVEAONE-OR OU MAY ALSO BUILD OR 0 OR LESS. UILTFOR SALE ORLEASE FRSELF WITHIN ONE YE;�� RESUNIE THAT YOU BUILT METION YOU MAY NOT UR CONSTRUCTION MUST ING REGULATIONS. IT is L Y YOU HAVE hEIMMAL I ICENSING If. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY H I IRE� PURCHASED. THE BUILDING DEPARTMENT�SUG6'��110�MMPENSATION INSURANCE BE Ill. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING TAX ANDADR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES. IV. PENALTY; MhLICENSED CON ACTORS CANNOT BE EMPLOYED UNDER A CIRCUMSTANCES OWNERS B—EING SUbpJECT TO—$5,0M00PE5AL—T%—NDER FLORIDA STATUTE NO 455-228(l). AN-0 CUPAT NALLICENSE-IS OTADE U THE OWNER SHOULD PHYSICALlY SEE THE COUNTY -CE FICATE CERTIFICATE" TO ASCER F OMPETENCY, R THE FLORIDA "CONTRACTORS BUILDING DEPARTMENT( IN IF A PERS IS A LICEN ED CONTRACTOR. TELEPHONE THE 7 826)IF IN DO BT. V ACKNOWLEDGEMENT;I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE Si��TEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. C;,r) i6r,r�- C � Qd PHONENUMBER 2 ty d p.d:"P&r! I la,0�bY4.ff1"h=un all-fatan'..t. M Notary Pubir at Las,,a.Stata,0 0 P=Y= 0 TOM GINDLUPE%M Nolaqsignawra: MY COMMISVON#FF W�l UPIRES:�Iober 6,Mg ORDEREDBY The Law Offkes of Rod Schloth t 2187 S Third:St L So JacksOnvitte Bch,I FL 32250] I 904-372-9351 beach@rod-law.com FL1307,1912 BOUNDARY SURVEY I OUVALCOU4rY so W(a) A TME PLQ RW L 74. g OF n: So I:OF rc, IT ;jN I,V,,K.4PA'M M FEW Gai THE MKOW JVYC�S TO U U�TED IVIONt X THIS"OK P�WAS IMFID I�TOE CITY 01 ��N,C%I K" �Olt COEVIT NVIINIER ftll,Wl 7zEvx'3 . . . . . . 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