1484 LINKSIDE DR - FENCE =)' �I f CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
misor.s, ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
i 9r
FENCE PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-FNCE-2575
Job Type: FENCE PERMIT
Description: REPLACE FENCE
Estimated Value: $1,600.00
Issue Date: 11/21/2016
Expiration Date: 5/20/2017
PROPERTY ADDRESS:
Address: 1484 LINKSIDE DR
RE Number: 172374-6390
PROPERTY OWNER:
Name: Mirkis, Wanda Living TRUST
Address:
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.
r-up yr, City of Atlantic Beach APPLICATION NUMBER
. Building Department (To be assigned bythe BuildingDepartment.)
` 800 Seminole Roadiir)
//g p �- )
,�;� r Atlantic Beach, Florida 32233 5445 I l0 ���'E- 7�
Phone(904)247-5826 Fax(904)247 5845 /
w10. E-mail: building-dept@coab.us Date routed: < (- 4 i S! I(-5,
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 1484 L(11 KS0c O t� Department review required Yes No
Quilding
Applicant: Ow _ie..___ Planning &Zonin j
Tree Administra or
Project: F-ElO GC R�_T_loti j `p 1 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 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��% -.—s9 ‘....--"G ate: 1// 0/
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
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845 I t -F NCE
Job Address: I E i G/12 bil, Permit Number:
Legal Description Parcel #
Floor Area of Sq.l-'t. Sq.Ft
Valuation of Work$ /(SO ' Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial esidential
If an existing structure,is a fire sprinkler system installed? (Circle one): es o N/A
Florida Product Approval #
For multiple products use product approval form
Describe in detail the type of work to be performed: a,//11 i A,7,1 Lc_ Cv /u
Property Owner Information:
Name: 14.)J IU D 4 i ) j 1Z,1<f 5 Address: 148'hi L/ N/4-S i n G b�.
City A4- t1., 3,eState ELZip 3,R.23.?Phone q bS( - Loog'-
E-Mail or Fax#(Optional) W z m i r t{ Q et-0 L. Lo>�
Contractor Information:
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 is hereby made to obtain a permit to do the work and it . allations as indicated. I certify that no work or installation has commenced prior to the
issuance of a permit and that all work will he performed to meet th'.standards gfall laws regulating construction in this jurisdiction. This permit becomes null
and void rf'work is not commenced within six(6)months. or if co truction or work is suspended or abandoned for aperiod gfsix(6)months at any time after
work is commenced. I understand that separate permits must e secured for Electrical Work, 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 herebycertify that/have read and examined this application and know the same to he true and correct. All provisions of laws and ordinances governing this
type of work will be complied with whether specified herein or not. The granting qf a permit does not presume to give authority to viola or cancel the
provisions of any other federal,state,or local law regulating construction or the performance of construction.
Signature of Owner i C(AL J 111 ,4 6v6 Signatu intractor
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Print Name OJ Acs / S �P°1
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subscribed .efore me
this `lb ay of f�� V 201 �o` ,,A1/-0 ay of ,20
V WA 7/ ?Y!"s s•. ceea
�:o cf.
. is - Jr. i otary Public
v��, 4� Revised 01.26.10
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C1 ('AkNCA.I.PROCESSOR:it.CURVEVOR AND MAPPf R...,A83 STATEWIDE FACSIMILE MOOR 14 141S7E
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CITY OF ATLANTIC BEACH
IJ:WN ER / BUILDER AFFIDAVIT
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 THAT
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 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 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 REOUIRED 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 WORKERS 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.
ADD 1 e? 1- 1/1/12-S !v/ a at,ESS PHONE/0 "/NUMBER
A �S%c).J
by p c- Yh 16Z k S
PRINT NAME
I l I 1
I ATURE / DATE
Before me this 15✓ day of /(�`- Q V .2q 1G i 1 the county of
Duval,State of Florida,has personally appeared herin by himself/herself and affirms that
all statements and declarations are true and accurate.
Notary Public at Large,State of I`-( .County of U V CI,'(
❑Personally Known 7 1
❑Produced Identifica �`� - — �T
APIA • MY COMMISSION#FF 928951
Notary Signature: A /III . ov EXPIRES:October 6,2019
I ; �:= Bonded Thru Wary Public Underwriters
F.131.1)0 nr,-Build o Affidavit:REVISED:4 I 1009