CE 283 Belvedere Street 2017 Ez.BB r
• ;,A,, City of Atlantic Beach
APPLICATION NUMBER
• ' Building Department (To be assigned by the Building Department.)
t)'. a eaRoad 4� EMO jOOCD?fAtlantic Beach,
Florida 32233-5445
Phone(904)247-5826 • Fax(904)247-5845
E-mail: building-dept@coab.us Date routed: C.0/Ice,/ 1
City web-site: http://www.coab.us 7
r
APPLICATION REVIEW AND TRACKING FORM
Property Address: 783 ELUE eE ST Depa ired Yes No
'PrUTerrill1111M1.11111
Applicant: -(1 CA_(PS � UPlanning & _-
� Tree Admin
Project: �� o Nth 1�.� f\A.e) 143111
'•
blic 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. . ❑Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING
Reviewed by: Date:
TREE ADMIN. Second Review: A roved as revised.
❑ Pp ❑Denied. ❑Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. . ❑Not applicable
Comments:
Reviewed by: Date:
•
Revised 05/19/2017
1
1�'' i BuildingPermit Application Updated 5/5/17
Jrfr p
I ..m City of Atlantic Beach •
Dv, : r 800 Seminole Road,Atlantic Beach, FL 32233
- It or Phone: (904) 247-5826 Fax: (904) 247-5845
r agJBe i� 14.Viath-Lbedg..., UCmar7 — Ooc
Job Address: ./ Permit Number: `
k• Legal Description lo'' 1(O 4 cC &I,Ilifir StvC ( s 12. RE# 1i-()5O 2 — 0 0 D
l.OT45.S,LOT ,�
. k Valuation of Work(Repla ement Cost), Heated/Cooled SF Non-Heated/Cooled A
• Class of Work(Circle one): New Addition Alteration Repair Mov- -= •ooI Window/Door.
• Use of existing/proposed structure(s)(Circle one): Commercial `esiden
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes N/A
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal
Describe in detail the type of work to be performed:
• ' )fie be_ remaied p6,-0-4--_
Florida Product Approval# for multiple products use product approval form
Property Owner Information " ' ,
Name:W
1I ci `'�='' �.
Z-mCi*e. Address:
City-radcksbn iALQ elean State lC— Zip c3a?5t Phone gcy-o jX '-7 a-L I
E-Mail trGi-C e- e I.C ..
Owner or Agent(If Atent, Power of Attorney or Agency Letter Required P4dLk'1
Contractor Information
Name of Company:P -iitA,1 f 6u:) of LL r✓ Qualifying Agent:
Address (LSGSe.Iv../wAIv.hl C LR.- City PI d State Y) _ Zip 3 L2 7
Office Phone 349 -Z1q 9 Job Site/Contact Number
State Certification/Registration#CBC 12.S73)4 E-Mail P fiCetivk Wee Q cti-n^r,c IvQT
•Architect Name& Phone#
Engineer's Name&Phone# •
Workers Compensation
Exempt/Insurer/Lease Employees/Expiration Date
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 of a permit and that all work will be performed to meet the standards of all the laws regulationg
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS,
WELLS, POOLS, FURNACES, BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
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
RECO RDIN NO CE OF COMMENCEMENT. /
_.... A- ,
/ i , h . %
Signature of Owner or Agent) (Signature of tractor)
(including contractor) �j�
•
jgned and sworn to(or affirmed)before me this C7 day of Si ed and sworn to(or affir -•' be'. - • this day of
',Jut.)e_ , ,„ 7 . -- c e._, 2o( by �
• 1 . IL _ • A. AIM
vM4
:. ure of Not.r Si:nature of Nota
LE$A J NIX-MA r.,,,,.:.. _
MY COMMISSION 1$FF9S2514 ..:; TOFU G1tIDLESPERGER
• y. „ `•-_ MY COMMISSION FF 924951
•t EXPIRES February 12.2020 EXPIRES:October 6,2019
]Personally Known OR � ,� F PersonallyKnown OR
Ioafa otalSorvK.o.onn [ ] �1 i -.--...:',;.'7.1t:,`,';
i t GonCed Th u No;ary Public Underwriters
[ ]Produced Identification [ ] Produced Identification
Type of Identification: Type of Identification:
1
�k.:aj�� -,r. ATLANTIC BEACH BUILDING DEPT.
•t„ DEMOLITION — PROPERTY OWNER
Std
z J RELEASE FORM
~-�0iiiJr
Date: ) ) 3'
To Whom It May Concern:
I /We the current property owners of: Lot I 50 `I2 L-0--455
Block c_g ► 9- c-0 . ,,,14-c-Ovcrrcl
Legal Description of Property c
\I ZLC � L -
IAKA c13 l � Y44?w'hL F� 3-3have �-(rp
contracted with to have
IA) I I (Address of Property)
c\
`USG • to remove the .... /-11)0 Le
(Company Name) 1rn,
(Single Faynily,Duplex,Commercidl,etc.)
Prior to the construction of: Nie_ -- 11( tit 't �yC i N,t•/ 1!
•
As a condition of issuing the permit we agree to the following:
1. All utilities are to be located and clearly marked.
2. Once house is removed, lot is to be graded and leveled.
3. All construction debris is to be removed from the property.
4. Affected area is to have grass or seed in place.
5. Erosion control devices will be put in place and will remain in place until grass
has covere• . ected area or new structure is completed and landscaping is in
-.
Signature ►CVLa-1
Signature
THIS SPACE FOR RECORDER'S USE ONLY
OWNER .72,_
-- Signed ' &- A- Date: --/•'/�7
LA J NQ(-MACK ilef�e me his /. day of it ni 62''r//j in the County of Duval,State
MY COMMISSION aM FF452511 Of Florida,has pers ally appeared`►Yn C pad, �1
-r EXPIRES February/2.2020 Notary Public at Large,State of Florida,Count of Duval.
1404 4.8.0-53 Far■w+«rys«,.o,R My commission expires: E.6 / Q, 2,e yL
Personally Known:
or
Produced Identification:
Y° Fannie Mae
June 14, 2017
To: City of Atlantic Beach
800 Seminole Rd
Atlantic Beach, FL 32233
ATTN: City Permitting Department
This letter confirms that the below listed Company is engaged as an approved Fannie Mae vendor
and has our approval to sign for permits, record Notice of Commencements and Notice of
Terminations on behalf of Fannie Mae for this property.
Should you have any questions, you can contact me at Robert a stirlina@fanniemae.com or 214-
242-8349.
Approved Fannie Mae Vendor:
Tracey McCue Paulsen
Terry McCue Real Estate, Inc
1122 9th St S
Jacksonville Beach, FL 32250
Fannie Mae Property Address:
Al 605L7
283 Belvedere St
Atlantic Beach, FL 32233
Sincerely,
I
1
Robert Stirling J
Asst. VP
Fannie Mae
STATE OF TEXAS
COUNTY OF DALLAS
SUBSCRIBED TO AND SWORN BEFORE ME this 14th day of June, 2017 by Robert Stirling,
Fannie Mae Asset Manager Q
��,""moo; Shannon Newsome T
Puldir, Notary Public
4> .p Liar.of Teta.
''t Of 4- Expires:10-01.2018
•
Fannie Mae 14221 Dallas Parkway.Suite 1000 Dallas,TX 75259