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743 SAILFISH DR - FENCE \J ;ally ts1 CITY OF ATLANTIC BEACH Alit s) 800 SEMINOLE ROAD T5 ATLANTIC BEACH, FL 32233 ''2,0.}-19 INSPECTION PHONE LINE 247-5814 FENCE WALL OR BARRIER - FENCE MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 PERMIT INFORMATION: PERMIT NO: FNCE17-0069 Description: 6' FENCE Estimated Value: 0 Issue Date: Expiration Date: PROPERTY ADDRESS: Address: 743 SAILFISH DR RE Number: 171234 0000 PROPERTY OWNER: Name: PROPERTY PROPERTIES LLC Address: 1144 FRUIT COVE RD ST JOHNS, FL 32259 GENERAL CONTRACTOR INFORMATION: Name: Address: Phone: Name: XL PROPERTIES & CUSTOM Address: 1144 FRUIT COVE RD DEVELOPMENT LLCI1333 HIDEAWAY DR S JACKSONVILLE, FL 32259 Phone: PERMIT INFORMATION: Please see attached conditions of approval. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOU PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. * A notice of Commencement is only required for work exceeding an estimated value of $2,500. For HVAC work, a Notice of Commencement is only required when HVAC work exceeds and estimated value of$7,500. City of Atlantic Beach APPLICATION NUMBER jS r Building Department (To be assigned by the Building Department.) ,{+.:{ 800 Seminole Road E�I'jQ_ + 7 _O D( • �r Atlantic Beach, Florida 32233-5445 n(1 / Phone(904)247-5826 • Fax(904)247-5845 I / -.; (:).1119's=. E-mail: building-dept@coab.us Date routed: L 0` Z F7 l City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 74 SQL sh r De art n�ent review required Yes No uildino Applicant: X TO !Winning &Zonm ree A minis r Project: ( is or lic 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: joe.Approved. ❑Denied. ❑Not applicable (Circle one.) Comments: BUILDING PLANNING & ZONING f OYCI 11 Reviewed by: Date: - TREE ADMIN. V� ✓Second Review: Approved as revised. ['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 's;ILAN-j- City of Atlantic Beach APPLICATION NUMBER irr- J1 !;ABuilding Department (To be assigned by the Building Department.) v 800 Seminole Road ����_ sl Atlantic Beach, Florida 32233 5445 J 7 -b0Gc/ v Phone(904)247-5826 • Fax(904)247-5845 :1,,,3 !)f' E-mail: building-dept@coab.us Date routed: I d( Z F3 (I 7 City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 7 4 S -S L ' --41-\ G" De artment review required Yes` No ildinq ✓ Applicant: X L P �.O PG.,2Tlc—.S 4-�L1STo/Vl�-_ nning &Zonrn� � reeAdminis Project: G ' FEND Cp d ,,lmrank, U•lic 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: "pproved. nDenied. ['Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING `Il30'17 Reviewed by: Date: /D- TREE ADMIN. Second Review: nApproved as revised. rlDenieAY ❑Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: nApproved as revised. ['Denied. nNot applicable Comments: Reviewed by: Date: Revised 05/19/2017 ..:1. �' Building Permit Application OFFICE `DOPY r City of Atlantic Beach 800 Seminole Road,Atlantic Beach, FL 32233 ‘'"°%?=`'`'r Phone: (904) 247-5826 Fax: (904) 247-5845 Job Address: 744.3 Jl ",I..` / 1)/C, 477, /.3671-, ;.),23`i Permit Number: FN 0_,t E 7-0069 Legal Description D-.fi.D /7- _`aa<~ .. /7.; &K /..4101.') L vi,Ltr/G9r/&;, RE#/7/J ;,/ 9900 Valuation of Work(Replacement Cost) �.7 0{");� { ( p $ Heated/Cooled SF _ti/4..- Non-Heated/Cooled ;111-4- • Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door • Use of existing/proposed structure(s)(Circle one): Commercial Residential • If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No 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„Qf work to be perf med:, Nth./ t,tio,...;. ,--C-7/1...A ti,/ t , , • r , ,,,T,t( 4- 0( a,kri�(�_k rhe ,:=0-rt- ,--\17,1.---- b 8.-,v..i t wD .: r D.c $(44--iti), eirr 57-2(,0-)oc 5 ..+i i).r,t,r, x~,, r7 n 'r[- - Florida Product Approval#.0/t - for multiple products use product approval form ProperlyOwner Information Name: "t..y'E" `r° .:020fI';-, /1_1"_ Address: /NV , 4, ;_r- ( •)L.L f'0 City •-fit— y''')14,„-L..-_, State F(.,... Zip 3'.1..D.-7 Phone_'/ — /r),1- 327—7 E-Mail XL, 1''pt,j 51+i( rte A..., c ,.71 y1 Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information Name of Company: /1.. ) ,. '; �j 46,..-9-Ni) %,L:L/`c tQualifying Agent: ',,'. Address /// /`y�1 j,r t-.•"t,'L- ,et) City 3r -jyy�-i!-A, _ State PZ.,... ZIp -.:? r'", a' Office Phone 7,9 ?,:)(1-Job Site/Contact NumberX i'2' State Certification/Registration#c.L>G /6 3.1,,,,,),:t E-Mail XL--P, ))".) (AA co r-V I .C 7 2�t1 Architect Name&Phone# -- Engineer's Name&Phone# ,_ Workers Compensation -" -TAS 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 RECORDING YOUR NOTICE-2/,/,,../L ,� ICOF COMMENCEMENT.��� __ ,.�/f (Signature of Owner Agent) (Signature of Con tor) (including cont ctor) Signed and sworn to(or affi ed)before me this/eiay of Signed and sworn to(or affirmed)before me this/ day of , 2Ol7 ,by HiL4C_ y' CC 1 , cO1 ' by t79r k1 ,L) ' — ____ (Signature of Notary) (Si nature of Notary) „�,,,.. RICHARD MOTTOLA 'ussy Rue1or!Ieuo1�y6rtaylfapp9 ��••~" •,, 610d'S L has saJldx3'moo AW .*f `�'. Nor, ' i±Florida 66EB16 d1 #uolsspuI03 r •' - „,s.,, ,, . _ ?9 [.}Personally Kno lipoid{o aim a1 n A o 3 `• (t rsonally Kno fa�r;1 •r I•, n.Expires Sep 15,2019 O Produced'dent' ation S I4 d 1 N �.,.. [ I Produced Identif agei,�`, , yt ,n Type of Identificati • r10110W ONI►H01!! Type of IdentificatioEw41/t.___: (,51,m-,74,JCity of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) , 800 SeminolecRoad OCT 2 5 2017 FiV C_E 17-o0C 5 Atlantic Beach, Florida 32233-5445 tJ `� Phone(904)247-5826 • Fax(904)247-5845 :40 9 r E-mail: buildin de t coab.us Date routed: 10l Z ft 7 �J,31� 9- P @ City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 7 4 3 SDepartment review required Yes No uildinq Applicant: X L P`ZO PG,2TtC S -�0S l0nn�fanning &Zonin ree Administrator Project: ( -) C FEND CE- is or u lic 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. ['Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed b • Date:A —20-7) / TREE ADMIN. Second Review: I/Approved as revised. ❑Denied. ❑Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by:1:A24/,Ig*s,`.6L Date: 7-- FIRE FIRE SERVICES Third Review: Approved as revised. ❑Denied. ['Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 0 3A'`1 r-/r, CITY OF ATLANTIC BEACH \J' /, : its 800 Seminole Road .itik. ' ;i-A NOV ! 4 2017 Atlantic Beach,Florida 32233 'R` Telephone(904)247-5800 -r J FAX(904)247-5845 REVISION REQUEST SHEET OR CORRECTIONS TO REVIEW COMMENT Date: 61 113 I l - Received by: Resubmitted: Permit Number: ENC-611- oo(pc( Original Plans Examiner: Project Name: Project Address: t`13 SQ t I Fi,3 VX to{ • Contractor: )((_ Q fD 4 S Contact Name: Contact Phone : Contact e-mail: Revision/Plan Check/Permit Fee(s)Due: $_�__•_ Description of Proposed Revision to Existing Permit: SLP fbr ,Pw i Additional Increase in Building Value: $ Additional S.F. Site Plan Revised: Public W/U Approval: By signing below.1(print name) affirm that the above revision is inclusive of the proposed changes. Signature of Contractor/Agent(Contractor must sign it increase in satuation) Date Office Use Only Date: Approved: Rejected: Notified by: -_. . Plan Review Comments: Department review required Yes No Building ____._ _.4 4 6 ZIZ,./(/4„„„:_...z' Planning&Zoning Tree Administrator — Plans Examiner ubl+64.4a44,..> c public Utilit '17 Public Safety r� Date created d'13,I6 Rcrl Fire Services S�L�if,,, City of Atlantic Beach APPLICATION NUMBER \�s 14 tt J Building Department _ (To be assigned by the Building Department.) 800 Seminole Road OCT9 �IV I _��� `u -N = "r Atlantic Beach, Florida 32233-5445 C 2 5 201 c Phone (904)247-5826 • Fax(904)247-5845 j ft r�,il�' E-mail: building-dept@coab.us Date routed: I o` Zs7 City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 74 �Jcufkk r De artment review required Yes No uildinq Applicant: L ao P&r,L`TtCS q.._e_os-rO - anning &Zonin• ree A•minis •r Project: t) C FEND C_ . --i. lc ►!or lic 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. MCnied. ❑Not applicable (Circle one.) Comments: L� 4- � /,o ��✓SCA-g /,�� 1C-V(4-- BUILDING z BUILDING /G,.q St�,�.t�`�— BT c,r r1//� _� PLANNING &ZONING Reviewed by: ? � L✓, -- Date: /o L 7/77 TREE ADMIN. Second Review: r✓,pproved as revised. ❑Denied. ❑Not applicable P :fleWORKS Comments: BLIC UTILITIES /0 -2G —l7 PUBLIC SAFETY Reviewed by: ` `J�' Date: r' i /C (7 FIRE SERVICES Third Review: Approved as revised. nDenied. nNot applicable Comments: Reviewed by: Date: Revised 05/19/2017 Perrone, Jennifer To: xlpropjax@aol.com Cc: Johnston, Jennifer Subject: 743 Sailfish Drive— FNCE17-0069 Attachments: BD - ROW Form (2017).docx Mark: On further review, Public Utilities is requiring that the attached Right-of-Way/Easement Permit be submitted to the Building Department prior to your Permit for the 6'Fence at 743 Sailfish Drive being issued. When you go to pick up your Permit at the Building Department, please see Jennifer and she will make sure that I get your completed form for our Department. If you have any questions or concerns, please feel free to contact me. Thank you! Jennifer Perrone Administrative Assistant City of Atlantic Beach Public Works (904) 247-5834 iperrone@jcoab.us 1 REVOCABLE ENCROACHMENT PERMIT REVOCABLE ENCROACHMENT PERMIT by the City of Atlantic Beach, Florida,a municipal corporation organized and existing under the laws of the State of Florida,hereinafter referred to as"CITY"and PROPERTY PROPERTIES LLC of Atlantic Beach,Florida,hereinafter referred to as"USER". WITNESSETH: That the CITY does hereby grant the USER permission on a revocable basis as described herein the right to enter upon the property for the purpose as described in the City of Atlantic Beach. This work is generally described as Fence installation. • 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 USER, said notice to USER shall be given by certified mail, return receipt requested,to the following address 1144 Fruit Cove Rd, St. Johns. FL 32259 • • 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 requ`<-ements 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 must be replaced with smooth concrete left natural in color so that it matches the existing and adjoining sidewalks." • The USER,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 within 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 right-of-ways and other public land. USER further 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. 7/14!&)4t 1241Date 11-5-2017 Property Owner/Age (signed in presence of Notary Public) STATE OF FLORIDA,COUNTY OF DUVAL _ The foregoing instrument was acknowledged this S day of /(/61/4'VLj��' ,20 /7 , by Al /9"- /e-- A../e/1„e, 'r^ ,who personally appeared before me and (printed name of Signer) acknowledged that he/she signed the instrument voluntarily for :ie purpose expressed in it. ignature of Notary Public, State of Florida Approved/Public Works Department: Personally Known o- Produced Identification(Type) „// Ar rITIIII:J ICHARDMOTTOLA Scott Wiliams, Public ' orks Director y Public-State of Floridamission#FF 918399m.Expires Sep 15,2019ttroup i National Notry Assn. .,_ y !,_,A.1,71:1 CITY OF ATLANTIC BEACH r .: sA J' t 800 Seminole Road 'J NOV i 42017 Atlantic Beach,Florida 32233 .-1_ , :, ! z r Telephone(904)247-5800 FAX(904)247-5845 REVISION REQUEST SHEET OR CORRECTIONS TO REVIEW COMMENT Date: I 1113111— Received by: Resubmitted: Permit Number: EN cell- 00 0C( Original Plans Examiner: Project Name: Project Address: `13 �l4 v (Of . Contractor: )(L- ftp)(2-6 A;f S Contact Name: Contact Phone : Contact e-mail: Revision/Plan Check/Permit Fee(s)Due: $ Description of Proposed Revision to Existing Permit: • Additional Increase in Building Value: $ Additional S.F. Site Plan Revised: Public W/U Approval: By signing below.I(print name) affirm that the above revision is inclusive of the proposed changes. Signature of Contractor/Agent(Contractor must sign if increase in valuation) Date Office Ilse Only Date: (V(4 i( Z Approved: 1/ Rejected: Notified by:_-______ i Plan Review Comments: • Department review required Yes Building No - _ --� Gam. Planning&Zoning Tree Administrator Plans Examiner C Public !Vi G / ( 7 'ublic UtijjXjes.) - — • - Public Safety ---- Date Created 4/13/16 Rev.3 Fire Services 7 '3 $6. -LF. sN-i J ,e. - .e,,vc_ • SCALE: 1"=20' —20'RIW FOR ROAD(PLAT) �....... .______ ______ _ .—. . . - 5'WALK t 60- N85°20'02"W 80.65' Si) 'EAStM NT 4Jlc..Lh1 A A n P6\z! FOUND 1/2" o FOUND 1/2" IRON PIPE 0.0' 0 i- IRON PIPE 0'_0 .55"`N 60' 10'- 6.72'' 0.0' LOT C1 7 - LOT 15 piFINI H FLOOR rBLOCK. 6 r c ELEVA ION=14.36 is, r o .9 l o CD _ Z NN'tt� •- M M " ' - ... ..: �O O 0�0�NM T W� SI ® I _......._( NI T � N N IMMINIMMIN VJ r ISM W °�,� i I - i /,,,,,t , W Q,^O .. ,MJe._ C� - -; - A K - co W w I-0 V J 8 W o L> J� O � W �1 c„7 , v > o`1 (� (C Z_N g A .- 35180 0 z .a 7 0-10 Hd H __-D G L 25'BUILDING SETBACK LINE N zW M O QS SET 1/2" d.TMETER N85°20'02"W 80.65' UTILITYI FOUND 5/8" IRON IMOD°H` �T dHl OHL- dHL dHL OHL OHL OHLBoxlpHL IRON PIPE LB#7463 UTILITY SITE BENCH MARK POLE ELEVATION=12.46 o (S RIM) SANITARY o d - MANHOLE O I .. : N85°20'02'W 378.60' SAILFISH DRIVE EAST (BEARING BASE)__3 60'R/W (IMPROVED) PUBLIC UTILITIES 'i) { } APPROVED _ 4-1/004/1./ SSC A - { } DENIED -'t/GE { } NOT APPLICABLE TO DEPT 73 $6.�F. sN h ,e- - P / tic_ (pc(i/tis SCALE: 1"=20' 20'RIW FOR ROAD(PLAT) 1485620T2IN 80.6-5' a 'EA MT `E4Nr IA .s n '-----", n o N— — (p 1141--'1.- FOUND 1/2" o FOUND 1/2" IRON PIPE 0.0' O Y IRON PIPE 0'-0.55" N 60' 10' -6.72" 0.0' LOT 17 - r - --as= L T,1.5 BLOCK 6 �'_ — FINISH FLOOR ' K 6 e .. i, L ELEVAfTION=14.36 ` — II L)' 0 CD M / f W 'f f Vim+ 0 ib M O�OV NM .:-- 06 O) 1 'j 9 r g N w I i I `�� m 0 1 (o'jAtk. W ' L.J J Fd- N W 6) ( ' !', 1 1O s W 3� O ` WW UO J i i •2I k 0 WZWV � QQQ � A. ac. N JtaOO 'J ra r zIF. z 25'BUILDING J SETBACK LINE In N zW 00 ,( i c;.,,,,, • SET 1/2" ( METER N85°20'02"N/ 80.65' UTILITY; HL FOUND 5/8" IRON FM aHL OHL OHL OHL OHL- OHL OHL OHl�.- HL IRON PIPE LB#7463 UTILITY SITE BENCH MARK POLE ELEVATION=12.46 o (S RIM) SANITARY o j o MANHOLE r i N85°20 02"W 378.60' • :- SAILFISH DRIVE EAST (BEARING BASE) 60`R/W (IMPROVED) --�---- ; - PUBLIC WORKS CE ..i) iAPPROVED x x Y x X K x = Gt/OD,( 717 •67r04 { } DENIED ( } NOT APPLICABLE TO DEPT ,t/Ga 74'3 $6.vF2 s,-/ b ,e. - /. ivc,g 14/LLs SCALE: 1 /� V 20'RAN FOR ROAD(PLAT) /"/�� C40;014//�C�F/,. 5'WALK � }'� _ N85°20'02"W 80.65' cs s _EA M T (pi Tx}�L — FOUND 1/2" o FOUND 1/2" IRON PIPE 0.0' O IRON PIPE 0'-0.55" N 60' 10'-6.72'' 0.0' LOT 17 LOT 15 BLOCK 6 ��. FINI H FLOOR sLa�,K 6 F_•I/t�■/�I ELEVA ION= 14.36 M�y� Z NN aP M Vim/ `CD I� © 1 1 co 0..NM N UJ o 1�AI's I i I 1 j -� b, w a 17 _u) _. LO H N W O� J co (9 I !M o' zy 0 0 - �� Q ZQ 4V 4 - j,0 a->Qoo I- C.).!.. z z N _i0 t-a I- 25'BUILDING SETBACK LINE IC) N zW ,--)‘-- ,-.::,c ,pO i / — "• W ATE R SET 1/2" METER N85°20'0 "VV 80.65' UTILITY/ IRON ROD ail ' OHL OHL OHL HL OHL OHL HL FOUND 5/8" LB#7463 UTILITY SITE BENCH MARK IRON PIPE POLE ELEVATION=12.46 o (S RIM) SANITARY o o MANHOLE o co co N85°20'02"W 378.60' SAILFISH DRIVE EAST (BEARING BASE) - ----- ----------------------- 60'R/W (IMPROVED) LEGE.4v.D x x Y K K K = 41/oo3[,„/ S?t:rK Rt- Building Permit Application Updated 5/5/17 r City of Atlantic Beach 800 Seminole Road,Atlantic Beach, FL 32233 `'' Phone:(904)247-5826 Fax: (904)247-5845 y Job Address: 717Z 5, c p 1 Ar , (, /WI ' .;L73 Permit Number: 'FN 'Lt 17-000) Legal Description 3o--(e..D / - 5 ,)qe /7.S' kik, :ins azrr,or/4 RE# Valuation of Work(Replacement Cost) ,?O('C) �� ( p $ Heated/Cooled SF;�f�- Non-Heated/Cooled tf • Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door • Use of existing/proposed structure(s)(Circle one): Commercial Residential • If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No 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: A/O J J ENc': 7o 86' &71-ic.G :t` (,t" t aiit i1/4,1, :r E e-/Ct. 5 '7c 64.-D F,t -e../.i -:,tic; 'Row YAK() V B:2r/-!- . -Xf3g1. Florida Product Approval# 4,x/4-~ for multiple products use product approval form Property Owner Information Name: "P 4ecfryt + "Ir`� / L,f"_ Address: //t/?/ 'G%-:: µ C K3z� City .5c-- .y94-f, :7 State-FL. Zip 3-'),..)5-9. Phone ' c/' — JO's`. .3.27-7 , .277 E-Mail ')c t.., 'ex,P Th-i( r i4t>:,, Owner or Agent(If Agent,Power of Attorney or Agency Letter Required) Contractor Informatiorg_ t( , 1 i1 `L t t ualifying Agent: i i - , In F '11.f [ Name of Company: Address //4/4" t'" tr ,e L) City,51 .r >.: ; i Office Phone 4/ 7194/•_ j ' _Job Site/Contact Number 910, 41,?),-)v—3777 State Certification/Registration#%,.6[6 / j `Q ( E-Mail At-NJ j(-; j ,,.. I Architect Name&Phone# H 201 7 Engineer's Name&Phone# _.� t R Workers Compensation ,". yi'1 Exempt/Insurer/Lease Employees/Expiration pate Application is hereby made to obtain a permit to do the work and installations as indicated.l 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 RECORDING YOUR NOTICE OF COMMENCEMENT. 4(41, . 71//a/Li (Signature of Owne /Agent) (Signature of Con tor) (including cont/Agent) Signed and sworn to(or affi ••ed)before me this/day of Signed and sworn to(or affirmed)before me this/ day of c20C-7 ,by . :a'. _ 't A 1 , aO/7by (Y/i` €k (Signature of Notary) (Si nature of Notary) ussvtietoNleuolteNOnoiwpapu J64. ,"" RICHARD MOTTOLA 610Z'S t das saildx3*moo AIN AR* •1`t% Notary, ;:• , of Florida [..1-Personally KnoN 66EB16 ii #uolss wwo •1 '` w C usSlou .• ;1315J49 Y 0 •' ° [te rsonall Kno M n.Ex [ ] �P!)ol�to 11S o! n (ie o [ ]Produced Identi affo,o�� .' plass Sep 15,2019 Produced Identi ation I4 d i N ,t dt,` oa Type of ldentificati • V10110W OHVH3Il1 • , �` "' 'trough Nation"Notary n. "'����"' Type of Identificationww•