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302 1ST ST FNCE18-0132 FENCE PERMIT FENCE WALL OR BARRIER PERMIT PERMIT NUMBER r i FNCE18-0132 CITY OF ATLANTIC BEACH �~ 800 SEMINOLE ROAD ISSUED: ATLANTIC BEACH. FL 32233 EXPIRES: MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION. ALL WORK MUST CONFORMTO THE CURRENT 6TH EDITION1 OF • ' ! ► BUILDING CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES . ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY. NOTICE: In addition to the requirements of this permit,there may be additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional permits required from other governmental entities such as water management districts,state agencies, or federal agencies. JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK: 302 1ST ST FENCE WALL OR BARRIER FENCE 6' FENCE $6150.00 TYPE OF • • GROUP: 169736 0000 ATLANTIC BEACH COMPANY: ADDRESS: ' Sun Tech Industries of 5203 Cruz Road Jacksonville FL 32207 North Florida a ADDRESS: CITY: STATE: ZIP: ERO JAMES M 302 1ST ST ATLANTIC BEACH FL 32233-5228 WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR 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. LIST OF • • Roll off container company must be on City approved list . Container cannot be placed on City right-of-way. 1 PUBLIC WORKS ON SITE RUNOFF INFORMATIONAL Notes: All runoff must remain on-site during construction. 2 PUBLIC WORKS ROLL OFF CONTAINER INFORMATIONAL Notes: Roll off container company must be on City approved list(Advanced Disposal,Realco Recycling,Shapells,Inc.,Republic Services,Donovan Dumpsters, Phillips Containers,JDog/Dennis Junk Removal). Container cannot be placed on City right-of-way. Issued Date: 1 of 2 FENCE WALL OR BARRIER PERMIT PERMIT NUMBER r s, FNCE18-0132 CITY OF ATLANTIC BEACH v� 800 SEMINOLE ROAD ISSUED: ATLANTIC BEACH. FL 32233 EXPIRES: 3 PUBLIC WORKS RIGHT OF WAY RESTORATION INFORMATIONAL Notes: Full right-of-way restoration,including sod,is required. 4 PUBLIC WORKS FENCING REMOVED INFORMATIONAL Notes: All old fencing must be removed from job site by Contractor. FEES DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT BUILDING PLAN CHECK 455-0000-322-1001 0 $17.50 FENCE 455-0000-322-1000 0 $35.00 PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00 STATE DBPR SURCHARGE 4S5-0000-208-0700 0 $2.00 STATE DCA SURCHARGE 45S-0000-208-0600 0 $2.00 TOTAL:$81.50 Issued Date: 2 of 2 .ira,yf� City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road '�� Atlantic Beach, Florida 32233-5445 � Phone(904)247-5826 • Fax(904)247-5845 . ? ` L r,.19 E-mail: building-dept@coab.us / ?O,$ Date routed: j z % City web-site: http://vmw.coab.us x APPLICATION REVIEW AND TRACKING FORM 40 Property Address: .� � --� ( Department review required Yes No _ uildin Applicant: LU C—CI-C l Iy (-)uS'7-,(-( - Panning &Zoning � Tree Administrator Project: lSJ ( �G��C 'Public Works 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. of applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: z t_'_ ""(__Date: Z` 76�! oe TREE ADMIN. 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 City of Atlantic Beach APPLICATION NUMBER JS r )ti Building Department (To be assigned by the Building Department.) r 800 Seminole Road Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 • Fax(904)247-5845 E-mail: building-dept@coab.us Date routed: cl) _ City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM C)'Z,-' Property Address: 5— J ( Department review required Yes No _ uildm Applicant: s U IU C-.Ck4 � IV C)0 S�2( Xadfinin g &Zoning // Tree Administrator Project: ublic Works u lic Utilities Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Require 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: D2 proved. []Denied. ❑Not applicable (Circle one.) Comments: BUILDIN PLANNING &ZONING Reviewed by: DateOf : TREE ADMIN. 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 City of Atlantic Beach APPLICATION NUMBER Js � Building DepartmentOEF'VC (To be assigned by the Building Department.) 800 Seminole Road Atlantic Beach, Florida 32233-54 n ,) ��.(✓ � V Phone(904)247-5826 • Fax(99 24Y� 57 $ 2018 / b E-mail: building-dept@coab.0 Date routed: .I Z z L — City web-site: http://www.coab. ' .' 11 �`r APPLICAT�N REVIEW AND TRACKING FORM Property Address: _ S I Department review required Yes No _ uiIdin Applicant: ,S U IU [✓Ct-� N U�S j/Z C -Q annso ing &Zoning Tree Administrator Project: � ( ���7C� ublic Works u lic Utilities Public Safety Fire Services 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:j Date: / TREE ADMIN. 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 City of Atlantic Beach APPLICATION NUMBER �S r � Building Department (To be assigned by the Building Department.) Seminole Road Atlantic Fimo c l V -5 Z J" ` Atlantic Beach, Florida 32233-5445 � '" Phone (904)247-5826 • Fax(904)247-5845 E-mail: building-dept@coab.us Date routed: Z z _ City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM 3t�. s-f- Property Address: _ l — I Department review required Yes No _ uildin Applicant: -SO IV CCH N n IU—S j 2l parming &Zoning � Tree Administrator Project: lSJ ( ���7C� ublic Works u lic Utilities Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified B 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 _3_ Reviewed by' Date: ' cl TREE ADMIN. 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 Building Permit Application Updated 10/9/18 r City of Atlantic Beach Building Department "ALL INFORMATION 800 Seminole Road,Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY 3�aPhone:.(904)247-5826 Fax: (904) 247-5845 Email: Building-Dept@coab.us IS REQUIRED. Job Address: JAI ( a'� STree� �1'F�Qgl"(_ 7jP�C�Permit Number: �[\� "�� Legal Description 5'fo9 I6-2S-- owl AI&J.C. &,Lc�_ Sl�z Ise- z -ilk 3 RE# l6gJ5$ -000 Valuation of Work(Replacement Cost)$ GI SD .°� Heated/Cooled SF Non-Heated/Cooled • Class of Work: ❑New ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window%Door • Use of existing/proposed structure(s): ❑Commercial Mesidential • If an existing structure,is a fire sprinkler system installed?: ❑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: Florida Product Approval# for multiple products use product approval form Property Owner Information30 Name Address_ / s e-e Cit, A H.1-% Bf&c State F 1 Zip_ ZZ 3 3 Phone 9,D�l - ID - E-Mail �N L� rhG 1 9,Z(a Arta., • /n Nn Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information _ Name of Company rl CLJJVAVt:e5 CIrA) .1P- QualifyiingAgent Address ZD 1�A City 3QCkSDu4J711e_ State _Zip 3ZZo} Office Phone ".- Z_t?—7-/ov Job Site C,oritact Number qbq qS5'-(o V,o Z State Certification/Registration# C16 OS9 7y1 E-Mail lkn.�.z.�� Sl�,i4.v•�•H Architect Name&Phone# Engineer's Name &Phone# Workers Compensation Insurer OR Exempt 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 regulating 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. NOTICE: In addition to the requirements of this permit,there may be additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional permits required from other governmental entities such as water management districts,state agencies, or federal agencies. 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 YgWR PAYING WICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND BTAI INANCING 'CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE allR G Y N ICE COMMENCEMENT. 0 Z (Sig u o 0 er or Agen �� (Signature of Contractor) 2 u d 0 O 15 M, LL n° i ed and sworn to(o affirmed)before me thi� day of n�ed aan(dd sworn to(or affirmed befor e this W day of zLU y �0.M4S �l7 �� --' by UJ 0 U UJ �Mme'ftp � NAA QN, 00 (Signature of otary) Signature of�ary) l;��� S'ACY RAGA Personally Known OR :jl'� ;: STAEY MAG [ ersonally Known OR =' AAY:,kr • • �1`.?nf V FF963N 5 Produced Identificati a : ?•+":.C.'Npti y.:!nN#FFggg�aQ [ ]Produced Identification �r +s' gig!:cart 2?,BOZO e of Identification: 0t" Type of Identification: ► q • �� REVOCABLE ENCROACHMENT AGREEMENT u�. REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach, Florida,a municipal corporation organized=ng unAde�the laws of the State of Florida, hereinafter referred to as"CITY"and /" 1. or, 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 .301 l S+ S+feP_ ' 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 • 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 easement or 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 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 easements, 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. `rS Date 17.'ZO-19 Property Owner/Agent(signed in presence of Notary Public) STATE OF RIDA,COUNTY OF DUVAL The fo o* g instrument was acknowledged this Zj day of d_ 20 who personally appeared before me and (printed name of Signer) acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it. ;�� 44�77 Signature of Notary 14iblic, State of Florida l STACY RAGA Department Approval: ,.Personally Known ,.: �OMMtSgIpN g FF963d/8 Produced Identification(Type) EXPIR6s FeWVVY n.2020 Scott s, bloc Wor (rector 0:\Public Works\ADMIN\Revocable Encroachment Agreement.docx Revision Date:8/31/18 RIGHT-OF-WAY/ EASEMENT PERMIT Permit#Issued by the City of Atlantic Beach PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES Job Address3bl $}reek Phone ?D`l - Permittee �5 Te rr, 4+v Email e �-Irr- f_s ✓0,c APs LL c Q(7 Requesting Permission to Construct t'e A L t_ Location(Reference to Cross-Street) E&K+ 4�on 5� Pr"vP • Permittee declares that prior to filing this application they have ascertained the location of all existing utilities, both aerial and underground and the accurate locations are shown on the sketches. • Whenever necessary for the construction,repair,improvement,maintenance,safe and efficient operation, alteration or relocation of all,or any portion of said street or easement as determined by the Director of Public Works,any or all said poles,wires,pipes,cables or other facilities and appurtenances authorized hereunder,shall be immediately removed from said street or easement or reset or relocated hereon as required by the Director of Public Works and at the expense of the Permittee unless reimbursement is authorized. • All work shall meet City of Atlantic Beach or Florida 'Department of Transportation Standards and be performed under the supervision of -306 k `Tear: 4' t (Project Superintendent) with Company Name Soy Tec H J,Ju,S�r,e9 a /0 F,Phone 90y-qS$-640 r- • • All materials and equipment shall be subject to inspection by the Director of Public Works. • All city property shall be restored to its original condition as far as practical, in keeping with City specifications and the manner satisfactory to the City. • 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 right-of-way are to be included with this application. • The permittee shall commence actual construction in good faith within days. If the beginning date is more than 60 days from date of permit approval then permittee must review the permit with the Director of Public Works to make sure no changes have occurred in the area that would affect the permitted construction. • It is understood and agreed that the rights and privileges herein set out are 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 save harmless the City of Atlantic Beach from and against any and all loss,d age and cost of expenses arising in any manner of the exercise or attempted exercises by the holder of the afor rights and privileges. • The it for of Public Works shall be notified twenty-four(24)hours prior to starting work and again i e t upon completion. _ Date P mittee(signed in p sence of Notary Public) STATE OF FLORIDA,COUNTY OF DUVAL The foregoi=e. ent was acknowledged this � day of C_ 120 A, by o /R C�7(i> __1 who personally appeared before me and (printed name of Permittee) acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it. 45 ��� - rsonally Known Signature of Notary Pdbc,State of Florida Produced Iden STACY MAGA y MY COMMISSION 9 FF963418 EXPtR66 February 22.2020 v_ • ''1F•�'SJ F MAP SHOWING SURVEY OF NORTH 65 FEET OF LOFT 1, I3LC:C.K 2, PI,AI? W. 1 SUUDIVhI XC3 "A" AI'L.'1WIC, BF'.ACI; AS R MRDED IN PLAT BOOK 5 PAL' 69 OF THE CURRENT` PUBLIC RECORDS OF FI AL CCi[ JI-Y, 77 rI.(iPli A. EAST COAST DRIVE PAVED FND 1/2"I.P. 65.0' FNO 1/2"I.P to �i • ri a N \ N 0.2 pC' STORY� •� cpT10. I 0 SOUTH 65' Q 75.4' k O OF LOT 1 F DRIVEWAY O i 1.s� 2- STORY a.O �� W <:::. : o W > WOOD o FRAME WOOD aQ STEPS RES_No.302 v DECK Z WOOD 3 a PORCH^'S C '44.4' 0.2' (65'1 ' aC SET TACK 65.0 IN R.R.TIE 7 1 � I � EVE1.OpME�� 7 p,P i 1 LOT 5 i I NOTE ANGLE AS PER FLAT NO B.R. L AS PER PLAT I .-E.�Y CERTIFY THA, iI1E PFIDPERiY SHOWNHERLRECIV LIES IN E?,CC;llj ZaCE "C:" AS SHCW-N 1. F cX-,D HAZARD BUMARY WP FOR ATLANiT.IC BEACH, Eai.,OP.IDA. I I-x;W'i CEWIFY -TO 1HRCh'.'E.R/11_T011OLS CONSTRIK.'I'IGNI C(kTX-Y T IAT 1 HATE S•tJM YED IE LANT)S AS SRwi Ili TILE ABOVE CAP'I`ICN 1W) THAT THIS MIV IS A TR(F, A 4D C:01=1 RFXREMTrATION �wFi�E 'i----Y IK-L—N,2+SJ."+l-Z^lllNDA_RD_.PL ' NENT'S ADOPTM BY f E FLORIDA STATE BOARD OF PROFESSIONAL LAND SURVEYORS C'HAPTCR 21HH GCI i I El El Z3 E7 El - DATE: EAST COAST ♦ , • I IPROJECT#: 1009 PAGE 2 OF 2 SHADOW BOX FENCE SERVICES SACLE: NTS ::I PUBLIC WORKS PLAN REVIEW COMMENTS �(/ 1 '7 Date: �� � Application#: /v / / Proiect Address• Check Box CONDITIONS OF APPROVAL TO PRINT ON PERMIT to Select All concrete driveway aprons must be 5"thick,4000 psi,with fibermesh from edge of pavement Driveway to the property line. Reinforcing rods or mesh are not allowed in the right-of-way. ❑ Apron (Commercial driveways—6" thick). Full erosion control measures must be installed and approved prior to beginning any earth Erosion disturbing activities. Contact the Inspection Line (247-5814) to request an inspection from Public ❑ Control Works for Erosion and Sediment Control Inspection prior to start of construction. Onsite All runoff must remain on-site during construction. l� Runoff Post Const. If on-site storage is required, a post construction topographic survey documenting proper TOPO construction will be required. All water runoff must go to retention area and retention overflow ❑ Survey must run to street. Pool Pool—Wellpoint(if used) must discharge into vegetated area 10' minimum from street or drainage ❑ Wellpoint feature (swale, structure or lagoon). A separate Pool Permit is required. Roll off Roll off container company must be on City approved list(Advanced Dispdsal, Realco Recycling, Container Shapell's, Inc., Republic Services). Container cannot be placed on City right-of-way. ROW Restoration Full right-of-way restoration, including sod, is required. Utility Any utility cuts in the road must be repaired using COJ Standard Detail Case X and must be overlaid ❑ Road Cut 10' in each direction from the center of the cut. Repair must be shown on the plans. Construction Provide construction site management plan, including location of silt fence, dumpster, portable ❑ Site Mgmt. toilet. Right-of-Way Permit is required if using right-of-way for construction parking. Runoff All runoff must remain on-site. Cannot raise lot elevation. ❑ Document Strongly suggest thorough documentation of impervious areas be recorded. ❑ Impervious Slab Slab and driveway to be fully removed. ❑ Driveway Maximum Maximum driveway width within the City right-of-way is 20'. ❑ Driveway Circular Maximum circular driveway width within the City right-of-way is 12'. ❑ Driveway Grass Full site to be grassed. ❑ TOPO Must provide a topographic(TOPO)survey with water retention for final C.O. Inspection. O Survey Revision Any plan change must be submitted as a Revision to the Building Department. 00 Fencing All old fencing must be removed from job site by Contractor. t!� Removed Decking All old decking must be removed from job site by Contractor. ❑ Removed A, ❑ "Vi. City of Atlantic Beach APPLICATION NUMBER jS r " Building Department (To be assigned by the Building Department.) �` 800 Seminole Road F7 DC �r Atlantic Beach, Florida 32233-5445 �l Phone(904)247-5826 • Fax(904) 247-5845 E-mail: building-dept@coab.us Date routed: City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 3 0 I S S_� ' Pgpartment review required Yes No (► -� uildi Applicant: S�nsh�AL l.{�S�f��l� lb rk( Planning &Zonin ministrator Project: Public Utilities Public Safety Fire Services 0) R iew 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. �enied. ❑Not applicable (Circle one.) Comments:C��� IG� _ 'a/ c BUILDING PLANNING &ZONING Reviewed by:X Date: TREE ADMIN. 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 L��; City of Atlantic Beach APPLICATION NUMBER jS r Building Department (To be assigned by the Building Department.) J � 800 Seminole Road �r Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 • Fax(904)247-5845 II E-mail: building-dept@coab.us Date routed: � L IT City web-site: http://vmw.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 3 0�' artment review required Yes No Applicant: SD(l�S�I�R� GY1S�f Lt�bl� -7 "1 rP ( Planning &Zonin ministrator Project: LPcL-.( �Q' �v�-� )L� Pub4GAUarks 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. [:]Not applicable (Circle one.) Comments: ?•On tris YJorl -e BUILDING. PLANNING &ZONING Reviewed by: Date://-/ s­/z7 TREE ADMIN. 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 City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road �+r F-7 0 Atlantic Beach, Florida 32233-5445 Ol.l 8 217 Phone(904)247-5826 • Fax(904)247-5845 -^ �n l!)" E-mail: building-dept@coab.us Date routed: City web-site: http://vvww.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 3 0�' 15 S� artment review required Yes No C- S\`�.� r -7 � uildi Applicant: SWl SKLft bt D/6 f Y\(_. Planning &Zonin r �" " mmistrator Project: Q-��r Lo_ 1' ot)t �u1C Pu s 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. []Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by� Date: / -� TREE ADMIN. Second Review: []Approved as revised. Denied. ❑ pp ❑ ❑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 City of Atlantic Beach APPLICATION NUMBER JS r (t Building Department (To be assigned by the Building Department.) 7, 800 Seminole Road F CA - � _eAtlantic Beach, Florida 32233-5445 �Cr 1 g ZQ,� Phone(904)247-5826 • Fax(904)247-5845 I Jii1�r E-mail: building-dept@coab.us Date routed- JIT City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 3 �' I S S� artment review required Yes No .� r( -7 � ulldi Applicant: SD(15h�R� �� �i�l � Planning &Zonin S\�+ ministrator Project: l>2��G�. �� C�b'� kC 0(j Pu s 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. Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: W . Date: 40f 1 4( TREE ADMIN. 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 1 JS Building Permit Application Updated 5/5/17 City of Atlantic Beach FFICE COPY OCT800 Seminole Road, Atlantic Beach, FL 32233 I � 20,] Phone: (904) 247-5826 Fax: (904) 247-5845 Job Address:p l} �i �j�'S'�`'�� �� c�l �'' Permit Number: ­T—Do(0-i Legal Description /C�,,{ RE# Valuation of Work(Replacement Cost)$ f✓K/` Heated/Cooled SF Non-Heated/Cooled • Class of Work(Circle one): New Addition Alteratio6iepDllvlove 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: Florida Product Approval# for multiple products use product approval form Property Owner Information Name: Address: - City >�� 4-C State Zip��ZZ 3 Phone ©G/�- -/O-- 3 d Z E-Mail &,m of b dX7-9' AL O^ Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information14 /' /� Name of Company: ,9)15wm1: 60.0— � Qualif ing Agent: t*y A�YRR* Address V7 mft` City �Sttate Zip37 :33 Office Phone / Job Site/C ntact Number TR 2sz State Certification/Registration# (Z 11E-Mail ltil�SdGlL Lie4t . GJ�'I Architect Name&Phone# Engineer's Name& Phone# Workers Compensation em t surer/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 hG YOU NOTICE OF COMMENCEMENT. (Signature of Owner or Agent) (Signature of Contractor) (including contractor) .�h Signed and sworn to(or affirmed) before me this IL day of Sin nd sworrn to(or affirmed) before m this )4 day of ,�, I���Y' U 11 by Niru ah C, r a C(M�, I by G 1i 2 FORD MyCOIBRYSSIq#GG 146834 (Signature of Notary) uI"�"Bf�IW!J_ LWN ? -V EXPIRES:SVWmber 28,2021 Nota O Babed Ttru Not"Pubic t>Adenwwe�s ry Fl orioda Comm. �Personally Known OR [ ]P onally Known OR ,2018Produced Identification [ roduced Identification ��jType of Identification:'Vr%yt-cs I iu,1L� Type of Identification: Com( �