1875 Beach Ave Fence PermitBuilding Permit Application
City of Atlantic Beach
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: 1875 Beach Ave Permit Number:
Legal Description Parcel #________169681-0000_________
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work $ Proposed Work heated/cooled ___0___ non-heated/cooled _____0___
Class of Work (circle one): New Addition Alteration Repair Move Demolition pool/spa 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
Florida Product Approval # _____________
For multiple products use product approval form
Describe in detail the type of work to be performed: ___Replace wood portion of existing fence with same height wood fence per approved variance 15-ZVAR-1022
Property Owner Information:
Name: Tracy Synan Address: ___1875 Beach Ave
City Atlantic Beach State ___FL Zip ___32233 Phone ___233-1346
E-Mail or Fax # (Optional)___tsynan@me.com
Contractor Information:
Company Name: N/A 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 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 laws regulating construction in this jurisdiction. This permit becomes null and void if work is not commenced within six
(6) months, or if construction or work is suspended or abandoned for a period of six (6) months at any time after work is commenced. I understand that separate permits must be 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 hereby certify that I have read and examined this application and know the same to be 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 of a permit does not presume to give authority to violate or cancel the provisions of any other federal, state, or local law regulating
construction or the performance of construction.
Signature of Owner
Print Name
Sworn to and subscribed before me
this Day of , 20
Notary Public
Signature of Contractor
Print Name
Sworn to and subscribed before me
this Day of , 20
Notary Public
Revised 01.26.10