1440 Beach Ave RES20-0003 Int Remodel Paver Dway City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
1r 800 Seminole Road r Z0 4000-
Lip Atlantic Beach, Florida 32233-5445 1 l`��
Phone(904)247-5826 Fax(904)247-5845
E-mail: building-dept@coab.us Date routed: � t
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 144+0 S E 1-\ ,(-t `-AUDepartment review required Yes No
t` ildir�l-?_
Applicant: 3,('``,t) F)l ( p( k_) tannins &Zoningng j
Tree Administrator
Project: I Ni C(2-L 02, L�=►'Vlc�(J F - iblic Word
Pilblic Utilities s
Pea&R L 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: 2:14 Approved. enied. 4 ❑Not applicable
(Circle one.) Comments: 7'h i only Row-10,/ 0 in,.4_ 1',L 1,p
BUILDI TS -ihaf co/Y.-ea:I--
PLANNING &ZONING
Reviewed by: Date: 4/--/- 20
TREE ADMIN.
Second Review: KlApproved as revised. ❑Denied. ❑Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY J 0 B C OPYy: Date: 3-D-c...)
FIRE SERVICES Third Revie4Pro e�c./tpFbatrglip®orgRised. ❑Denied. Not applicable
Building Department
Comments:City of Atlantic Beach, FL
OFFICE •w- 'o :PY Date:
Approved By Permit Desk
Revised 05/19/2017 Building Department
City of Atlantic Beach, FL
01.. tJ City of Atlantic Beach APPLICATION NUMBER
s (To be assigned bythe BuildingDepartment.)
- Building Department g p
•�. 800 Seminole Road {� ry
X Atlantic Beach, Florida 32233-5445 1 ti l__Sc ZO*OOO 3
j.... ,
Phone(904)247-5826• Fax(904)247-5845 S�
viriR101- E-mail: building-dept@coab.us Date routed: I vl ZGZ G
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: \ 44 0 EACA-{, R v , Department review required Yes • No
%B iildina �_
Applicant: [3c-). C.0 )(Lp(tor &Zoning j
Tree Administrator
Project: ' N & Yl0(J E �_-- iblic VVorST"
L-Public Utilities , •
P e-R bRk r P* Public Safety
yFire 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. I (Denied. [ jNot applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING3411---Lci
Reviewed by 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: I lApproved as revised. nDenied. ❑Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
(10..;vp,-,c. City of Atlantic Beach APPLICATION NUMBER
Building Department +—f''�.• (To be assigned by the Building Department.)
.0
800 Seminole Road l// , Uv/�,
Atlantic Beach,Florida 32233-5445 J
Phone(904)247-5826 • Fax(904) -514AR ' 8 2
v;091? E-mail: building-dept@coab.us Date routed: J C g
/eU? C?
City web-site: http://www.coab.us
BY. -_
APPLICATION REVIEW AND TRACKING FORM
Property Address: \ 4l1- rKjE..IAp.j4 �`��;' Department review required Yes No
Applicant: 13 )SC,C) I_ ,\ _Planning&Zoning
Tree Administrator
�P_u
Project: N i G� l U V_ "(7 L_-✓ (�t `-- blic Works
------ -
Public Utilitie _
t v V W L. Public Safety ---
f
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 I
PLANNING &ZONING
Reviewed b i,/": Ps te:
.t• %iai
TREE ADMIN. Second Review: Approved as revised. Denied. Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed • : _ `/� _ , Date:„‘V'i-0
FIRE SERVICES Third Review: Approved as revised. (Denied. ❑Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
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Revision Request/Correction to Comments **ALL INFORMATION
HIGHLIGHTED 1N
City of Atlantic Beach Building Department GRAY IS REQUIRED.
' 800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: i- Z U ' L - L/00 3
' ''NNIgiKevision to Issued Permit OR Corrections to Comments Date: 0/2d
Project Address: /11-1 16(007 /7 VC
Contractor/Contact Name: „619,1(0 41/C1)/I6 (G-ti •4(1174' 1 7Zb) ,A oetsev
Contact Phone: '111/ —233- v/61 Email: -�,/c/t/IP61/CCOCbC • (" l'-/
/.A/ n/0-1 , ,Vacs/ 077-/-4TCc 17)
Description of Proposed Revision/Corrections: 01
(4' nr rei2S 9
i elli'iC% C idi7N6 /e/7114011 09. C/iJ /?7 D a`'(/1'( AN/C ISI-o LOLf-perdi ii yi'/✓e-r./
09'lNc7Sf(ci.1,4,Z yzau
,��o�= 2 WALL) OF J.�xrE-e Inc: /9'dD �lQiACI /✓Y�7fNl` '
T/cls SAPID niv p gni/J/f fizt2' ,14:49 ,c,c/fs
,2[72 ,..c' /c cry'0 (if- ge✓Ccs,4/ "vii) x: /?A" Ar// it USG /fP('/je,,r/ftiv&r e,e
I -TCDD -4 VC\S affirm the revision/correction to comments is inclusive of the proposed changes.
(printed name)
• Will proposed revision/corrections add additional square fo to original submittal?
No 'Yes (additional s.f, to be added: )
-"ItIll proposed revision/corrections add additional increase in buildin:4 'o original submittal?
No "Yes (additional increase in building value: $ 7 )) ractor must sign if increase in valuation)
*Signature of Contractor/Agent: a `&-7
(Office Use Only)
v Approved Denied Not Applicable to Department Permit Fee Due$
Revision/Plan Review Comments
Department Review Required:
Building ���11'1��
Planning&Zoning Reviewed By
Tree A..is' istrator
•ublic •rks
Public Utilities -_,( ( --, 4
Public Safety Date
Fire Services Updated 10/17/18
REVOCABLE ENCROACHMENT AGREEMENT
City of Atlantic Beach **ALL INFORMATION
800 Seminole Road,Atlantic Beach,FL 32233 HIGHLIGHTED IN GRAY
IS REQUIRED.
REVOCABLE ENCROACHMENT AGREEMENT 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
i i iS W I E 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 Df211/r W '1 12e PCirCrl41en+r 0/ (0( tA; UY�r�Yiea /i(fd +'Ft
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 I Doic 4
• 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.
t)71/
Date •16P/2a
Property Owner/Agen signed in presence of Notary Public)
STATE OF FLORIDA,COUNTY OF DUVAL //
44
The foregoing instrument was acknowledged this (P day of /1/9/fC H , 20 ?. ,
by . (/ SA-/ , who personally appeared before me and
(printed name of Signer)
acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it.
rig'/l/GAL C7 rRel� 1-r
viz:tie; WIWAM L.POPE Department Approval:
Signature of Notary Public, State of Florida • '•• MYCOMMISSION#GG348645
a EXPIRES:October t9,2023
X] Known +� !.�r.= v �,./�w •
•„P no• Bonded Thnu Notary Puh6c
[ roduced Identification(Type) r ••••••• r • ,tt Williams, Public Works DirectorDi
H:\Applications&Forms\Word Documents\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18 r" 21{
sy��r City of Atlantic Beach APPLICATION NUMBER
jiiftittpco Building Department (To be assigned by the Building Department.)
r • s) 800 Seminole Road ZO-000 3
.� Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 • Fax(904)247-5845
. r Rlr? E-mail: building-dept@coab.us Date routed: 18V ZCI)Z G
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 1 44 0 EAC_(-(, 'kV Department review required Yes No
�nildina
Applicant: E)_C-c) Rot L 111(iOC1 ('lannina&Zoning;.
Tree Administrator
Project: ' 02 C ✓VlU(J�
C-Publ-ic_Utilities_y
P A-y 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:
•
APPLIC ON STATUS
Reviewing Department First Review: Approved. Denied. Not applicable
(Circle one.) Comments:
BUILDING ?
PLANNING &ZONING Reviewed by. — V— Date: "/ 9� ZO
TREE ADMIN. Second Review: Approved as revi ed. Denied. Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: Approved as revised. (Denied. INot applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
PUBLIC UTILITIES PLAN REVIEW COMMENTS
Date: (3-79 Application u: Z ESZO 0 60$
Prot Address: 9 W ea4c#1 ,Q
Check Boat Check
APPLICATION TRACKING COMMENTS to Add Box to
Comment Print
Underground Avoid damage to underground water and sewer utilities. Verify vertical and
Water Sewer horizontal location of utilities. Hand dig if necessary. If field coordination is E ®�
Utilities needed,call 247-5878.
Meter Boxes „,►!
Ensure all meter boxes,sewer cleanouts and valve covers are set to grade
Sewer emoUt and visible. m
A sewer cleanout must be installed at the property line. Cleanout must be
RT1 Sewer covered with an Rn concrete box with metal lid. Cleanout to be set to grade 0
Cleanout and visible.
A reduced pressure zone backflow preventer must be installed if irrigation will
RPZ be provided or if there is a private well on the property. Backflow preventer
Backflow must be tested by a certified tester and a copy of the results sent to Public
Utilities.
Plans note the building will be unsprinkled. If plans change,any fire line
Senses installed must be metered with a Sensus touch-read meter in a properly sized
Touch-Read vault and an appropriate backflow preventer installed. Backflow preventer ❑ 0
Meter must be tested by a certified tester and a copy of the results sent to Public
Utilities.
Fire Sprinkler it fire sBackflprinkler system Is provided,call 247-5878 tor backflow requirements.
ow At a minimum,will require a double check backflow preventer. ❑ ❑
Requirement
Fire Line Fire lines must be metered with a Sensus touch-read meter. Meters larger 0 0
Meter than 2”must be installed in a vault as noted in JEA specifications.
Utility Map See attached Utility Map. 0 0
Disconnect Disconnect and cap water and sewer lines. ❑ 0
&Cap
Inspection Must call the Inspection Line at 247-5814 to request an inspection of the ❑ 0
Prior disconnected and capped water and sewer lines prior to demolition.
❑ ❑
❑ ❑
❑ ❑
0
0
NOTICE OF COMMENCEMENT JOB COPY
bier „ , 4 - )Qs c2-0003
State of I" R 1Pd Tax Folio No.
County of PUMA
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713 of
the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMENT.
Legal Description of property being improved: /0-0 /b- 2-9 f 4ij v,0,9 .4)' Lti G 13,4K 60
Address of property being improved: 1+--o n c ki 4a .
General description of improvements: 1119 c 1'v1 �i�?'GN-en .1i9.-I e J.-Cc/IT/a& Ai PcI c e
pi 41,v‘ 'i7i 1^/ /1ASrele s (A)Gil G-P7A//cMe( • /4,010A9D/12G-04/Z-1 PEtv oRtvew4y
Owner: .ZT, SAI&' Address: 14±D I3kZith` /411.0- - /9•r)-• j /`• �a✓er2.l
Owner's interest in site of the improvement: / 'CU/DL' •f
Fee Simple Titleholder(if other than owner):
Name:
_ o
Contractor: �O�a BU l J-P/iv Ca/KiRif C-ro f 5.j I-4/C C j
Address: 02/5-8/1M/ otr jCp• - '319CXSQ/N/�//8j ,_'-. 3.9.233 (
m
Telephone No.: 9O¢ —04( Fax No: 794 e- m/'0'7 2-4
Surety(if any) °'
Y Y
Address: Amount of Bond$ w
Telephone No: Fax No: 0 a J
o o
0-Rw iA
�v7
Name and address of any person making a loan for the construction of the improvements 0
c� mom z
Name: oa$w8
ca o z z 0
Address: o E 0°z
o00w
CYCCUCY
Phone No: Fax No: OZ
Name of person within the State of Florida, other than himself, designated by owner upon whom notices or other documents may be
served: Name: `-
Address:
Telephone No: Fax No:
In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.06(2)(b),Florida Statues. (Fill in at Owner's option)
Name:
Address:
Telephone No: Fax No:
Expiration date of Notice of Commencement (the expiration date is one (1)year from the date of recording unless a different date is
specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER
Signed: Date: 3111,2.°2 0
Before me this n day oth 10-1-0 in the County of Duval,State
Of Florida,has personally appeared `s(t SvC t
Notary Public at Large,State of Florida,County of Duval.
My commission expires:
_ 4�Aiv,�-w KR au.r , - or
;';n� �iuced Id it "`_. /
COPE- /
.; MY COMMISSION#GG 348645
EXPIRES:October 19,2023 `' '
�• �:' Border!Ttw Notary PubicUnaerwiMers ,{ # t/
MAP O F SURVEY
LOT 6, BLOCK 60, MANDALAY, AS RECORDED IN PLAT BOOK 10, PAGE 11
OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA
JOB COPY40 BEACH Y PAVAVIED ENUE
_ 50.02' FOUND 1/2" IRON
PIPE (NO CAP) FOUND 1/2" IRON
FOUND 1/2" IRON TRASH BIN - - ---I,-- - - PIPE (NO CAP)
PIPE (NO CAP) p
e� S y g 100.9'± BY PLAT
X
POWER POLE ) 9'0. o 0 9 �m ( 100.01' FIELD )
in � E" �COoNO
0 o `WALKTE
W
/ /6/1 0.4lai
° 1STFLOOR-- 2ND-FL6CrRt I
^ CONCRE.T€ FOOD-DE n 16i p
i �� , li I U)
/L� K 8.4' 34.2' 7.3' � �
,.I/ i
IN U
U"-" " LOT 5, BLOCK 60 �m
K N a
z I--- O
TWO STORY ; 'd" Q
03 N FRAME cn v- 6.0 Cl_
RESIDENCE -
N O. 1440 .x� o a 1 Trer
a _.1� 3
H a / \, ' r 1 F— LL
LJ 6.0' 8 }' Nm z
LOT 9, BLOCK 60 N % o n 10 ' o W =
d0" 0 ri o.a � ' ; W
.—
%8.5' 34.2' 7.3' v 1 o
0.7' - - - - -
.r
x D
0
CONCRETE
" J
0 ;.(
U K
z cr LOT 4, BLOCK 60
0 0
0 ` 0
0
-,0
,5.1' r
1 WOOD D W
112.0'
5.11_ — - - - - -
6,A h �9�
, 0090hap r;
_
-
_ _ x 5' WOOD FENCE
s' 3'
—
FOUND 1/2" IRON '4' CHAD NIC FENCE- 1SET MAG NAIL do
PIPE (NO CAP) f 0'6� DISC LB .3672
50.351
� (50' BY PLAT) 1
LOT 8, BLOCK 60 LOT 7, BLOCK 60 1 LOT 3, BLOCK 60
I
1
NOTES:
1. THIS IS A BOUNDARY SURVEY. I
I 10020 40
2. ANGLES ARE AS PER FIELD SURVEY.
3. THE NORTH ARROW WAS PROTRACTED FROM THE PLAT. SCALE: 1" = 20'
4. THERE ARE NO BUILDING RESTRICTION LINES AS PER
PLAT. THIS SURVEY WAS MADE FOR THE BENEFIT OF
THE PROPERTY SHOWN HEREON LIES IN FLOOD GREG SAIG AND JILL M. SAIG; PNC MORTGAGE,
ZONE "X" (AREA OUTSIDE 500 YEAR FLOOD A DIVISION OF PNC BANK, N.A.; OLD REPUBLIC
PLAIN) AS DETERMINED FROM THE FLOOD NATIONAL TITLE INSURANCE COMPANY; AND
INSURANCE RATE MAP, COMMUNITY PANEL RICHARD T. MOREHEAD TITLE & ESCROW.
NUMBER 120075 0001 D, REVISED APRIL 17,
1989 FOR THE CITY OF ATLANTIC BEACH, 4 —D kl
DUVAL COUNTY, FLORIDA. •
"NOT WI TH OUT THE SNATURE AND THE
DONN W. BOATWRIGHT, P.S.M.
ORIIGINALLID RASED SEAL OF A FLORIDA LICENSED RESURVEY: FLA. UC. SURVEYOR AND MAPPER No. LS 3295
SURVEYOR AND MAPPER." JUNE 10,2011 FLA.. LIC. SURVEYING & MAPPING BUSINESS No. LB 3672
CHECKED BY: BOATWRIGHT LAND SURVEYORS, INC.
DRAWN BY: MCC 1500 ROBERTS DRIVE DATE: JUNE 19, 2002
FILE #: 2011-0400 JACKSONVILLE BEACH, FLORIDA 241-8550 SHEET 1 OF 1 1
v orr nnnn nnn
JOB COPY
J
Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road,Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
r pY Phone: (904) 247-5826 Fax: (904) 247-5845 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: i44O B -Ac-i` ,Qv . Permit Number: l.0 s (DLL).- C/ 003
Legal Description )0-11 /d -A'- ;•Q j' ./"1/944 1v?Ly k‘07/o ,9i�k (Po RE# i 7 1 BL, I OCOc
Valuation of Work(Replacement Cost)$ 5-9 o 10 Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition Alteration ❑Repair ❑Move 0 Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial ®Residential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes ONo
• Will tree(s)be removed in association with proposed proiect?❑Yes(must submit separate Tree Removal Permit) ❑No
Describe in detail the type of work to be performed:
1 -Ac;igh h i--rol s/fiiz t-o 11v,s' - REQ 00(4 r/ e M/ A'1,95TeR sN4):4 gAr
Ri-F(Atisi-im4 rl19kPWto) f 1002s Della .PR4i Wf / tu-,AoCe wi.; H /1)a9ve f
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name .3-i L 1- r) --(.4-/C Address )4+0 94/1 GA i4 i -
City f 1 L '`r) s /3LA c d State JJ' Zip 52,2-33 Phone 9'9 - 3"' -Mi9
E-Mail K-irpt1S t 1101.C-eWl.
Owner or Agent(If Aigent, Power of Attorney or Agency Letter Required) n/a
Contractor Information
Name of Company Bosco Building Contractors, Inc. Qualifying Agent Todd Bosco
Address 2158 Mayport Rd. City Jacksonville State FL zip 32233
Office Phone (904) 241-0320 Job Site Contact Number (904) 233-0904
State Certification/Registration# CBC 1250212 E-Mail todd@boscocbc.com
Architect Name&Phone# RI:L. r.‘ '
' , iEn
Engineer's Name&Phone#
Workers Compensation Insurer Impact Staff Leasing, LLc OR Exempt 0 Expiration Date 08/15/2020
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify thatwor ofwQirtst�llation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards (``kith I lating
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 maybe additional restrictions applicable to this property that maybe found in thepublic records of this coup •`
P P � p P Y tY;i,d
there may be additional permits required from other governmental entities such as water management districts,state agencies;tt)r
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 YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
1„,0: I, IN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
REI ' '! ING• �O,�U,,R,'NOTICE OF COMMENCEMENT. , , ,,,7 _--
it : (Signature • Owner or Agent) (Signature of Contractor)
•
:ete .rworn to(or affirmed) (bef a me this 1� day of Signed and sworn to(or affirmed)before me this b day of
o : - , In , cJ by 11 ,13 L( ,1.07.0 ,bYT -fib, co
Signature of ary) I (Signature of Notary)
..'.rp;;;0 :'•."•'•• WILLIAM L.POPE \ �
A. L I a• •• MY COMMISSION#GG 348645 '
1'° j /. .�`- EXPIREi11��'�19 23 .
';;¢�j _f % Known O ..f..;o•
•..—. Identification — _
T.,nn of I�cn+ifi,..rinn•
310 12-6 REMODELIN6 AND RENON/ATIONS FOR
7HE5
14,40 BEACH AVE.
A7LAN71 G 5EA C H, r -LA. 32233
F.EVISED II -25-2011
NOTE: THE SCOPE OF WORK 15 ON THE INTERNAL FIRST AND
5EGOND FLOOR AND 5EGOND FLOOR B/1-GONY ONLY. THERE
15 NO GHANGE TO THE FIRST FLOOR FOOTPRINT OR SITE
GOVERAOE.
REVIEWED FOR CODE COMPLIANCE
CITY OF ATLANTIC BEACH
SEE PERW ITS FOR ADDITIONAL
REQUMEMENTS AND CONDITIONS
REVIE.YED BY: 0 DATE:
JOB COPY
fi2EV 151 ONS
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xALE, NOT TO xALE Z
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0� I
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