601 Coastal Oak Ln POOL20-0014 1 of 6 permit application_1 of 8Building Permit Application
City of Atlantic Beach
800 Seminole Road, Atlantic Beach. FL 32233
Phone: (904) 247-5826 Fax: (904) 247-5845Job Address:ank 0).Permit Number:
Description •
Updated
Valuation of Work (Replacement Cost) S Heated/Cooled SF Non- Heated/Cooled
• 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 RemovalDescribe in detail the type of work to be performed:
Round pool
Florida Product Approval #for multiple products use product approval formOwnai
Name•Address:State PhoneE-Mail
Owner or Agent (If Agent. wer of Attorney or Agency Letter Required)
n Informa o
Name of Compan 3 Quali •ng Agent:
Addre City State ZipOffice Phone Job Site/Con act Number
State Certification/Resistration a-fiSF2FSä7F;;--—-—-—Architect Name & Phone #
Engineer's Name & Phone
Workers Compensation
Exempt I Insurer I Lease t' Exp.ration Oate
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation hascommenced prior to the issuance of a permit and that all work will be performed to meet the standards ef all the laws resulatt•nsconstruction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORS PLUMBING. StGNS,WELLS, POOLS. FURNACES. BOILERS. HEATERS, TANKS, and AIR CONDITIONERS, etc. NOTICE: In addition t. the requirements ef thispermit. there may be additional restrictions applicable to this property that may be found in the public records of this county, andthere may be additional permits required from other governmental entities such as water management districts, state asencies.federal agencies.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance With a)applicable laws regulating construction and toning.
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
RECORD NG YOUR NOTICE OF COMMENCEMENT.
(S.nature ot Owner or A«nt)(Soatv.•e •t CeotTXt•t)contractor)
this lSsworn to (or a ) before n t day of neo svs•tn to (or a
by
(Signature Of Notary)
I Personattv Known ORProduced identitvctype of kientification:type ot kientit«att.a.
roe
Pools by John Clarkson
an aquatech• builder
City of Atlantic Beach
800 Seminole Rd.
Atlantic Beach, FL 32233
Prepared b Phone: 904-223-4050
Signature:Date:
Applicable codes: 2017 6th Edition Florida Building Code
2014 NEC Current JB LDC
Occupancy Class: R-3, Type of Construction V-B
Page 1: Survey
Page 2:Pool Plan
Page 3: Steel
Page 4: APSP
Page 5:MDX
Page 6: SDX
Page 7:Hydraulics
Page 8: Type of Pump
Page 9: Type of Filter
Page 10; Type of Heater (if any)
Page 11: Alarms
State Certified License:CPC License # 009595 & 1457425
Contact: Lawrence Rahim 904-923-1305
Home wner Info ation:Name:
Adress:3
Poos by Ciaoson • 600 St Road N, Jocksonv&. FL 32225 • (904) 2234050 • Fax (904) 223035 • CPC CPC •
TREE & VEGETATION AFFIDAVITCity of Atlantic Beach
Community Development Department800 Seminole Road Atlantic Beach, FL 32233
FOR INTERNAL OFFICE use Y
PERMIT
(P) 904-247-5800
SITE INFORMATION
ADORESS
SUBCXVtSION
1750
APPLICANT INFORMATION
NAME
ln.
BLOCK LOT
RRESIDENTIAL Cl COMMERCIAL OTHER
PHONE •
ADDRESS (Omsfal (2.1k (n cut'
-A±lankcæcn--—-——— -Ec--3ZSS———
EMAIL OWNER C)LEGAL AUTHORtZEO AGENT
I affirm that I have reviewed the provisions of Chapter 23, "Protection of Trees and Native Vegetation-. of
the Municipal Code of Ordinances for the City of Atlantic Beach Florida and/or I have participated in a pre-
application meeting with the Administrator of those regulations. Subsequently, I affirm that no regulated
trees and no regulated vegetation will be damaged, destroyed and/or removed from the aboædescribed
property and/or adjacent properties including right-of-way.
I HEREBY CERTIFY THAT ALL INFORMATION PROVIDED ts CORRECT: of
SIGNATURE OR NAME
AGNA AN (2 RIN pc NAME
ned and sworn before me on this
dentification venfied:
)athSwottv Y
Notavy
My Conunission
Owneds)
by State ot
County of , v