1040 Little Cypress Key RESO20-0018 Permit PacketOWNER:ADDRESS:CITY:STATE:ZIP:
HOOD KAY L 1040 LITTLE CYPRESS KY ATLANTIC BEACH FL 32233
COMPANY:ADDRESS:CITY:STATE:ZIP:
TROPICAL ENCLOSURES BY
MASTER SCREENS, I 4411 KELNEPA DR JACKSONVILLE FL 32207
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
172027 5814 SELVA LAKES UNIT 03
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
1040 LITTLE CYPRESS KEY
RESIDENTIAL OTHER SINGLE OR
TWO FAMILY RESIDENTIAL
OTHER
screened enclosure and
pavers $10500.00
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
1 PUBLIC WORKS EROSION CONTROL INSTALLATION INFORMATIONAL
Notes:
Full erosion control measures must be installed and approved prior to beginning any earth disturbing activities. Contact the Inspection Line (904-247-
5814) to request an Erosion and Sediment Control Inspection prior to start of construction.
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.
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.
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
1 of 2Issued Date: 8/26/2020
PERMIT NUMBER
RESO20-0018
ISSUED: 8/26/2020
EXPIRES: 2/22/2021
RESIDENTIAL OTHER PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $105.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $52.50
PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.36
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
ZONING REVIEW SINGLE AND TWO FAMILY USES 001-0000-329-1003 0 $100.00
TOTAL: $286.86
2 PUBLIC WORKS ON SITE RUNOFF INFORMATIONAL
Notes:
All runoff must remain on-site during construction.
3 PUBLIC WORKS ROLL OFF CONTAINER INFORMATIONAL
Notes:
Roll off container company must be on City approved list. Approved list can be obtained at the Building Department at City Hall. Roll off container
cannot be placed on City right-of-way.
4 PUBLIC WORKS RIGHT OF WAY RESTORATION INFORMATIONAL
Notes:
Full right-of-way restoration, including sod, is required.
5 PUBLIC WORKS CONSTRUCTION SITE MANAGEMENT INFORMATIONAL
Notes:
Provide construction site management plan, including location of silt fence, dumpster, portable toilet. Right-of-Way Permit is required if using right-of-
way for construction parking.
6 PUBLIC WORKS RUNOFF INFORMATIONAL
Notes:
All runoff must remain on-site. Cannot raise lot elevation.
7 PUBLIC WORKS DECKING REMOVED INFORMATIONAL
Notes:
All old decking and debris must be removed from job site by Contractor.
2 of 2Issued Date: 8/26/2020
PERMIT NUMBER
RESO20-0018
ISSUED: 8/26/2020
EXPIRES: 2/22/2021
RESIDENTIAL OTHER PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $286.86
RESO20-0018 Address: 1040 LITTLE CYPRESS KEY APN: 172027 5814 $286.86
BUILDING $105.00
BUILDING PERMIT 455-0000-322-1000 0 $105.00
BUILDING PLAN REVIEW $52.50
BUILDING PLAN CHECK 455-0000-322-1001 0 $52.50
PUBLIC WORKS PLAN REVIEW $25.00
PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00
STATE SURCHARGES $4.36
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.36
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
ZONING PLAN REVIEW $100.00
ZONING REVIEW SINGLE AND TWO FAMILY
USES 001-0000-329-1003 0 $100.00
TOTAL FEES PAID BY RECEIPT: R12982 $286.86
Printed: Wednesday, August 26, 2020 1:47 PM
Date Paid: Wednesday, August 26, 2020
Paid By: TROPICAL ENCLOSURES BY MASTER SCREENS, I
Pay Method: CREDIT CARD 356451267
1 of 1
Cashier: CG
Cash Register Receipt
City of Atlantic Beach
Receipt Number
R12982
1111!! ·~ TRAKiT
RESO20-0018 - revision
Building Permit Application
City of Atlantic Beach Building Department
800 Seminole Road, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Updated 10/9/18
**ALL INFORMATION
HIGHLIGHTED IN GRAY
IS REQUIRED.
Job Address : 1040 Little Cypress Ky Permit Number: ___________ _
Legal Description 44-6016-2S-29E SELVA LAKES UNIT 3 LOT 111 I RE# 172027-5814
Valuation of Work (Replacement Cost) $~1_0,_5o_o ____ ~ Heated/Cooled SF _____ Non-Heated/Cooled (20
• Class of Work : □New ~dd ition □Alterati on □Repai r □M ove □Demo □Poo l □W i ndow/Doo r
• Use of existing/proposed structure(s): □Commercial ](Residential
• If an existing structure, is a fire sprinkler system installed?: □Yes □No
• Will tree s be removed in association with ro osed ro·ect? □Yes must submit se arate Tree Removal Permit 0
Describe in detail the type of work to be performed:
&teen TTX)rn -t ~\/if lA.)0(¥...
Florida Product Approval # __ 7~5_\.o __ \ _-___,__R ---'----Y...,_
35
__ · _________ for multiple products use product approval form
Prop tion
Name __ ~ _________________ Address 1040 Little Cypress Ky
City 1At1anticBeach State __ F_L __ Zip 32233 Phone qcij-5d-\-\Cf67
E-Mail'--------------------------------------------'
Owner or Agent (If Agent, Power of Attorney or Agency Letter Required) ___________________ _
Contractor Information
Name of Company Tropical Enclosures by Master Screens Qualifying Agent:..=--;::..;...--+..___.,_:.....;-'----'-.=;..,....--'---___J
Address, 7117 AOantic Blvd City Jacksonville
Office Phone \904-744-3500 Job Site Contact Number Ashton Newsome ,..._______________ -------------,,----·-
State Certification/Registration# SCC131150288 E-Mail troplcalenclosures@gmail.com
Architect Name & Phone# JO(U fct,ytl( JdC4,v Lt 'l-7 Z, /:ffikid . Sfiiha"l
Engineer's Name & Phone#-~----------------------------------
lY frJOI
Workers Compensation Insu rer~--------------OR Exempt □ Expiration Date,..._ ______ _
Application is hereby made to obtain a perm it to do the work and installations as indicated . I certify that no work or installation has
commenced prior to the issuance of a perm it and that all work will be performed to meet the standards of all the laws regulating
construction in this juris diction . 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 requ irements of this
permit, there may be additional restrictions applicable to this property that may be found in the publ i c 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 ail the foregoing inform atio n is accurate and th at all wo rk wili be done in compliance with ail
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 LENDE
EN
Signed and sworn to (o
--:1lKLR _, i.o
[L,KnownOR
[ ] Produced Identification
Type of Identification : _____________ _
Doc# 2020134662, OR BK 19260 Page 1730, Number Pages: 1,
Recorded 06/29/2020 01:56 PM, RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10.00
NOTICE OF COMMENCEMENT
State of Florida Tax Folio No. 172027-5814
County of_D_u_v_a_l ________ _
To Whom It May Concern :
The undersigned hereby inform s yo u that improvements will be made to certain real property, and in accordance with Section 713 of
the Florida Statutes, the following information is stated in this NOTICE OF COMMENCEMENT.
Legal Description of propert y being improved : _4_•...:..s..:...0 _1&-...:.2...:.s-_2_9E=-S..:...E:_L_VA_LA_K_es_uN_I_r _3 _Lo_r_1_1_1 ______________ _
Address of property being improved: 1040 LITTLE CYPRESS KY, Atlantic Beach FL 32233
General description of im provements : _P_a_v_e_rs...:.,_S_c_re_e_n_E_n_c_lo_s_u_r_e ___________________ _
owner: Kay Hood Address: 1040 Little Cypress Ky ----
Owner 's interest in site of the impro vement: _1_0_0_0_1/0 ___________________________ _
Fee Simple Ti1leholder (if ot her than ow ner): ______________________________ _
Name :-----------------------------·-----------
Contractor: Tropical Enclosure by Masterscreens
Address: 7117 Atlantic Blvd, Jacksonville, FL 32211
Telephone No.: 904-744-3500 Fax No: ___________ _
Surety (i f any) ______________________________________ _
Address: ______________________ Amount of Bond$ ________ _
Telephone No : _________ _ fax No: ___________ _
Name and address of any person making a loan for the construction of the improvements
Name:---------------------------------------
Address: --------------------------------------
Phone No: ___________ _ Fax No; ___________ _
Name of person within the State of Florida . other than himself. designated by owner upon whom notices or other documents may be
served: Name :---------------------------------------
Addres s:---------------------------------------
Telephone No: ___________ _ Fax No:
In addition to himself, owner designat es 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 (I) year from the date of recording unless a different date is
specified): ____________________ _
~
RESO20-0018
HOMEOWNER SUNROOM ENCLOSURE AFFIDAVIT
The purpose of this document is to make you aware of any limitations in the enclosure that is being permitted at your
residence . The table be low , Sun room and Screen Enclosure Requirements provides a brief description of the various
sunroom category requirements. There may be restrict ions on the use of your present home depending on the category
of sunroom you are installing . The property owner is hereby notified that should they make changes to the sunroom
which could include , bu t not be li m ited to , addi t ion of any form of temperature control system or removal of the
doors/windows sepa rating the sunroom from the host structure , the room may become non-compliant with the
requirements as mandated by the Florida Build ina Code , the Florida Model Enerav Code and State Statutes .
OWNER
I have read this complete form and understand I am receiving a Category _1 __ Sunroom . (1-V)
Printed Nday Hood -, ~ Address 1040 Little Cypress Key
Signed } 41,r--~ ~~ Date : VJ I J}-0{ 1d-u_
Before~ (} <JL-1 d;y of 'JUa {2 J-Od O in the County of Duval , State of Florida, has personally appeared
Kay Hood herein by himself/he rse lf and affirms a ll
statements and declarations herein are true and accurate . ------------------•~••~--•~~~~v~•~~~7
Notary Public at Large , State of Florida County of Duval •~ ~ )\_ Notary Pub lic S tate of Florida •~ ' ~ ~ "''~~•·~ '"'· •rham ,
P e r so n a ll y Kn ow n D o r Produce d Id en tificatio n ~ '~ ~J:..J My Commission GG 313508 ◄'
ID Typ e n 1 __,,, i. ; A! Expires 0311812023 l
I,/ -~--------·-..1,._..._-.------->
Sunroom and Screen Enclosure Reguirements
Category I II Ill IV V
Habitable Space No No No Yes Yes
Foundation Walls <200p lf Walls <200plf Walls <200plf can Walls <200plf Walls <200plf can
can have 8 "W can have 8"W have 8"W x12"O can have have 8"Wx12"O
x12 "O ftg or 3-x 12 "O ftg or 3-ftg or 3-1/2" slab if 8"Wx12 "O ftg ftg OR have site
1 /2" slab if no 1/2 " slab if no no concentrated OR have site specific
concen t rated concentrated load >750Ib OR specific engineering
load >750lb OR load > 750Ib OR have site specific engineering
have site spec if ic have site spec ific eng inee ring
ena inee rina ena ineerina
Existing exterior
GFCI outlet Relocate or add additional outlet to exterior if enclosed
Exit Lighting Not Requi red Required Required Required Required
Interior Electric Not Required Not Requi red Requ ired Required Required Outlets
Emergency Egress from Egress and Exit Egress and Exit Egress and Egress and Exit
Escape exist. structu re must meet code must meet code. Exit must meet must meet code .
Openings allowed if open to code.
at mosphe re and
has screen doo r
lead in g away
from res ide nce .
Misc. Window Host structure Windows must Windows may be Host structure Host structure
and Door windows/doo rs be removable fixed or removable. w indows & windows & doors
Requirements shall not be Host structure Host structure doors shall not may be removed .
removed. windows/doors windows and be removed . Forced entry , air
shall not be doors shall not be Fo rced entry , leakage and water
removed . removed . Forced air leakage penetration
entry , air leakage a nd water requirements
and water penetration apply.
penetration requirements
requ irements apply .
apply .
Wind Borne
Debris Opening Not Required Not Requ ired Requi red , can be on host structure , if bui lt under existing
Protection roof
Energy Sheets Not Required Not Required Not Required Required Required
RESO20-0018
AFFIDAVIT FOR ATTACHING A NEW STRUCTURE TO AN EXISTING STRUCTURE
TO: Building Inspection Division , City of Jacksonville, 214 North Hogan Street
Kay Hood
Home Owner:--------------------------------
Name
1040 Little Cypress Key
Atlantic Beach /:i![¥124tidress
City. State and Zip Code
Scott Norton sec 131150288
Contractor:--------------------------------
Permit Number B-
As the Contractor for the proposed new structure located at the above address, I have personally viewed
with the above named home owner those portions of the existing structure on which portions of the
proposed new structure are to be attached for structural s upport. I am confident that the drawings and details
included with this permit application depict the existing conditions of the host structure, and the members of
the existing structure upon which the new structure are to be attached are so und with no rot or deterioration
The home owner has been advised by me that, in my best judgment based on experience and knowledge of
structural adequacy, the members of the existing structure upon which the new structure are to be attached
are sound with no rot or deterioration and will support all structural loads and forces imposed on them . By
signing below, I hereby declare that I will hold the City of Jacksonville harmless and release it from an y
responsibility and liability for any adverse consequences or failures resulting from this work, and further
that I will not initiate, execute or enjoin any legal action against the City of Jacksonville for such
consequences or failures.
A copy of this document will be recorded as an official record with the Building Inspection Division
permit history so that any and all future buyers/owners of this property may be made aware of the
status of work performed on this st~
s;gned~~Date_Jf_;Jq; J-0
Before me this 2.!l_day of ]U[]g 9-o;}CJ
In the County of Duval , State of Florida, has personall y appeared
Scott Norton
____________________ herein by himself/herself and
Affirms all ~tatements and declarations herein are true and accurate.
fl({j).M ~
Notary Public at Large, Syi.te of Florida , County of_D_u_va_l ________ _
Personally Known_~_o orr Produced Identification __
ID Type ______________________ _
General Notes A. CONCRKTE & FOUNDATION DESlGN: t. ALL r 'IINC.:R.I:TC! <iRAOE BEAMS At-.D ftXJTINt,::, SHALL BC
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RESO20-0018
PRODUCT APPROVAL INFORMATION SHEET FOR THE CITY OF ATLANTIC BEACH. FLORIDA
Project Name: ____ fum+-4---'-"""""c..._ _____________________ _ Permit # _____ _
Project Address:.__._,\ a..._L\--'-O-=------~U __._t-\:_.__\l,~C""'--~.f.¥f) ......... re~~S-\4Jj~--PtlL...l...L.LJ,\ 0 ......... 0:ti~' c'-----4-'let....,.,o ......... Cb.______.___ __ _
As required by Florid a Statute 553.842 and Florida Administrative Code Rule 9B -72 , please provide the information and product approva l number(s)
for the building components listed below as app li cable to the building construction project for the permit number li sted above. You shou ld contact
your product supp lier if you do not know the product approval number for any of the applicable listed products. Information regarding statewide
d pro uct approval may be obtained at: www .floridabuildin <>.oni.
Category/Subcategory Manufacturer Product Description Limitation of Use State# Local#
A. EXTERIOR DOORS
I. Swinging
2. Sliding
3. Sectiona l
4. Roll up
5. Automatic
6. Other
B. WINDOWS
I. Single hung
2. Horizontal slider
3. Casement
4. Double hung
5. Fixed
6. Awning
7. Pass-through
8. Projected
9. Mullion
10. Wind breaker
I I. Dual act ion
17. Other E\\~ r 1\1"(\N\Sl-k ~oru.l 1-sroT-Tl ~
Category/Subcategory Manufacturer Product Description !Limitation of Use State# Local#
E. SHUTTERS
I. Accordion
2. Bahama
3. Sto rm panels
4. Co loni al
5. Roll-up
6. Eq uipm ent
7. Other
F. STRUCTURAL
COMPONENTS
I. Wood co nnector/anchor
2. Truss plates
3. Enginee red lumber
4. Railing
5. Coo lers -free zers
6. Concrete admixtu res
7. Material
8. In su lation forms
9. Plastics
I 0. Deck-roof
11. Wall
12 . Shed s
13. Other
G. SKYLIGHTS
I. Skylight
2. Other
Category/Subcategory Manufacturer Product Description Limitation of Use State# Local#
H. NEW EXTERIOR
ENVELOPE PRODUCTS
I.
2.
In addition to completing the above list of manufacturers , product description and State approval number for the products used on this project, the
Contractor shall maintain on the job site and available to the Inspector, a legible cop y of each manufacturer's printed specifications and installation
instructions along with this Product Approval Sheet.
I certify that this product approval list is true and correct to the best of my knowledge. I further certify that use of different components other than the ones
li sted in this document must be approved by th e Building Official.
(Contractor Name) (Print Name) Sc.o /-4-A.lc.•{2 ~
Company Name :--°"v--6 ,Cc,J (" vie
Mailing Addre ss: I 111 A-t/4« {c., f5{td.
City :~-State: {:{, Zip Code : 3)2 / /
Telephone Number: (t!c'( )_:Y/_'l_t/_-3_5-_a_0
_____ Fax Number: (8 i'2 ) 3 '-19 -05/ s-
Ce ll Phone Number : ( 9.;-'( ) '1'15 -7 ZS-I-E-mail Address: f /.Jft4:.i-/eJ1(:/oSur-P.{j)3 ~-/ ,0:,,4-<.
Revision Request/Correction to Comments **ALL INFORMATION
HIGHLIGHTED IN
GRAY IS REQUIRED. City of Atlantic Beach Building Department
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT #: _____________________
Revision to Issued Permit OR Corrections to Comments Date: ________________
Project Address: ____________________________________________________________________________________
Contractor/Contact Name: ____________________________________________________________________________
Contact Phone: ______________________________ Email: _________________________________________________
Description of Proposed Revision / Corrections:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
I_______________________________ affirm the revision/correction to comments is inclusive of the proposed changes.
(printed name)
Will proposed revision/corrections add additional square footage to original submittal?
No Yes (additional s.f. to be added: _____________________________)
Will proposed revision/corrections add additional increase in building value to original submittal?
No *Yes (additional increase in building value: $____________________) (Contractor must sign if increase in valuation)
*Signature of Contractor/Agent: _______________________________________________________
__________________________________________________________________________________________________
(Office Use Only)
Approved Denied Not Applicable to Department Permit Fee Due $_______________
Revision/Plan Review Comments_______________________________________________________________________
__________________________________________________________________________________________________
Department Review Required:
Building _____________________________________________
Planning & Zoning Reviewed By
Tree Administrator
Public Works
Public Utilities _____________________________________________
Public Safety Date
Fire Services Updated 10/17/18
□ □
□ □
□ □
□ □ □
RESO20-0018
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S U RVEYOR and MAPPER No '"S 3295
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SHEE, OF
Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department
800 Seminole Road, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us
** ALL INFORMATION
HIGHLIGHTED IN GRAY
IS REQUIRED.
Pe rmit Number: Job Address: 1040 Little Cypress Ky ------------
Legal Descri ption 44-60 16-2S-29E SELVA LAKES UNIT 3 LOT 111 REIi 172027-5814
Valuation of Work (Replacement Co st) $_1_0_,S_oo _____ Heated/Cooled SF _____ Non-Heated/Cooled (l0
• Cl ass of Work: □New ~dditi on □Alteration □R epair □Move □Demo □Pool □W indow/Door
• Use of existi ng/proposed structure(s): CJCommercial J(Res identi al
• If an existing structure, is a fire sprinkler system i nstalle d?: □Yes □No
• Will tree s be removed i n associ ation with ro osed r o·ec t? □Yes must submit se arate Tree Removal Permit 0
Describe In detail the type of work to be performed:
Slie.en (t:O(Y\ -t ~\/if U00~
Florida Product Approval # __ 7~5_\.!>_\_-_R~-q~ __________ for multiple products use product approval form
Property Owner Information
Name Kay Hood
City Ailantic Beacil
Addres s 1040 Little Cypress Ky
Sta t e_F_L __ Zip 32233 Phon e qcLi-c.JC',\-\(t 5 ']
E-M ail __________________________________________ _
Owner or Agent (If Agent, Power of Attorney or Age ncy Letter Required) ____________________ _
Contractor Information
Name of Company Tropical Enclosures by Master Screens Qualifying Agent ----------------Ad dress 7117 Allantic Blvd City Jacksonville State FL Zi p 32211 ---Office Phone _9_04_-7_4_4_-3_5_0o ___________ Job Site Con tact Number _A_sh_t_on_N_e_ws_o_m_e __________ _
State Certification/Registration# SCC131150288
Arch itect Name & Phone# .-.......,.,.....+--~.,....---"-".._._....._:~"-------....MC~i.-----1c...u._e.........._ ___ "'-l~=--------'----'c....;.__._,""---,,__ __
Engineer's Name & Ph one II __________________________________ _
Workers Compensation Insurer ________________ OR Exempt o Expiration Date _______ _
Application is h ereby made to obtai n a permit to do the work and in stallations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work wil l be performed to meet the standards of all t he laws regulating
construction in this j urisdiction. I u n derstand that a se parate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, an d 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 ail t he t oregoing intor mation is accu rate and that all work wili be done in compliance with ail
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 LENDE EFO
COMMENCEMENT.
[~Known OR
[ ] Produced Ident i ficati on
Type of Identification: _____________ _
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signed b y Joel
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ENG INEER OF RF.COR O:
Dav id W. Smith P.E.
rcORIDA LIC e NSF,, 53608
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