501 SEASPRAY AVE FNCE20-0095 _A, • Building Permit Application Updated l0/9/18
' ' City of Atlantic Beach Building Department **ALL INFORMATION
%Jy FL 32233 HIGHLIGHTED IN GRAY
800 Seminole Road, Atlantic Beach,
•�t<<'�' IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: ,•,-,--(::;)/ S6/'-rp,Q4 Lf /}(/E , Permit Number: EE ZO L C±) D
Legal Description I(o - ZS.- ZCIE- ',c'_e 2 ' -K-c - L r,--1- Z70 RE# 17 0 4 3 I-003 0
Valuation of Work(Replacement Cost) $ .3 c 0 0 Heated/Cooled SF / D Non Heated/Cooled
• Class of Work: ONew DAddition OAlteration 2Repair OOMove DDemo OPoo ' i�aOVE
• Use of existing/proposed structure(s): DCommercial r sidential
� SEP 8 2020
• If an existing structure, is a fire sprinkler system installed?: OYes 0110
• Will tree s be removed in association with •ro.osed •ro'ect? FlYes must submit se•a,., • Tree Removal Permit Flo
Describe in detail the type of work to be performed:
AC/0L�G/NG ' FENCE U"-/-74 V/AI
Florida Product Approval# for multiple products use product approval form
Property Owner Information /
Name d—G3SE/°H S/4�Cg,,1,14-4 Address 4—C2/ , -X-7•4J'/'fre./¢-i' qi/E _
City )9TL/4-N/--/C Al /1 Ce/ State FL Zip 3 2.23 3 Phone q7c/— IC 411? g2_1-
E-Mail M4/146/✓7 3772tE""")�� Gc/f'1CAI cT, Nom-'
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company Big Jerry's Fencing Qualifying Agent
Address 12670 Rear:h RIvri, 3-131 City Jacksonville state FL Zip 32246
Office Phone 9f14-476-7528 Job Site Contact Number 904-476-2528
State Certification/Registration# N/A E-Mail jon@BigJerrysFencing.com
Architect Name& Phone#
Engineer's Name& Phone#
Workers Compensation Insurer N/A OR Exempt X Expiration Date 2/2022
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 YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTOR E-Y BEFORE
RECODING YO • eTI OF MMENCEMENT. —N.
/V, 4 . rd ___9ert- Z7 }`)
(Signa of wn or Agent) (Sig ature OITEMTra oT r
Signed and sworn to(or . firmed)before me this day of Signed and sworn to (or affirmed) before me this, day of
cernittl it/, ,209D, •y 40.5.e•k n a.k CI/ _4_9,11
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[ I Produced Identification
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CONC. DRIVEWAY LOT 270 SPECKMAN RESIDENCE
501 SEASPRAY AVE.
- - - - ATLANTIC BCH,FL 32233
1001
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CONC. DRIVEWAY LOT 270 SPECKMAN RESIDENCE
501 SEASPRAY AVE.
�� ATLANTIC BCH, FL 32233
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* FENCE allIMMIS
¢ /3v' /ivc^e_uP,416 E
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