27 SARATOGA CIR N - FNCE20-0099 Ys 'r-� Building Permit Application Updated 10/9/18
--' City of Atlantic Beach Building Department **ALL INFORMATION
MMI\Ty 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
u;:9? IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: 2.7 Sit/4kW)G C.//ee(C Aler Try Permit Number: r)CGZO -009 J Q
Legal Description 31-/3 3s,26-79E irciwric Reativge.1 umid-or-240c'6 3 RE# i 7/ 790 ' U006
Valuation of Work(Replacement Cost)$ /900 Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial O'Residential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes ❑No
• Will tree(s)be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) LI No
Describe in detail the type of work to be performed: aft/A/CC ff f}W L/tie- f"lam , /,' ?Az-L `1-7A(-4.....tn,".)
CEA'
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name ! d i_ty act",L"S7 C'A Address Z .5404 vvlr/j/,GL
l. c 4) 1
City /�TcA�l GA.6' c t? State Zip ?ZZz3 Phone 3(2. 2'q-7)
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company CG>-Srre Cua-ST "Ct "- Qualifying Agent Ai D ek ti I S 7--
Address
"Address /?2,..,11 l�-a 41.-44),46- $ itsic C7 City rnTt - State SF Zip 322_33
Office Phone ye--4 -70C 7 1 -- Job Site Contact Number
State Certification/Registration# E-Mail (.TOL FGRE . 6-41-74-i C'. COl
Architect Name&Phone#
Engineer's Name&Phone# J
Workers Compensation Insurer OR ExemptExpiration Date '7/!1/2/
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 ATTORNE RE
RECORDI G YOUR NOTI --OF COMMENCEMENT.
7
49.: (Signature(Signature of Owner or Ag nt) (Signature f Contractor)
re l ly 7 N eo 5 4, ec d Jvaa 4i- -(Signed and sworn to(or affirm-d) before me this day of Signed and sworn to(or affirmed)before me this day of
•
ws - , jev r , ozcPo , by • "
'� '�i%, ir� `,iTs�//ice • twii w�ie�
0 Notary Public Sta ,• -- nor kik Notary Public a e.
a. 4 '' Roberta D Carli . (Sig :ture of Notary) a" I. igna re of Notary)
Roberta D Carlisle
My Commission GG 251658 y * My Commission GG 251858
, �'?��� Expires 09/15/2022 �j1 Expires 09/15/2022
33[ sen: n. .06
.:
Produced Identification cL UL [ ]Produced Identification
Type of Identification: )3Z'S3-G%T..-44t?!eD-O Type of Identification:
/ 1..:-:,`1,-,,,, REVOCABLE ENCROACHMENT AGREEMENT
/-�.c ', **ALL INFORMATION
City of Atlantic Beach
I . 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
0045rting undf T_ 1 Cv c") 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 -4✓�� /^/5.7'`-
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 27 5424 sr-C6 4 C/2. A/
• 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 hereb --_umed by • e USER.
- p-/� Date q/9/2020
Property Owner/Agent (signed in presence of Notary Public)
Jo^//'r+rA yvz r<✓/5T
STATE OF FLORIDA, COUNTY OF DUVA c�
The foregoing instrument was ack • edged this (1/q/ day of� CP , 20 7 0
by �__ �'' , who personally appeared before me and
(printed name of Signer)
ackn w dged at, e/sh- signed the instrument voluntarily for the purpose expressed in it.
:-.4 Department Approval:
Sign re of Notary Pu•lic, St. e o Florida ' ,,,;;;;.o�',-. 70NIGINDLESPERGER
ersonally Known ' ':� .F:'' MY COMMISSION#GG 353178
`,�.:o; EXPIRES:October 6,2023
[ I Produced Identification (Type)
l''''.;F�rF o`' BonaedThruNotaryPumicunderwriters Scott Williams, Public Works Director
H:\Applications&Forms\Word Documents\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18
POLLY T. NEWSTL Au
COUNTRYWIDE HOME LOANS .
. ATTORNEYY J11TLEt INSNOEN JR,FUND, INC.
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SARATOGA CIRCLE NORTH
(600' RIGHT Cr WAY')
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LEGEND:
R - RADIUS —x—0. FENCE i
L - LENGTH O - CONCRETE
NOTES N 20-2815. E REVISIONS
I BEARINGS ARE )ASCD ON THE PLAT GEARING Or ALONG THC
WESTERLY BOUNDARY UNE OF SUOJECT PARCEL )AIC DESCRIPTION
T OY GRAPHIC PLOTTING ONLY THE CAPTIONED LANDS LIE WITHIN 11.000 ZONE:
N AS SHOWN ON THE
NATIONAL FLOOD INSURANCE YAP DATED APRIL 17. 1065, COIJIJUMTY NUuaER 120075, PANEL 0001 D
3 THIS SURVEY REFLECTS ALL EASWCNTS k RIGHTS OF WAY AS PER RECORDED PLAT 8/OR TITLE COuuITUENT
IF SUPPLIED UNLESS OTHERt%SE STATED, NO 01HCR TITLE VERWTCAnON HAS BEEN PERrORNED 01 THE UNOLNSIGNED.�
/_ THIS SURVEY NOT VALID NrnIOUC THE FJIOOSSED SEAL Or THE CERTIFYING SURVEYOR. _
JOB # 9265 DATE or FIELD SURVEY. 08-26-09 I DISK # ZIP'26 ' I SCALE: I" = 20'