149 10th STREET FNCE20-0103 /;-';'''''-':,,,. . Building Permit Application Updated 10/9/18
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;r` City of Atlantic Beach Building Department **ALL INFORMATION
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',,, HIGHLIGHTED IN GRAY
.�; 800 Seminole Road, Atlantic Beach, FL 32233
i, . Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: 14 cl Tzy,+LL Si- A4- Ia,it:c, (, ,act, F 132233 Permit Number:PNCC ZO— U i O3_
Legal Description S;,,y1.- ]'o,w,:) y 0)00 RE# 17 0252 - 0 UV O
Valuation of Work(Replacement Cost)$ 327 LH 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 /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) /No
Describe in detail the type of work to be performed: C/' Flu u 001 r,.:ve„, 1 .4,,,,,.._... o«1 any yl orkl-, e J ,,,,,t si-
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Florida Product Approval# _ _ for multiple products use product approval form
Property Owner Information
Name Ge.orr,:cA Goodl:N, Address I'-19 Te.h41, S I.
City d{1c.,t:c, ` f3.e-GL SState PI Zip 32233 Phone et 09 1-1Si29g'7
.5,E-Mail � tr:rw,ds Q ccimc .o. . tic+
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company Superior Fence and Rail Qualifying Agent Zach Peyton
Address 5470 Highway Avenue • CityJax state FL Zip 32254
Office Phone 904-683-6349 Job Site Contact Number 904-502-1496
State Certification/Registration# 165859 E-Mail britani.norman(c�fencingjacksonville.com
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer 9142503 OR Exempt 0 Expiration Date 8/15/2021
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 ATTORNEY.BEFORE
RECORDING YO TICE OF COMMENCEMENT /' y, _Jay)6_ 6, _.&,--ii,(), , . � .L /7)/
(Signature o •wner otJgent) '� (Signature of Contractor)
Signed a d sworn to(or affi ,d)befo e this C�day of Signed and sworn to(or affirmed)before me this 16 day of
SF zQ b I - i 'LO. , -, September, 2020 y Brad Part -r
�.r/� _ _,.AVA�..., o 0//i f_
__41P# a ` QT') (Signature of Notary)
All
c2R`�Y ;-, TONT ���' *�T” Notary Public State of Florida
LESPERGER rsonall (1)
lMIONGG35317 ]I roduced IdentificationIonrType of Identification: i Op .? etober6,2023 Ty of Identification: a,wExpires 06/16/2024
_ . ' ,enwrters
,1 r� REVOCABLE ENCROACHMENT AGREEMENT
City of Atlantic Beach
�' **ALL INFORMATION
' '1�
a i•- HIGHLIGHTED IN GRAY
t,�' . . 800 Seminole Road,Atlantic Beach,FL 32233 IS REQUIRED.
REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach, Florida, a municipal corporation organized and
existing under the I iris of the tate of Florida, hereinafter referred to as "CITY" and
r\RI- L1 l t r• of Atlantic Beach, Florida, hereinafter
referred to as "USER". _...%
WITN ESSETH:
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 re (\ e_e___ .
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,saicl rotice to US R shall be given by certified mail,return
receipt requested,to the following address [49 l S-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.
fv ‘1,....5400ciiiiDate r)Q( oJ " O
Property Owr er/Agent(signed in presenc f Notary Public)
STATE O ili ORIDA, COUNTY OF DUVAL
The fore: ng instrument was acknowledged this 1.5 day of c J e , 20
I
b. _ _6 k* • +• a l ( ^ who personally appeared before me and
• ted name of Sig )
ackn•fp
,ged that he/she sign:d the instrument voluntarily for the purpose expressed in it.
a A 4A A., _ Department Approval:
Signature of Notary Public,State • . o ••al'ikYP TONIGINDLESPERGER
[ ] Personally Known ?*•
A. %,:. ' MY COMMISSION#GG 353178
";.,�� EXPIRES:October 6,2023 _S tt Williams, Public Works Director
[ ] Produced Identification(Type) '••:,oFp.°p' Bonded ThruNotary Public Undenviite
H:\Applications&Forms\Word&Excel Document Originals\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18
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! MAP OF BOUNDARY SURVEY
DESCRIPTION:
THE WEST 108. 3 FEET OF LOT 1 IN BLOCK 40 OF " ATLANTIC BEACH CORPORATION "
ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK 6 PAGE 1 OF THE
CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
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1 LOT 2 J.z,
::• BLOCK 40 �X I LOT 8
4 9' E ,_, BLOCK 40
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