318 Royal Palm FNCE20-0009 Permit PacketOWNER:ADDRESS:CITY:STATE:ZIP:
GIRARDEY CAROL 318 ROYAL PALMS DR ATLANTIC BEACH FL 32233
COMPANY:ADDRESS:CITY:STATE:ZIP:
COAST TO COAST FENCE
CO 1221 GALAPAGOS AVE S JACKSONVILLE FL 32233
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
171706 0000 ROYAL PALMS UNIT
02A3.00
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
318 ROYAL PALMS DR FENCE WALL OR BARRIER FENCE FENCE $1700.00
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 ON SITE RUNOFF INFORMATIONAL
Notes:
All runoff must remain on-site during construction.
2 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.
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: 11/4/2020
PERMIT NUMBER
FNCE20-0009
ISSUED: 11/4/2020
EXPIRES: 5/3/2021
FENCE WALL OR BARRIER PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PLAN CHECK 455-0000-322-1001 0 $17.50
FENCE 455-0000-322-1000 0 $35.00
PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $81.50
3 PUBLIC WORKS RIGHT OF WAY RESTORATION INFORMATIONAL
Notes:
Full right-of-way restoration, including sod, is required.
4 PUBLIC WORKS FENCING REMOVED INFORMATIONAL
Notes:
All old fencing and debris must be removed from job site by Contractor.
2 of 2Issued Date: 11/4/2020
PERMIT NUMBER
FNCE20-0009
ISSUED: 11/4/2020
EXPIRES: 5/3/2021
FENCE WALL OR BARRIER PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $81.50
FNCE20-0009 Address: 318 ROYAL PALMS DR APN: 171706 0000 $81.50
BUILDING $35.00
FENCE 455-0000-322-1000 0 $35.00
BUILDING PLAN REVIEW $17.50
BUILDING PLAN CHECK 455-0000-322-1001 0 $17.50
PUBLIC WORKS PLAN REVIEW $25.00
PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00
STATE SURCHARGES $4.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL FEES PAID BY RECEIPT: R14023 $81.50
Printed: Wednesday, November 4, 2020 8:26 AM
Date Paid: Wednesday, November 04, 2020
Paid By: COAST TO COAST FENCE CO
Pay Method: CREDIT CARD 392197250
1 of 1
Cashier: CG
Cash Register Receipt
City of Atlantic Beach
Receipt Number
R14023
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9
Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department ALL INFORMATION
s
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
IS REQUIRED.Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: 3 l (Z-cx.-tc;..l (7C-& -N----,;)' Permit Number:
Legal Description 31-6(®33.-...1s-.79c 00f Pro FKoyi4L-PAtAISU,air719Loii, '3LyI2 RE# 17/ 706 -OQ00
cu
Valuation of Work(Replacement Cost) 700 Heated/Cooled SF Non-Heated/Cooled
Class of Work: New EAddition 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 protect? Yes(must submit separate Tree Removal Permit) No
Describe in detail the type of work to be performed: t ,
v`-f f,---,.--. ..—},- C. C-t 2.4_. rC..-\-V--A LY c-__, ,,,_4—
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name C=-G`uz C ort,..-/-/- - Address 3 \i (2-c'-`ca 12c,...\---,.. -V -v
City t --_--- ..c-... "- State Zip 3 .-7.-33 Phone Cr-1.h—'41 L —-IS-
E-Mail v._ `A_ c- ,L.,..‘.,-\ c.. -E2 yCc--(n,avto ` c=-0---
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information ead5-7-0 cr FeeVe.e
Name of Company 5 c_-- -Qualifying Agent 6,-----,-,7 Jc.) ,,,_
Address l? 6746 146z2S ,4V City 1o, ..1c.----t..it State ( Zip 322-33
Office Phone 90.1 11/9 a>z 36)1410V 71'Y 7 ?SSob Site ContacttNumber
State Certification/Registration# tiC-pc_/4 E-Mail C.. j-c.,,-c ---
Architect Name&Phone#
J
Engineer's Name& Phone#
Workers Compensation Insurer OR Exempt Expiration Date 7//)ice Z/
Application is hereby made to obtain a permit to do the work and installations as indicated, 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.
i
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPER YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN AAl: i
RECORDING YOU NOTICE OF COMMENCEMENT.
i, 4Agent)Signature of Owner nature of Contractor
Signed and sworn to(or affirmed)before a this 6 day of . e1d d sworn to(or a'9i)before m- this2 lay of
Ocd-o 15. ,t--- , -C9?-0, by c'o I 6; ras LIS.:' F i-_—, . '
Signature af_Notarv)
4Mliiiii •JANMAURICIO WALKER ROBERTSON J IS
MY COMMISSION 4 HH 009325 TONI GINDL R1_ 0naIl y Known OR °`tPVUtiP:
MYCOMMISSI053178PersonallyKnownOR . .EXPIRES:June11,2024
EPE;°: Produced Identification =*: ,T,: *:Produced Identification
l
BondedThruNotaryPudicUneerwriters A', .:ot EXPIRES:October 6,2023
Type of Identification: /./ ,Q__r-,,-- -,r-lac_.ype of Identification:F:• oQ; .- -
i REVOCABLE ENCROACHMENT AGREEMENT
r
f `,
ALL INFORMATION
I City of Atlantic Beach
y HIGHLIGHTED IN GRAY
r'J 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 laws of the State of Florida, hereinafter referred to as "CITY"and
C'd ST TD Com-5T -. ,--)4'-zZ 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 Fo p'C.i 11.-) sr-At ( ,.(s'1` (U..)
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 -- 1 g . /3t -PALI+,9 r+•
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 fro' -any of the work herein under the terms of this permit and that all of said
liabilities ar- .: - •• .s •• -• the USER.
Date ld/26/2f7ZD
Property Owner/Agent(signed in presence of Notary Public)
STATE OF FLORIDA,COUNTY OF DUVAL
The foregoing instrument was acknowledged this Z(7 day of0 CI 20 __
by Ct ' _Tl4-,4N. cJ ( c-- who personally appeared before me and
Il.tinted •. e of Signer)
ack l. ledge• tha 'e/she signed the instrument voluntarily for the purpose expressed in it.
11. orAw • Aid 0;q;,. TONI GINDLESPERGER
MY COMMISSION#GG 353176 Department Approval:
EXPIRES:October 6,2023
Signature of Notary Public,St. of Florid ":.'::,pFF,,o?=:Bonded ThruNotary Public Under iters
Hrsonally Known
j Produced Identification(Type)Scott Williams, Public Works Director
H:\Applications&Forms\Word&Excel Document Originals\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18
c=1 -
it RIGHT-OF-WAY/ EASEMENT PERMIT APPLICATION ALL INFORMATION
4r City of Atlantic Beach HIGHLIGHTED IN GRAY IS
A800 Seminole Road,Atlantic Beach, FL 32233 REQUIRED.
PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES
Job Address 31% Q4y,P1., f I,w1 S 'De__ Permit Number
Contractor Information
1
Company-.245r f UAcr f r k( (jv Qualifying Agent J/414"0 A.-q-
r-Oz ()I L5
Address
es/+
iZ /F 14 VT' City 471 - 3C- State FL Zip 3.7 Z'/
Phone 74 2-
7S5
Email C-7 _C -' ,''br(L - C'7--+'1
State Certification/Registration#
Architect Phone Email
Engineer Phone Email
Workers Compensation Insurer OR Exempt/ Expiration Date-7
Permittee declares that prior to filing this application they have ascertained the location of all existing utilities,both(aerial
and underground and the accurate locations are shown on the sketches.
Whenever necessary for the construction, repair, improvement,maintenance,safe and efficient operation,alteration or
relocation of all,or any portion of said street or easement as determined by the Public Works Director,any or all said poles,
wires, pipes,cables or other facilities and appurtenances authorized hereunder,shall be immediately removed from said
street or easement or reset or relocated hereon as required by the Public Works Director and at the expense of the
Permittee unless reimbursement is authorized.
All work shall meet City of Atlantic Beach or Florida Department of Transportation Standards and be performed under the
supervision of JIk..) ct or.4(cJ r p&----- Project Superintendent)
with(Company Name)C:ujg" `ja 7‘,45'1.-- PE—Ile-6r GJ Phone Qp 7u$' 7 7 5 :-
All materials and equipment shall be subject to inspection by the Public Works Director.
All city property shall be restored to its original condition as far as practical,in keeping with City specifications and the
manner satisfactory to the City.
A sketch of plans covering details of this installation,as well as a copy of a recent survey shall be made a part of this permit.
Calculations showing any increase in impervious area on owner's lot or in the City right-of-way are to be included with
this application.
The permittee shall commence actual construction in good faith within days. If the beginning date is more than 60
days from date of permit approval then permittee must review the permit with the Public Works Director to make sure no
changes have occurred in the area that would affect the permitted construction.
It is understood and agreed that the rights and privileges herein set out are granted only to the extent of the City's right,
title and interest in the land to be entered upon and used by the holder,and the holder will,at all times,assume all risk of
and indemnify,defend and say- armless the City of Atlantic Beach from and against any and all loss,damage and cost of
expenses arising in any mann: of the exercise or attempted exercises by the holder of the aforesaid rights and privileges.
The Public Work i..-- or s'al..- • Tied 24 hours prior to starting work and again immediately upon omplletion
00Date /0 Z- G Z c
P,yV gn-d in presen .-Notary Public)
STATE OF FLORIDA,COUNTY OF DUVAL
The foregoing instrument was acknowledged this 2 j
day of 0- 0 e_e--- 20___
er
by N
evuer T604 L‘LUrCr— who personally appeared before me and
I printed name of Permittee)
TONI GINDLESPERGER
acknowl d th. he. •ned the instrument voluntarily for the purpose expressed in it. ••,01.6k"-:-;1 :MY COMMISSION#GG 353178
o, EXPIRES:October 6,20231,,,FF%°P Bonded Thru Notary Public Undervrtiters
Personally K
Signof Notary Public,St.te••rida Produced Identification (Type)
H:\Applications&Forms\Word&Excel Document Originals\201801001 Right-of-Way Easement Permit Application.docx Revision Date:10/1/18
rs., ! City of Atlantic Beach APPLICATION NUMBER
Building Department To be assigned by the Building Department.)
M.\
800 Seminole Road C1
1", _• r) Atlantic Beach, Florida 32233-5445 V Iv a 20-- C1)07t.---',:4'r
Phone(904)247-5826 • Fax(904)247-5845
4 01119:'
v
E-mail: building-dept@coab.us Date routed: "Z/(01 7 0
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
1)
Property Address: 'S I a OL L d tel Lvi l Department review required Yes No
LC) uildiApplicant: 2‘... --c ( CSA ` tinning&Z-onin:
Tree Administrator
Project: C, " --c.r 3(2 ublic Wok,)
C---e c Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required
Review or Receipt
Date
of Permit Verified By
Florida Dept.of Environmental Protection
Florida Dept.of Transportation
St.Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: Approved. I 1Denied. Not applicable
Circle one.) Comments:
BUILDING
PLANNING &ZONING 1
Reviewed b Date: 2- 7 -Zb
TREE ADMIN.
Second Review: Approved as revised. Denied. I INot applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by:Date:
FIRE SERVICES Third Review: Approved as revised. Denied. Not applicable
Comments:
Reviewed by:Date:
Revised 05/19/2017
City of Atlantic Beach APPLICATION NUMBERk,- .'
Building Department jecEivE To be assigned by the Building Department.)
800 Seminole Road rl
Atlantic Beach, Florida 32233-5445 I— mez, C ) lett//
Tj nn
Phone(904)247-5826 • Fax(904) -5 U 6 Z
Z/L2
L illi• E-mail: building-dept@coab.us Date routed: Z 0
City web-site: http://www.coab.us BY•
APPLICATION REVIEW AND TRACKING FORM
Property Address: j t Uli A d A Wits Department review required Yes No
r4Buildin
Applicant: Co icA& -c ( v 0,c\ PI PtBnninq &Zo—nines
Tree Administrator
Project: C2 r
cmc bl c Wok6j
C. E. u12. l,tilitie '
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required
Review or Receipt
Date
of Permit Verified By
Florida Dept.of Environmental Protection
Florida Dept.of Transportation
St.Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: /Approved. Denied. Not applicable
Circle one.) Comments:
BUILDING
v
PLANNING &ZONING
Reviewed b Date: `_Z 2 2
TREE ADMIN.
Second Review: Approved as revised. Denied. nNot applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by:Date:
FIRE SERVICES Third Review: Approved as revised. Denied. Not applicable
Comments:
Reviewed by:Date:
Revised 05/19/2017
i,.,
r
City of Atlantic Beach APPLICATION NUMBER
Cfs-.'' .. '
1
Building Department To be assigned by the Building Department.)
800 Seminole Road C 1
44"=._ ,. AtlanticBeach, Florida 32233-5445
s.
I\)a_ 2cw0 71'J
Phone(904)247-5826 • Fax(904)247-5845`'
Lr,j E-mail: building-dept@coab.us Date routed: t;p ZO
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
r)
Property Address: 1j I 8 ` OVAL , A Wyk Department review required Yes No
Linq
Applicant: L_,c) A.&'T ( c GAS- nnmq &Zonis
Tree Administrator
Project:
I
C 3Q publicW
1is_Ltiliiies•->
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required
Review or Receipt
Date
of Permit Verified By
Florida Dept.of Environmental Protection
Florida Dept.of Transportation
St.Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATIONffSTATUS
Reviewing Department First Review: Approved. Denied. Not applicable
Circle one.) Comments:
BUILDING
PLANNING &ZONING
Reviewed by:Date:s-/
7
GZU
TREE ADMIN.
Second Review: Approved as revised. tenied. nNot applicable
PUBLIC WORKS Comments: Oeni 4264 VA ,i I QeV i S;bin t S S L korlAc
P(PUBLIC UTILITIES Pe4 h. R A, 62';'4./i p+...x
PUBLIC SAFETY Reviewed by: Dater////ZV
FIRE SERVICES Third Review: I 'Approved as revised. De led. Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
0.A9=-,7-4,., City of Atlantic Beach APPLICATION NUMBER
jS/+ .; Building Department To be assigned by the Building Department.)
800 Seminole Road Y n
15 iv Atlantic Beach, Florida 32233-5445 I\J C 20-- W 7
Phone(904)247-5826 • Fax(904)247-5845
P,
olio- E-mail: building-dept@coab.us Date routed: *Z/6:2/ 7 0
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: .3 [ ' R C F}L. PA. Ll/y
Department review required Yes No
Buildin
Applicant: Co iq& t 0 C>Pk i nning &Zonin•
Tree Administrator
Project: CO I
C---_O-- -' bic Wow
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required
Review or Receipt
Date
of Permit Verified By
Florida Dept.of Environmental Protection
Florida Dept.of Transportation
St.Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: Approved. enied. Not applicable
Circle one.) Comments:
BUILDING e(^qA_ /—
PLANNING PLANNING &ZONING
Reviewed by:Date:
TREE ADMIN.
Second Review: Approved as revised. Denied. I INot applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by:Date:
FIRE SERVICES Third Review: Approved as revised. Denied. I Not applicable
Comments:
Reviewed by:Date:
Revised 05/19/2017
seg'. , Building Permit Application Updated 10/9/18
ik _;) City of Atlantic Beach Building Department ALL INFORMATION
j+
V
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
t tw
Phone: (904) 247-5826 Email: Building-Dept@coab.
usOF—
IS REQUIRED.
Job Address: 31 bi-L b L ns Permit Number: 1— I\iC,C- C_.:0 V 00
Legal Description i' i 33 dS — Z
clC
I f P QT- e1 Ck writ-M,/N4 RE# i 1 I1O(.0 - OOjO
NIT4 4-07 14 btoc Z
Valuation of Work(Replacement Cost)$1Uc,Heated/Cooled SF Non-Heated/Cooled
Class of Work: New Addition Alteration Repair Move Demo Pool Window/Door
Use of existing/proposed structure(s): Commercial Residential
If an existing structure, is a fire sprinkler system installed?: Yes No
Will tree(s)be removed in association with proposed project? Yes(must submit separate Tree Removal Permit) No
Describe in detail the type of work to be performed: fl' 1 O b 1^G 'CG/ )L4Cc--1.4'Tid/vChJ
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name Ci 2v - C r IUg.Dey Address 3/a-ROYAL /Id/
LrI3 _0Q.
City /frTL • 4cf State re- Zip _7Z Z 3 3 Phone '( 76` .f7/ — -73—z?
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company Cv/457—"rdeeessr" ier-i'C Qualifying Agent •ZAI A72- 4,1 S'
r
Address /2e/(4! VZ 6-0_5 City/517t. gel". State 'r-l..— Zip 3'a Z3 3
Office Phone girt/ 70$ 7 75-5 Job Site Contact Number
State Certification/Registration# E-Mail C TOC,e,„:- 6)Is'-,i/4/L• ce-n_,
Architect Name& Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt Expiration Date IAA/
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.
RR
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all wcWill be5done0in compliance with all
applicable laws regulating construction and zoning.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICtbF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO.VOUR PROPERTY. IF Ye U INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFOR'
RECORD G YOUR NOTICE OF COMMENCEMENT,r
Signature of Owner or Agent Signat - of Contractor)
Signed and sworn to(or affirmed)before me this3 day of Signed and sworn to(or affirmed)before me this,3C-Jday of
FE& , otoa CA• •L. ISA¢.Jt: Fe:3. , y ; o - r4` c•
T_• I Iii
u e .f .t. r- . r . .
J•, Notary Public State of Florida
A00%, Notary Public State of Florida
Roberta D Carlisle
r '; Roberta D Carlisle
belyersonally Known 0 My Commission GG 251658 N.Personally Known 0' moo` My Commission GG 251658
o Expires 09/15/2022 ad•
Expires 09/15/2022
Produced Identifica..n or f• Produced Identificati,n
Type of Identification: "'''''+ Type of Identification: .
fr-
PREPARED BY: 1
s r
E4 ',r.
IIIb...
NLly
i
MIG 4471IbPICR
t
IF! iii a-lea`" $
LAND SURVEYORS
Z.
a as
7Y T
Ser' Ing an-tiarafECo -_._.-.. t
P.
igniecargocarlvs
PROPERTY ADDRESS: 318 ROYAL PALM DRIVE ATLANTIC BEACH,FLORIDA 32233
FIELD WORK DATE:101281201a REVISION DATE(S):(REV.o 10/28/2014)
NOTES:
4i
R1410.2386
SETBACK INFORMATION SHOWN ON PLAT,NOT VERIFIED.
LOT A'PEAPS TO BE SERVICED BY CITY WATER AND SEWER.
BOUNDARY SURVEY FENCE OWNERSHIP NOT DETERMINED.
DUVAL COUNTY
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