1601 Beach Ave Fence Permit Submittal a 1 • a - - i 4
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i City of Atlantic Beach Building Department GALL INFORMATION
�1E:04
�' 800 Seminole Road. Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
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Phone: (904) 247-5826 Email: Building-Dept@coab.us is REQUIRED.
job Address: 1 app QD e_O_C:�-v n Q Q„ , 0 Permit Nurnner:
Lcgai Description 1 S- lo Q9-• -�9 G A p,,t.C_ 1bess..can \-).A.\- NO 1
1—CA- 1, ash, 1-ert A, r-r Creof t_or_ _A-. A se c-D plc. 1315 6. 13 8l-
Valuation of Work(Replacement Cost)S -.dynamo .00 Heated/Cooled SF Non-Heated/Cooled
• c ra$idi work: UNew UAdaitton uMiteration f.mepair uiviove uDemo DPooi DWindowiboor
• Use of existing/proposed structure(s): ❑Commercial *Residential eCE'VE
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• If an existing structure, is a fire sprinkler system installed?: ❑Yes gNo - cl.R - kij
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• Will tree(s)be removed in association with proposed proiect?DYes(must submit separate Tree Rer'oval elamitil 1
Describe in detail the type of work to be performed: lil i
! csc - Ou e__ 0-1c) l 'Q.,i\LQ-, \,5 ,_\\ f\Q.- .i I
'-oricia Product Approval# for multiple products use product approval form
'-rpertY Owner information
Name Tom.^n a Jc* st �,t- 'C Address 1 La G\ c-,--(----V\ C 3 Q---
City
City 4\-V). . b e_c, State -Fl_ Zip j a),,12,-), Phone c\c`\-k,o'S\ - to (A.,-,
E-Mail c Q-A- b C ME- ^y
3wrner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor information ernai I . ,1RGARDENDtS\&N COC'M 14 Ii' -COM
Name of Company _ )rh,.}:\A •c-k_ \c e 0_,C)- Qualifying Agent .J. Nhrw1 y Q,v.,S c4 2
Address 13al Mafcln.t.-Gx... J-1,- City __So,.c..k..SorW•\\State T--A__ Zip 3 a.a\1
Office Phone qn ut . -4 L.11/4'3• 1 1 "4-n- Job Site Contact Number `AO y• 2 3Z3. 1-lQ-m 5
State Certification/Registration# Gn €12. E-Mail St`n. ••\-N, , V t,dc.2 @ V cc.1100. c S,i`.
Architect Name& Phone# 1.... cr., 23C'�,e- S R-A c1 �
c\O L\• 305 . 1C71cn f
Engineer's Name& Phone# Cl I A
Workers Compensation Insurer i%'^c25 Vali OR Exempt 0 Expiration Date _7 / "_1
--.r vs rits=_rte worK arm installations as indicated. 1 certii v tnat no work or installation nas
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 an
applicable laws regulating construction arm « ,,;:,
i ARNINti TO OWFtEK: 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
REC RDING UR NOTICE OF COMMENCEMENT. , /J
� L _
(Signature of Owner or Agen /-- 7 (Signature of Contractor)
it
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i• • ur-o Nit.. (Signature of Notary)
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.`amu,, . Fence Addendum Updated1/14/2021
City of Atlantic Beach Building Department
v,tr,,r 800 Seminole Road, Atlantic Beach, FL 32233
(AI,;,,� PERMIT#
Phone: (904) 247-5826 Email: Building-Dept@coab.us 1
Job Address: \0.\\_ c. I Date:
1o0\ 1 .c--h Q_ t.-tea..,L,1 r e_,b c,..a.r Y f ao a‘
Property Type: Lot Type/ Features:
Residential One Street frontage (interior lot)
❑ Commercial 1 ❑ More than one street frontage (corner lot, through lot,
etc.)
❑ Swimming Pool
Fence Material: Fence Height (select all that apply):
❑ Wood (Four Foot(4ft)
❑ Chain Link ❑ Six Foot(6ft)
❑ Vinyl ❑ Other
❑ Block/Stone (Plan details required for footings and/or
retaining walls)
L Other Pc.) %AQ.r Com..\ec, pC1, i„n,r\,Lxi.,
Fence Location:
I Please submit an accurate and current boundary survey showing all existing improvements(including building footprint,
driveway, swimming pool, etc.)and location of fence/wall and any gates. Plan details required for block wall footings and/or
retaining walls and any portion or fencing above 6ft in height.
Will the fence be built in an easement?
❑ Yes (must submit separate Revocable Encroachment Agreement)
1X/No
Will tree(s) be removed in association with proposed project?
❑ Yes (must submit separate Tree Removal Permit)
.3Xj‘l o
Conditions of Approval:
• Roll off container company must be on City approved list. Roll off container cannot be placed on City right-of-way.
• All old fencing and debris must be removed from job site by contractor or homeowner.
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 YOUR NOTICE OF COMMENCEMENT.
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