574 Ocean Blvd Fence Submittal Building Permit Application Updated 10/9/18
0ECity of Atlantic Beach Building Department **ALL INFORMATION
/ 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
• st v.,.., IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: i -1zI O A J (SI...V I) Permit Number:
Legal Description j - '/ Ito-- ZS-Ne RE# r(..) ry 1 - OU.-/cJ
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Valuation of Work(Replacement Cost)$ 2 Z(> ) Heated/Cooled SF Non-Hea EG E IN`I E . ,
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AT I
• Class of Work: ❑New ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Wind Dc " 0 6 2021
• Use of existing/proposed structure(s): ❑Commercial ❑Residential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes ❑No BY.
• 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: (L c/'rlf)C: 01.1:70 cG' -L, r e,.J LA C.E, , /'-a--- NC j�
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Florida Product Approval# for multiple products use product approval form
Property Owner Information
NameSU'/4 TAC ) Address 57s/ O cc: A') `3/LV/p
City A-TLAN i 1 C.-(SE C-1-1 State rt✓ Zip 322 5 Phone q(fi•1 '333 Sta79
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company&./ja5r TO C40 145< <'C:``)C.li Qualifying Agent ,V'J l zz, i 4-r
Address /ZZV-41-0'/i t2S 44VE 5 , City 19 L., tet1 . State <``- Zip 3Z?;
Office Phone Job Site Contact Number
State Certification/Registration# E-Mail CTUC._cAif.E7 6-r'v i L C rT-r•
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt Expiration Date Vit/2 0 ?.- ‘
Application is hereby made to obtain a permit to do the work and installations as indica ed. 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 BE. IRE
RECORDING YOUR NOTICEOF COMMENCEMENT.
(Signatur of Owner or Agent) Sign Lure. Contractor)
SO � ,V f}eJa i r�r z)/),
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Si ned and sworn to(or affirmed)before me this day of Signed and sworn to(or affirmed) efore me thiss (e, day of
r4Y ,Q.,?1 ,by S..-.S,.,,,J p PAY , Q.:5,9-i „bye-1r 'rt ..1+a c:+ -«'r
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per w, Notary Public State of Florida i dor°4a,• Notary Public State of Florida
Roberta D Carlisle ` Roberta D Carlisle
[personally Know, Okt ` My Commission GG 251658 [personally Known OR My Commission GG 251658
Expires 09115!2022 [ ] �R Expires o9/15/2022
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Fence Addendum Updated 1/7/2021
,I City of Atlantic Beach Building Department
1! 800 Seminole Road, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Property Type:
Residential
❑ Commercial
Lot Type/ Features:
J/One Street frontage (interior lot)
❑ More than one street frontage (corner lot, through lot, etc.)
❑ Swimming Pool
Fence Material:
ood
❑ Chain Link
❑ Vinyl
❑ Block/Stone (Plan details required for footings and/or retaining walls)
❑ Other
Fence Height:
❑ Four Foot(4ft)
Six Foot (6ft)
❑ Other
Fence Location:
Please submit an accurate boundary survey required 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)
N o
Will tree(s) be removed in association with proposed project?
,❑ YesI (must submit separate Tree Removal Permit)
J1 "o
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.