0 11th St CIV18-0003 permit applicationBuilding Permit Application Updated 10/9/18
City of Atlantic Beach Building Department ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@coab.us
IS REQUIRED.
Job Address: Parkside Dr. Lots Permit Number: CIV18-0003
Legal Description RE#
Valuation of Work(Replacement Cost)$ 2 5 0, 0 0 0 Heated/Cooled SF 0 Non-Heated/Cooled 0
Class of Work: INNew Addition DAlteration Repair DMove Demo Pool Window/Door
Use of existing/proposed structure(s): Commercial NResidential
If an existing structure, is a fire sprinkler system installed?: DYes No
Will tree(s)be removed in association with proposed project? L Yes(must submit separate Tree Removal Permit) No
Describe in detail the type of work to be performed:
Civil - Site Work
Florida Product Approval# N/A for multiple products use product approval form
Property Owner Information
Name Selva Preserve, LLC. Address 248 Levy Road
City Atlantic Beach State FL Zip 32233 Phone (904) 333-5944
E-Mail lauraferrante@aol .com
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Laura Ferrante
Contractor Information
Name of Company RPC General Contractors, Inc.Qualifying Agent Daniel J. Rodrigues
Address 248 Levy Road City Atlantic Beach State FL Zip 32233
Office Phone (904) 241-4416 Job Site Contact Number (904)509-1863
State Certification/Registration# CGC1523403 E-Mail Jennifer@rpcgc.com
Architect Name& Phone# N/A
Engineer's Name&Phone# J. Lucas &Associates, Inc. (904) 396-3060
Workers Compensation Insurer American Builders Insurance OR Exempt Expiration Date 10/27/21
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 OBT,t ( FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORD eR N 0,/F CO ENCEMENT
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