770 Paradise Ln ACC19-0065 Brick Walkway r11,An;. , City of Atlantic Beach APPLICATION NUMBER
pis t \ Building Department (To be assigned by the Building Department.)
t 800 Seminole Road (1C(� 19 ._ 00/ 5
_�/ Atlantic Beach, Florida 32233-5445 l l•1.�C�7
� � Phone(904)247-5826 • Fax(904)247-5845 /
9r E-mail: building-dept@coab.us Date routed: 7/ !
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 77 9 PRAD LjJ Department review required Yes No
Rc1idin. , t�
Applicant: K G Planning &Zoning s
Tree Administrator
Project: ( 1 R L C LA3 A Li-CA/3 pv i':Public or _11)
d'ublic 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 f�J
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: <proved. Denied. I 'Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING i•a C1'./ /
Reviewed by: / Y ' Date:
TREE ADMIN.
Second Review: ['Approved as revised. ❑Denied. ['Not 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
Building Permit Application Updated l0/9/18
.iii...: ,FCity of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
woo, IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: 7 70 17AfAUr C4vL Permit Number: QR---\ 1 ' )(0J
Legal Description 5 7 3 1 !if-L ^ VI l: . 13 P,,,41, P?S-✓.CRE# 1-7 Z 3 7L -6L4z Q
Valuation of Work(Replacement Cost)$ Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New (Ciddition ❑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) }o
Describe in detail the type of work to be performed:
� ,VC/ i ,
D1 l(,I
CA � f'(,1Ww�Mt,viU o-1on� S L dLL '�-c� �Do
Florida Product Approval# for multiple products use product approval form
Property Owner Information / /_ n
Name ►IlIa.r- efig, 'Sr. Address / /0 f�G./k/V s� 1 W--�
City ! 1, ,l. State 1 L Zip 31L 3 3 Phone goy 145 q 2_1 N
E-Mail W(45 c/ - A4p• US
Owner or Agent(If Agent, ower of Attorney or Agency Letter Required)
Contractor Information
Name of Company )Ijf, 41(. Qualifying Agent A,..,/ ' e///
Address j3'60 l" ', 1 Q!' - Puka City MLA: RA_ State Ft, Zip 3-0-23Office Phone qd y 371_ 7 L76 1 Job Site Contact Number eitlii 14 4P. 11 fp/ 31 1 /crS
State Certification/Registration# E-Mail 'In 4 e ,'i 1,,/ • Cdr✓'►
Architect Name& Phone#
Engineer's Name&Phone#
Workers Compensation Insurer p(/'i m, — /9,‘ c-11, OR Exempt❑ Expiration Date
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 YOUR NOTICE OF COMMENCEMENT. /..„..,./
(Sign--7/4 -atur of Owner or Agent) ( ign: .f Contractor)
Signed and sworn to(ora' ed)bef ire me this,2y d/LL
ay of Signed and sworn to(or aff -d) Before e this Z day of
1-(Ll , 02--oi ' , .Ai .Ik ii Ss . 3-t_ i,I1 `'ljc . • . . 1. off/
—, �
g .� • . . _ 4...na itZr ota -
• TONI GINDLESPERGER
ersonall Known OR ;moo ;`y�,'.. TONI GINDLESPERGER ....1.1.Personally Known OR __- MY COMMISSION#FF 924951
y MY COMMISSION#FF 924951 y # EXPIRES:October 6'9
2019
[ ]Produced Identification [ ]Produced Identification =N: h
^:,,r�3.;a; EXPIRES:October 6,20'9 I."' ,, Bonded Thu Wary ubtc Underwriters
Type of Identification: '.2�;'Rh :•' Bonded ThtiNotary PubrcUnderwn�ters Type of Identification:
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road
• Atlantic Beach, Florida 32233-5445 C(�` l l OO( J
Phone(904)247-5826 • Fax(904)247-5845
`.".01119r E-mail: building-dept@coab.us Date routed: 7/z_57 L
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: '---77e Department review required Yes No
vB nT)
Applicant: Ke EA,c_ l ,,, Pta iTni g &Zoning
Tree Administrator
Project: (3 R t e tc LA-) A Lt-< ,0 A L/ 1 ublic Works
/ Cublic Utilities
1 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 Z./
Florida Dept. of Transportation
St. Johns River Water Management District ,� f
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPL CATION STATUS
Reviewing Department First Review: Approved. ❑Denied. ❑Not applicable
(Circle one.) Comments:
BUILDING // --
PLANNING &ZONING Reviewed by: Date:'1'2IQJt61
TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. ['Not 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
,,,:o—A`Ir TREE & VEGETATION AFFIDAVIT FOR INTERNAL OFFICE USE ONLY
'. 1\ City of Atlantic Beach PERMIT#
Kc) Community Development Department
800 Seminole Road Atlantic Beach, FL 32233
"1-9;,i � (P) 904-247-5800
SITE INFORMATION
ADDRESS ( 7D gcdctoirs, Levu._
SUBDIVISION }' ‘' roePceC;p„rJ,- BLOCK LOT li-i3
RE# 117:51 G - 07-69 0RESIDENTIAL E] COMMERCIAL ❑ OTHER
APPLICANT INFORMATION
fOq ] ( ']PHONE# ,3 y "1 r y
NAME WIII IU r''� CA55idA `�+
ADDRESS
)0ki,(`,‘e— CELL#
CITY STATE ZIP CODE
EMAIL I,v AV) (71 5 51t t I 1`'t L , V5 OWNER [ LEGAL AUTHORIZED AGENT
(''`
I affirm that I have reviewed the provisions of Chapter 23, "Protection of Trees and Native Vegetation", of
the Municipal Code of Ordinances for the City of Atlantic Beach Florida and/or I have participated in a pre-
application meeting with the Administrator of those regulations. Subsequently, I affirm that no regulated
trees and no regulated vegetation will be damaged, destroyed and/or removed from the above-described
property and/or adjacent properties including right-of-way.
I HEREBY CERTIFY THAT ALL INFORMATION PROVIDED IS CORRECT:Signature of Property Owner(s)or Authorized Agent
6) /71 2- DY /
SIG ,AT OF PLICANT PRINT OR TYPE NAME ss n7 DATE
SIGNATURE OF APPLICANT(2) PRINT OR 1TYPE NAME DATE
Signed and sworn before me on this a41 day of - l 0' 1, 019 by State of F
_..)
Cou
lnty of l�
VOA
Identification verified: ,J-
Oath Sworn: El Yes ❑ No
i(:a-----
st:ii:°Y•• TONI GINDLESPERGER Notary Signature
B.r : .>: MY COMMISSION#FF 924951
4, a; EXPIRES:October6,2019 My Commission expires
%?o-F°°' Bonded Thru Notary Public Underwriters
04 TREE AND VEGETATION AFFIDAVIT 03.01.2018
,11-i- vi,,;. City of Atlantic Beach APPLICATION NUMBER
�S �` Building Department (To be assigned by the Building Department.)
v 800 Seminole Road f�v �/� 1.9
- 006, 5
s' Atlantic Beach, Florida 32233-5445 f—1 l
Phone(904)247-5826• Fax(904)247-5845
g% E-mail: building-dept@coab.us Date routed: 7/Z- /L 9
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: '770 PA RAD( c- 1-t•-) Department review required Yes No
6Qif n
Applicant: KG ((, C-f1.-L 1 Q, PI`an ng &Zoning `)
-) Tree dministrator
Project: � ,_ R 1. CV.. 11`� �Lt-�.1.' �1 fl- public Works-TM
� C�
/ ublic Utilities_.
Pty
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 \ce?-1
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLIC ON STATUS
Reviewing Department First Review: Approved. I (Denied. I 'Not applicable
(Circle one.) Comments:
BUILDING /
PLANNING &ZONING Reviewed by: ` c.-.� ate: e-/-/7
TREE ADMIN. Second Review: A roved as re ed.
❑ pp ['Denied. ❑Not 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
�;t1.iv�;. City of Atlantic BeachRECEIVE
APPLICATION NUMBER
t > Building Department be assigned by the Building Department.)
;-,' - 4. A N') 800 Seminole Road 25 VE (\�� 1 (� _ ��� C
,61r s Atlantic Beach, Florida 32233-5445 JULU t"l l "t J
Phone(904)247-5826• Fax(904)247-584
�i;l 9r E-mail: building-dept@coab.us gy._ ate routed: 7/z..._ --7t, 1
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 77O P .RAU Li.D Department review required Yes No
__Brfirdin
Applicant: , E(( (,L-- t C.__-, ,,,,Plan nin g &Zoning Th
11 Tree Administrator
Project: 13 R t eV. LAD f.�i. { IZ I�ublic Works_(�
ublic 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 J
St. Johns River Water Management District � 1
Army Corps of Engineers v
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: VApproved. I (Denied. Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed byfte Date:
TREE ADMIN. Second Review:
'Approved as revised. I 'Denied. I (Not 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
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CERTIFIED TO: UNPLATTED LANDS OF SECTION 18,
WILLIAM & AMY BULL TOWNSHIP 2 SOUTH, RANGE 29 EAST
JP MORGAN CHASE BANK
OLD REPUBLIC NATIONAL TITLE INSURANCE CO.
DEBORAH W. TAYLOR ATTORNEY AT LAW, P.A.
I HEREBY CERTIFY THAT THIS SURVEY. PERFORMED UNDER MY RESPONSIBLE DIRECTION MEETS THE
MINIMUM TECHNICAL STANDARDS FOR LAND SURVEYORS IN ACCORDANCE WTH CHAPTER 61G17-6, FLORIDA
0, ADMINISTRATIVE CODE (PURSUANT TO SECTION 472.027, FLORIDA STATUTES), AND FURTHER CERTIFY THAT