130 5th St Fence Submittal Building Permit Application Updated 10/9/78
_ City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904),2,,4,71-5826 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: I J� �''�((['�YCIC�t • /� 1�r Q ; Permit Number: �8pMnb
Legal Description i (o9 `0r2S"2 •i /�{� liry 'v 15 111 1 r tJ RE# 170104)— bt o
to 22-
Valuation of Work(Replacement Cost)$ 2 ,oL'.a, v ,Heated/Cooled SF Non-Heat is Itt . ,
• Class of Work: ❑New XAddition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Wind. ' DollN 2 9 2021
• Use of existing/proposed structure(s): ❑Commercial XResidential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes jNo BY'
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit), I No
Describe in detail the type of work to be performed:
veew -colce adeted 4D Mtetj
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name t('Q Address
City •(iJState Zip 3 3 Phone 994'. (cm .N0211-
E-Mail ) � Q�/�.(.Or(
Owner or Agent(gent, Power
lof Attorney or Agency Letter Required)
Contractor Information
/-,��.1��, L
Name of Company CL�.�7T�.I • kS Co 94140 )Wi Qualifying Agent jauti et pcchlao
Address Atli ! L. Vit 'e c.i,t G City fk*%k MI IV. State g Zip 3
Office Phone eitit. 2Q• ' � ' ' Job Site Contact Number 4 : ' • • 10.4:
State Certification/Registration# `. . ,A E-Mail r, ' �' GDaS4114 .' - N b .ebnl
Architect Name& Phone# c (ir) A1-1// (��! ��• - !'1 5 --`Gj5
Engineer's Name& Phone# L� P � �' clout-Ad.-CCI Cf(2)
Workers Compensation Insurer 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 LENDE • •R AN ATTORNEY BEFORE
RECO NG YOUR.N CE;OF COMMENCEMENT.
-.rrLr� //
(Signature of Owner or Agent ( • actor)
Signed and sworn to(or affir ed before me this vD day of Signed and sworn to or affirmed)before me this 743 day of
�,.r - by w� ► Q Z'
JUN.. , qv , by r I i piatim
•_'• Comnisslon ii HH 09•: • _ •i► A ." •.- • 1.t I. .44v• I . P.. I i%
• '' ' i n.Q re of Notary)
ExpKes June 13,2025 � ��•"g � 5igna�re of Notary)
11`'a,op* Bood.d Ttw Budget Notary Services
Xiao "'•"�t+ TIFFANY MAXyyELE
Personally Known OR ,Personally Known OR * ,�r * Conxnissbn#HH092893
[ I Produced Identification [ I Produced Identification '�� T:\oma Expros June 13 2025
Type of Identification: Type of Identification: "of F`o0 Bonded Tin(24,4907s
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Fence Addendum Updated 1/14/2021
_ City of Atlantic Beach Building Department
800 Seminole Road, Atlantic Beach, FL 32233 PERMIT#
Phone: (904) 247-5826 Email: Building-Dept@coab.us MS —0370
Job Address: Date:
( 2i
Property Type: Lot Type/ Features:
Residential ❑ One Street frontage (interior lot)
❑ Commercial More than one street frontage (corner lot, through lot,
etc.)
Swimming Pool
Fence Material: Fence Height (select all that apply):
1g Wood X.Four Foot(4ft)
❑ Chain Link Six Foot(6ft)
❑ Vinyl ❑ Other
%Block/Stone (Plan details required for footings and/or
retaining walls)
❑ Other
Fence Location:
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)
%No
Will tree(s) be removed in association with proposed project?
❑ Yes (must submit separate Tree Removal Permit)
)(No
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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