1660 Sea Oats Dr Outdoor Shower Enclosure Submittal vri. Building Permit Application Updated 10/9/18
1 City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
<ott1 IS REQUIRED.
Phone: N, 66 }"C.5 ^
(904)8247-5826
Email: Building-Dept@coab.us
Job Address: Mal) CSL_ Ti-R.__ Permit Number:
Legal Description 3`1-5I -06) -25-2'i. 1.-VA 03 CIA/4 U INI IT b Liza &C,('I RE# (7Z62v o z z b
Valuation of Work(Replacement Cost)$ 10 j6 Heated/Cooled SF Non-Heat C E■FE
• Class of Work: j Jew ❑Addition DAlteration ❑Repair ❑Move ❑Demo ❑Pool ❑Windo oordUL 1 9 2021
• Use of existing/proposed structure(s): ❑Commercial laResidential
• 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) io
Describe in detail the type of work to be performed: ( ,v 5-i-- A L t— Oszl-"POO -{ c9 )I -6,,,)GwJ,0_6"
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name'-8<<-'- lE/c`/{ G-(24tF Address l bb() SC-' Gv I S
State ( L- Zip 32 3 Frr �7 0C1�5
City l4TL�4�n"tG �G�°�� � 3� Phone
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company C f S7 arAtc .�`'--f Qualifying Agent B .. .%7Z1 V Z G ( `;7-
Address /ZZ./(,4 A PASS i4fr1 , ' City/9-7-z OC • State Fc Zip ZZZj
3 .
Office Phone (r/7•74 '7O, ' ' 77-� >' Job Site Contact Number _ //
State Certification/Registration# E-Mail C 7-d C t'C"./C l1,11�1 L - cid"-,
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt Expiration Date 7 2y j
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 BEFORE
RECOR N YOU NOT E OF COMMENCEMENT. 2...2„.4.,,i_z.„7, -___
(Signature ofi
rer or Agent) (Signature of Contractor)
L' &14 M . G'12A rE Yen Solna r-Cen 5 in-Q
Signed and sworn to(or affirmed) before me this / / day of Signed and sworn to(or affirmed)be ore me this /G11 day of
, J0&/ 7Suij , x-0)1 , /
(Signature of Notary)
e �'".y Notary Public State of Florida �►+v•+ Nota Public State of Florida
. /1 Jessica A Dolquist t Notary. Jessica A Dolquist
[Personally Known OR i .. .:,:!1... ; My Commission HH 142217 ]Personally Known OR AAy Commission HH 142217
• 00 d Expires 08M4/2025 Produced Identification ‘4+r-;,;:,/ Expires 09/14/2025
[ ]Produced Identification �( ] �
Type of Identification: v�e'�ti+� ^ pe of Identification:
FIELD WORK DATE:6/9/2020 REVISION DATES: IREV..0 6nDi2o20
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prop9tiabas•,,medeQiPrrder m%S D'on,and lo the best of my knoltledge
and bel�3'Sis a 000 add uco.geSt}epreseNalon ola survey that meets the S0 0 ty 30
Standard;ds tiLOaI c@IFif to Dy the Florida Board of Professional Surveyors 8 it.
Mappers in Cl aplP/YJ ff of the Florida Administrative Code. ..w...
SED ON THE DATE SIGNED:6/10/2020 LAST DATE OFRECO WORK:609/20 GRAPHIC SCALE (In Feet) 1t
3,SELVA 1 inch = 301t MD
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Use of this survey other than Intended,without written verih'tndon,will be of the users'sole risk and without liability to the surveyor.
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r ''''`i Fence Addendum Updated 1/14/2021
ii City of Atlantic Beach Building Department
\f- 800 Seminole Road, Atlantic Beach, FL 32233 PERMIT#
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: Date:
IL lit ecA jY3 iS ?//4/z
Property Type: Lot Type/ Features:
Residential C"One Street frontage (interior lot)
❑ Commercial 0 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 0 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.