1865 Hickory Ln Deck, Fence Submittal Building Permit Application Updated 10/9/18
(11L,
City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
"cr�sil9' IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: t. 1.4:„.\44) 2 \ L•ti Permit Number:
Legal Description 37 29 (Y-1-1S-2 L 5'C Lt/41114i 4414 LIN I Tr(Z-C E.EPLA RE# II7zd't C) Re;C..
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Valuation of Work(Replacement Cost)$ Z./eiav Heated/Cooled SF Non-Heated/Cooled ���+
• Class of Work: New ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑WifOC �'I'!''"'
• Use of existing/proposed structure(s): OCommercial glResidential SEP 17 2021
• If an existing structure, is a fire sprinkler system installed?: ❑Yes g Jo
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate TreS frr"
Describe in detail the type of work to be performed: 2,tirate I SLC- ltz. PCC, 4- Pe"'- /" 2`r.‘"J`r`
'Cpt11ct 1,/04..0 '1? ELS taper K. t ar-F6.?-0
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name G✓A L7`r= d ^''," L L Address (Vi jtt-
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City411d,t/ s`r� � -�1G,(-F' State FL-- Zip_3L Z j 3 Phone �
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E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information _
Name of Company 0.4991r V-C.)69 i Qualif ing Agent J�41 ✓ .0�,4Z-a✓1
Address S' , W J 64rrQc-.SS PZ 4" City� BC-14State FL Zip _VZ
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Office Phone 9e72/4
Job Site Contact Number
State Certification/Registration# E-Mail Ord C ��.✓ �� ,����i- �� '� 1
Architect Name& Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt/Expiration Date •7/"/Z--5
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.
(Signature of Owner or Agent) Signate of Contractor)
IN' AWL_ �-- _ ����u .��veyl 5 urr 55 rne
Signed and sworn to(or affirmed)before m: this ?-day of Signed and sworn to(or affirmed)before me this /.day of
944-ev-kr ,,by , 94 , by
ign'p.ture of Nott dFbdda �, a ofNataFyy
• • ISI;t0'11-:Jess,..orr 22217 ••;461 State of Florida 06/14,:-....M,,. :..
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D4 Personally Known OR ,+y„�, . s` Personall Known OR
^�� rss 414/2025
[ ]Produced Identification [ ]Produced Identification •
Type of Identification: Type of Identification:
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MAP SHOWING BOUNDARY SURVEY OF
LOT 15. SEL VA MARINA UNIT NO. 12—C REPLAT, AS RECORDED IN I
PLAT BOOK 37, PAGE 29, OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY. FLORIDA.
CERTIFIED TO:
WALTER W. CAMPBELL AND LEA ANNE CAMPBELL
TICOR TITLE INSURANCE COMPANY
JAX NAVY FEDERAL CREDIT UNION
BUSCHM AN. AHERN, PERSONS AND BANKSTON
LOT 10
S 00'24'53- E 8G.00• (PLAT)
F ouND 1/r IRON PPE S 00'O8'O3" E 86.34' (MEASURED) Fanto 2-IRON PIPE
ST ANPED -LB 6645' 0 NO IDENTIFICATION
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N OO'11'07- W 86.04' (MEASURED) STARRED 'PIS .i.._
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(60_El RIGHT OF WAY)
C RTIFIED TO HF A TRUE AND
LEGEND:
COR'• - • .1 CORrGt
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R -- RADIUS --Y--Y..= FENCE
L - LENGTH \D 4. CONCRETE — J
NOTES: • RE/1SIONS
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I. Et: ,CS ARE BAD ON THE PLAT HEARING OF N 85.3.5'07• E ALONG THE I
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NOR:.:GRLY BOUNDARY LINE OF SJOJECT PARCEL DATE DESCRIPTION
2. DY L.r.PHIC PLOTTING ONLY THE CAPTIONED LANDS S LIC WITHIN FLOOD ZONE X AS D.-+OWN ON THE
NA11`.'IAL FLOOD INSURANCE NAP DATED APRIL 17- 1080. C01.47AUNI TY NUI, ER 120075. PANEL Df1QT_1L
3 THIS :.URVEY REFLECTS r.t.L EASEMENTS & RIGHTS OF WAY AS PER RECORDED PLAT S./OR TITLE C01-11.9WENT
IF SL;'PUEO. UNLESS OTHERWISE STATED. NO OTHER TITLE vERIFICATION HAS BEEN PERFORMED BY THE UNDERSIGNED-
._ TrIO. ::U74V Y NO VALID 1P1T1.1OVT THE EuBOS`x'T SEAL OF THE CER TFYINC SURVEYOR.
JOF j{ 10655 [LATE OF FIELD SURVEY: 02-28-00 I DISK 1/ ' CD-3 I SCALE: 1" = 20'
l. V.''''a.� �t CERTIFICATE
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1y II�II�% r r 1, 'o cksonvill c. Ftori-o 32204 BOARDANO REFIT: IRE E PROF koNIINM.SURVE GRI TANANDDARDPfRS IN FOR
TER D6,CT17E-G`LU+IDA
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tikFence 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
Job Address: Date:
L
Property Type: Lot Type/ Features:
Residential 12rOne Street frontage (interior lot)
❑ Commercial ❑ More than one street frontage(corner lot,through lot,
etc.)
0 Swimming Pool
Fence Material: Fence Height (select all that apply):
'Wood 0 Four Foot(4ft)
❑ Chain Link jiSix Foot (6ft)
O Vinyl ❑ Other
O 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)
FrNo
Will tree(s) be removed in association with proposed project?
❑ Yes (must submit separate Tree Removal Permit)
.Z?"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.