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354 AQUATIC DR RES24-0114 INTERIOR REMODEL 4.,-APP, BUILDING PERMIT APPLICATION FOR INTERNAL OFFICE USE ONLY !ff ),, Cityof Atlantic Beach Building Departmentp Z4 -6 �- ERMIT# RES L 1800 Seminole Road, Atlantic Beach, FL 32233 **ALL information required to process �0'i Phone: (904) 247-5826 Email: Building-Dept@coab.us Job Address 351/ gezi,,rn C b-g_. RE# 1 71 gl 8.-..s 1 in Legal Description '3 U --7/ 17 --vs y;47 C Ai k G(,i c glArdrii \S f-3 —tet Valuation of Work(Replacement Cost) /Q 600 Heated/Cooled SF /o 3— Non-Heated/Cooled SF •Class of Work: ❑ New El Addition Alteration ❑Repair ❑Move ❑Demo El Pool ❑Window/Door • Use of existing/proposed structure(s): ❑Commercial [residential • If existing structure, is a fire sprinkler system installed?:nYes❑No •Will tree(s) be removed in association with proposed project? ❑Yes (Must submit separate Tree Removal Permit) [-No Describe in detail the type of work to be performed: }WE01a'7EL [N; 2taZ ctIF Naroe, NEW C4r3/NF_'7"- )JUAC, 'ZEI7I/7E, Florida Product Approval# (For multiple products use Product Approval Information Sheet) Property Owner Information Name I�?✓E- i )4A2'7Y LL C Phone Address Spp 1Z©YAL ?RLb �2 City AT-LA NT,c_JEAG,J. State FL, Zip 3z233 Email Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information Name of Company }7 A^I Co,,,S t.)c77Phone 261�N3 6,yZ3 Address .9 Az 900 e•-ie7r "-B,._./D City JR Sc,NvILt_E State FL. Zip 32z// Qualifying Agent Liztc:DA9, Aoc-c_AND State Certification/Registration# CTS 125 770? Email ii p 0--PF_cAnr Caw Si goer.cam Job Site Contact Number 9Qtf,.9 gy,NI/ 9 Worker's Compensation Insurer OR Exempt 0 Expiration Date t/9/ c Architect's Name Email Phone Engineer's Name Email Phone 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 city/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 YOU PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE SITE OF THE IMPROVEMENT BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BE RE RECORDING YOUR NOTICE OF COMMENCEMENT. a 4/ILL A: 4/ature of Owner or Ag t) f (Signature of Contractor) ]�,., Signed( � and sworn to(or affirmed) be e me this • __ day of Si ned and sworn to(or affirmed)before m this I/0"r'1 dad ` ' i �' by riy.)it- �C , - 0;. by n�'^" ' /,` l 'W Signature of Notary ! & �C Signature of Notary /4' [ ] Personally Known I4. oduced Identification 1 Personally Known OR [ ] Produced Identification Type of Identification: ,`.r�•� fr� '� R � Type of Identification: . . . . - . _,,fie, pe.,rse944//,j ap r. ,. i y o n !MOTs • -.1 rotary=+.blit-State of Florida .J l / 1fir kia s • 7 Cornrr.ission;HH 188544 III • HM 238573 '> Exp.3/28/2026 My Comm.expires NovNy 30.2025 '.r. NOTICE OF COMMENCEMENT State of FL4O ..) i Pt Tax Folio No. County of ---Pt)vAL To Whom It May Concern: The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713 of the Florida Statutes,the following information is stated in this NOTICE OF COMMENC E T. �� L Legal Description of property being improved: 3 '—7J t7 —. 02 7 (4 (5 — 14.47`C. crO.Q $ (of 3-c Address of property being improved: 35V AQU$ITIC -.1-)R.� A 4_AN i,CEACt-/, FL. 3L.233 General description of improvements: V; 1.0 i-":,_ I/C/Ji. Owner: '--- 6�E f-brir 7Y LL C Address: 0-2)et) rka yAL?/44,1 'J►C, /7ZA,v i,c re, 4ce?. Owner's interest in site of the improvement: D1.,4)14E- _ Fee Simple Titleholder(if other than owner): Name: Contractor: r �Ec4$4 Co,vJ1R1.) 7oAl Address: qa,2,6 CFiEERY�J—3t_../ ? , J4c c5onrO R LE FC, 3ZZ)7 Telephone No.: 90V-994/—ii Fax No: Surety(if any) _ Address: Amount of Bond$ Telephone No: Fax No: Name and address of any person making a loan for the constructer- -``'Doc#2024115434,OR BK 21070 Page 1801, Name: Number Pages:1 Recorded 05/29/2024 01:01 PM, Address: JODY PHILLIPS CLERK CIRCUIT COURT DUVAL COUNTY Phone No: Fax RECORDING $10.00 Name of person within the Stat of Florida,other than himself,de , _ ...,..U1Ilel ILS may i‘ be served: Name�Av tD 1.L--6 Address: 1-2187 '--RigjN i 12—J )', i ftc4.Sot.,ti rc LE FL22 - 377 Telephone No: Fax No: In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section 713.06(2)(b), Florida Statues. (Fill in at Owner's option) Name: Address: Telephone No: Fax No: Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a different date is specified): THIS SPACE FOR RECORDER'S US ONLY OWNER i -7V: / ' i-4 Signed: Date: Y HENDRY , Before me this day of /�j �‘� in the Coynty of Duval,State 5...?..v'�Br �iic State or='.orida Of Florida,has personally appeared t`‘c__,, .t L ._`i---';- .. ...;„_,:-. :svotary Notary Public at Large,State of Florida,County of Duval. s' Commission;HH 18E5 , My Comm.Expires Nov 30, 2025 My commission expires: 1 1 _;:'.. __4~% Personally Known: !_ • or Produced Identification: 11 _ ( , ',I,C 1 i_.,( • • • • • 9?,..n o ..ti..�9. 'y.�: Y