522 AQUATIC DR RES25-0131 Resz5- ai31
,i.:;:.--..,--,...,,, Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department **ALL INFORMATION
;� 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
`u' 9 IS REQUIRED.
Phone: (904) 247-5826 Email:�Building-Dept@coab.us
Job Address: 52Z Ftq &-/ pr /f J1' 4tk 3-- Permit Number:7 7/9/ff " 57 7Y.
Legal Description 3 74 V e<-7 t ' L� -f-- /O RE#
Valuation of Work(Replacement Cost)$ 95-00 Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition 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) ❑No
Describe in detail the type of work to be performed: 5-.‘e),L O✓Gr� S''',�f/ 24. `ov /-
7
Florida Product Approval# /3/ 9Z, 2 for multiple products use product approval form
Pro•ert Owner Information & dress
�—qName 4✓ S5 /'/r 7"r`e' .i !tee- /44€6 J /),"
City L T ` /t . State pi Zip 727 ?3 Phone 9ov. G/.? . Veit 3
E-Mail Gawk OZZO tap' C.SA,oe/—
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information e e
Name of Company �/+E ei- 5.4l l'ff 4c me /tualifying Agent �/r�O-'- cK-c-S.
Address 2«/r G' SS iet 5-,'.L �-./. City / • State% Zip 32Z Z�/
Office Phone ?ell, L/ . .?g 3S-- Job Site Contact Number /
State Certification/Registration# /t SS - 2'7 E-Mail S fK" 5. i/Cs'`� Q no'( ..6e,
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer SC..i't �, 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 I OTICE a F •MMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEM . TS TO YO '
' ROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR NDER ORA A OR Y BEFORE
RECORDING YOUR NOTA COMMENCEME T.
A1� (Signature of Owner or Agent) Signature of Contractor)
Signed and sworn to(or affirmed)before me this 1'5day of Sig�ed and sworn to(or affir ed))bbefore me this I day of
4 �F► , og s ,by El..za. 4 t, r1� c.a.�t£- , V �) ./ eO2, ,bY v`�(F``� Ili` SCS
��r i 1 l ,
//��� f p/ (�ignatare of Notary)
c�o►�� G �; '.;:; ., ELIZABETH MCCARTHY
' ,a, ;": Notary Public,State of Florida ��� �,�..�....:..
,)Personally Knowr:5:•..-.. : Commission No.HH 611665
-[-]'Personally Known" R_::i.'.:�
[.Produced Identifi:atr�'@f^,s' My COMM.Exp.11/12/2028 [ ]Produced Identifi titin
.. TONI GINDLESPERGER
Type of Identification: I-L 0r. L- �cp -c Type of Identificatio gip`, ?_ MY COMMISSION#HH 407122
•,-e•• •o, CXPIRCS:October 6,2027
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No. ,A
State of to t itd et County of 11.•x..1A. I
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
COMMENCEMENT.
Legal description of property being i proved: 3 t 7/ 7-25 - Z1�
i'a lie tom--w/en-s Lo- /e -4
Address of property being improved: 57 G Lta I ' 4.1 • /` v«ei L -'2_2_,3
General description of improvements: 'S.tort ►ANl 0✓fe"_ c'ellt,'-
Owner �xcs v-,G// fes. /ems op— i"€ 4 &e d
Address V �L . 1r` Zr . /. 4
Owners interest in site of the improvem t 3 z z 33
Fee Simple Titleholder(if other than owner) _
Name
Address i•-�
Contractor S S
cir .tiers Ct-41.1i1 r-t`ir✓ vt.G
Address 2700 Petra/A- F.h..4- zi,r . 14% . PL 7Zz2,5--
Phone No. Fax No.
Surety(if any)
Address Amount of bond$
Phone No. Fax No. -
Name and address of any person making a loan for the construction of the improvements.
Name
Address
Phone No. Fax No.
Name of person within the State of Florida,other than himself or herself,designated by owner upon whom
notices or other documents may be served:
Name
Address
Phone No. Fax No.
In addition to himself or herself,owner designates the following person to receive a copy of the Lienor's Notice as
provided in Section 713.06(2)(b),Florida Statutes.(Fill in at Owner's option).
Name
Address
Phone 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 USE ONLY j OWNER —
•
Signed _ 1Y O DATE`i' I s15f.-- I
Before me this /S,day of Apa.,J ,Lc�s _in the C'I
Doc#2025102928.OR BK 21453 Page 860, CoJnty of Duval.i Air uState of Fi ri a.has soliallly apps r
Number Pages:1 himself herself and affirms thatall statements and dela herein
herein by �'L,_,yt/^)C
Recorded 05/01/2025 11:45 AM, are tire ana accuiar r
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL o;,,,,,,' ELIZABETH MCCARTHY
COUNTY ii!. ; Notary Public,State of Florida
RECORDING $10.00
: .-%�, '': Commission No.HH 611665
Not4yr-Rj Aft'i i wil tke m'-L`P.11/12/ y o' Ax.✓a *4
My commission expires ni /‘217...02t�
Personally Known 7C or
Produced Identificahgn_-2C Ft.--ArL s r_. ts!-,-"c r--_- - --__--