Permit Plumbing 1021 Atlantic Blvd 953 Lil Caesars 2012 " CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
.: ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12-00001346 Date 10/04/12
Property Address . . . . . . 1021 ATLANTIC BLVD
Tenant nbr, name . . . . . . UNIT 953 LIL CAEARS
Application type description COMMERCIAL INTERIOR BUILD-OUT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 50000
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Application desc
build out
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Owner Contractor
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EQUITY ONE ATLANTIC VILLAGE, MAYES CONSTRUCTION LLC
16 NE MIAMI GARDENS DR 13930 MCGREGOR BLVD
ATTN: TREASURY DEPT FT MYERS FL 33919
MIAMI BEACH FL 33179 (239) 633-3722
--- Structure Information 000 000 COMMERCIAL BUILD OUT
Construction Type . . . . . TYPE 5-B
Occupancy Type . . . . . . BUSINESS
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Permit . . . . . . PLUMBING PERMIT
Additional desc LIL CEASARS
Sub Contractor AMERICAN PLUMBING & SEWER INC
Permit Fee . . . . 153 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 4/02/13
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Special Notes and Comments
need noc
2010 FLORIDA BUILDING CODE, FLORIDA FIRE PREVENTION CODE
2008 NATIONAL ELECTRIC CODE
*REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING
DEPARTMENT IMMEDIATELY.
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Other Fees . . . . . . . . . STATE PLBG DCA SURCHARGE 2 . 30
STATE PLBG DBPR SURCHARGE 2 . 30
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 153 . 00 153 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 60 4 . 60 . 00 . 00
Grand Total 157 . 60 157 . 60 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
Oct 04 12 10:44a Catherine Macafee 239 362-2316 p.2
� 2—
NEW OR REPLACEMENT INSTALLATION: Project Value
$ Z,9 - �-
Type of Fixture Qty
Bathtub
Clothes Washer
Dishwasher
Drinking Fountain
Floor Drain
Floor Sink _
Hose Bibs
Kitchen Sink
Laundry Tray
Lavatory
Other Fixtures
Type of Fixture Qty
Septic Tank&Pit /
Shower
Shower Pan
Slop Sink
Three Compartment Sink
Toilet f
Urinal
Vacuum Breakers
Water Connected Appliances
Water Heater
Water Treating System
RE-PIPE:
Type of Fixture Qty
Bathtub
Clothes Washer
Dishwasher
Drinking Fountain
Floor Drain
Floor Sink
Hose Bibs
Kitchen Sink
Laundry Tray
Lavatory _
Other Fixtures
MISCELLANEOUS:
Type of Fixture Qty
Septic Tank&Pit
Shower
Oct 04 12 10:44a Catherine Macafee 239 362-2316 p.1
Shower Pan
Slop Sink /
Three Compartment Sink
Toilet
Urinal
Vacuum Breakers
Water Connected Appliances
Water Heater
Water Treating System
* Sewer Replacement * Back Flow Preventer * Grease Interceptor(Trap) 3 l% 2rM/7
gallons(Requires 3 sets of plans) 3 CD S A-i i FY( .
* Lawn Sprinkler System-Number of Heads * Well **
** SIR WD Well Completion Form. Completed form to be submitted to the Building
Department fo final inspection."
/ - wxt'r {ter
01)* Other W A7K41-- � Z- 1) S - 01leA.)
Permit becomes void if work does not commence within a six month period or wod is suspended or abancLonea tor sox
months.I hereby certify that I have read this application and know the same to be true and correct. All provisions of
laws and ordinances governing this work will be complied with whether specified or not. The permit does not give
authority to violate the provisions of any other state or local law regulation construction or the performance of
constriction,
Property Owners Name �i/1� Phone
Number 1021 19)117fV)ic tojvc� 'S
Plumbin Company&&PIZA"o eli, /w Office Phone
2T? _Fax
Co. Address: lo. x; S City r
State FL Zip 3
License Holder(Print): c State
Certification/Registration# el-2:- IV Tn ,
Xotarized Signature of License Holder
Swom and subscribed before me this day of
20
Signature of Notary Public
Bonding Company Name and
Address
11q—
Mortgage Lender Name and Address
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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 laws regulating construction in this jurisdiction. This permit becomes null and void if work is not commenced
within six(6)months, or if construction or work is suspended or abandoned for a period of six(6)months at any time
after work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs,
Wells,Pools,Furnaces,Boilers,Heaters, Tanks and Air Conditioners,etc.
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.
I hereby certify that I have read and examined this application and know the same to be true and correct. All
provisions of laws and ordinances governing this ty e of work will be complied with whether specified herein or not.
The granting of a permit does not presume to giv uthority to violate or cancel the provisions of any other federal,
state, or local law regulating construct' n or th performance of construction.
l
Signature of Owner
to ,d ,,air P•,,,, C014NIE L.TODD
Print Name Notary Public-State of Fbrida
_. °My Comm.Expires Aug 28,2014
;
%'�
Sworn to and subscribed before me ", ;;Y:F'� Commission#F EE 12385 8ondW ThMUO National Notary Ann.
this, Day of U (-y t`'/c , 20 i
Notary Public
Signature of Contractor _
Print Name CONNIE L.TODD
' Notary Public-State of Flo t
• •�My Comm.Expires Aug 26,2014
Sworn to and subscribed pefore me '�, rg Commission s EE 12365
this ` Day of C�� cc's ,20 / Sonde#Through National Notary Asan.
Notary Public
Revised 01.26.10
�i Cates _ /O2- 1 ,B L V d
NOTICE OF COMMENCEMENT g
State ofL Tax Folio No.
County of 1r1. V C z 'p
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 improved:
C,0 d1gWA)7'
Address of property being improved: 19 3 Ajleui h.:C el✓C . AYlc.-,-,,T,L &,.� � .52-23-'?
General description of improvements: R C du d CIC-) o (IOLA A,q,rG j� c�L ;
Owner: nvx Address:
Owner's interest in sid of the improvement: . ( � ! (� FL �� "�
Fee Simple Titleholder(if other than owner):
Name:
Contractor:
Address: ���C� �' L`/ri'. ,t5Y �lh"X ' 'e U'�17 �'� ✓-L 1
' ?t Telephone No.:
., P Fax No:
Surety(if any)
Address: Amount of Bond S
Telephone No: Fax No:
Name and address of any person making a loan for the construction of the iml Doc#2012216952,OR BK 16093 Page 487,
Number Pages: 1
Name: Recorded 10/04/2012 at 01:06 PM,
JIM FULLER CLERK CIRCUIT COURT DUVAL
Address: COUNTY
RECORDING$10.00
Phone No: Fax No:
Name of person within the State of Florida, other than himself, designated by owner upon whom notices or other documents may be
served: Name:
Address:
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 USE ONLY OWNER
Signed: .,, Date: A2 - Z
Before me this _day of h in thg County of Duval,State
Of Florida,has personally appeared j",`���[ - f1• !);;0�,
wl� l
ERIC KRALL Notary Public at Large,State of FI id Co my of Duval.
Notary Public=state of Florida My commission expires: �My Comm. Expires Sep 9,2014 Personally Known: or
: Commission# EE 24892 Produced Identification: „_1Z1 / t+ �� ��� jf0