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1021 Atlantic Blvd 953-975 DEMO19-0031 Unit 12 Int rt.A.,: ). DEMO PERMIT PERMIT NUMBER '-'" N ;\ DEMO19-0031 ��. - .. v� CITY OF ATLANTIC BEACH ISSUED: 12/19/2019 800 SEMINOLE ROAD ;`,c iir. - ATLANTIC BEACH. FL 32233 EXPIRES: 6/16/2020 MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION. ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES . ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY. 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. JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK: 1021 ATLANTIC BLVD 953- 975 DEMO INTERIOR ONLY UNIT 12 - INTERIOR DEMO $50000.00 TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION: CONSTRUCTION: NUMBER: GROUP: 177602 0040 SECTION LAND COMPANY: ADDRESS: CITY: STATE: ZIP: DUCKWORTH CONSTRUCTION 5726 STUART AVENUE JACKSONVILLE FL 32254 OWNER: ADDRESS: CITY: STATE: ZIP: EQUITY ONE ATLANTIC NORTH MIAMI 1600 NE MIAMI GARDENS DR FL 33179 VILLAGE INC BEACH WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. Roll off container company must be on City approved list . Container cannot be placed on City right-of-way. DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT DEMOLITION 455-0000-322-1000 0 $100.00 STATE DBPR SURCHARGE 455-0000-208 0700 0 $2.00 STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00 TOTAL: $104.00 Issued Date: 12/19/2019 1 of 2 LTN,\,,H _'i , DEMO PERMIT PERMIT NUMBER I rs s DEMO19-0031 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ISSUED: 12/19/2019�°';1� ATLANTIC BEACH. FL 32233 EXPIRES: 6/16/2020 Issued Date: 12/19/2019 2 of 2 ,sr' Building Permit Application Updated 10/9/18 u City of Atlantic Beach Building Department **ALL INFORMATION 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY ''<:.!.<01o___2. IS REQUIRED. Phone: (904) 247-5826 Email: Building-Dept@coab.us tUzI, , i Job Address: 997 Atlantic Blvd, Unit 12,Atlantic Beach. Florida 32233 Permit Number: ��v\©l ` -oU� l Legal Description 38-2S-29E 14.040 CASTRO Y FERRER GRANT PT RECD O/R 8130-2297 RE# 177602-0040 Valuation of Work(Replacement Cost)$ ' -$d't"-- Heated/Cooled SF�� Non-Heated/Cooled • Class of Work: ❑New ❑Addition ❑Alteratios�epair ❑MoveDem o ❑Pool ❑Window/Door • Use of existing/proposed structure(s): E Commercial ❑Residential • If an existing structure,is a fire sprinkler system installed?: ❑Yes FfNo • Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) C7iNo Describe in detail the type of work to be performed: Florida Product Approval # for multiple products use product approval form Property Owner Information 1 �-I'/ Name a k.a�.t 0 f� J Address 1512- L 4- ,i k ' ', City ik-{ctt.t, .R,0L State (-1_, Zip Phone C.O9 50F 01."2-V E-Mail I"C1„'_ ��,1„(m,,i--kteo.xg.l-,co(trt;GA . arhok. Owner or Agent (If Agent, Power of Attorney or Agency Letter Required) Contractor Information Name of Company Coleman Lay Group Inc,DBA wa�onn Construction Company Qualifying Agent Coleman Lay Address 844 Whitlock Avenue.Suite 200 City Jacksonville State Florida Zip 32211 Office Phone 904-783-8384 Job Site Contact Number State Certification/Registration# CBC1262908 E-Mail ColemanlayOdcc.to Architect Name&Phone# Engineer's Name& Phone# Workers Compensation Insurer Southern Owners Insurance Company OR Exempt IDExpiration Date 7/1/20 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 RECORDIN etyrOTICE OF COMMENCEMENT. ,�1 (Signature of Owner or Agent) I '"ignatur: . . tractor) g and sworn to f r -d before •- this l 9da of signed and sworn to(or affirme.)before me this day of r z�( b ' 1G7'. 0-0.:0 1-� Lt4S�t�Lt 7 n ,by I VI L A _.SI\ . ootary) ^� rNSi! .,ary) TONIGINDLESPERGER TIIEi1tn JMY COMMISSION#GG 353178 REANNA HANDLEY i P AP I � [ elly Known OR( 1 Produced Identification Notary Public,State of Florida ires 1/28/22EMy Comm. x Type of Identification:: t SS ,,,,-4 Type of Identification: P Commission No.GG 179736 Property Ownership Affidavit Date: December 19, 2019 To Whom It May Concern: I, George Whetstone here by certify that I am the Owner of the property located at 997 Atlantic Boulevard, Atlantic Beach, Florida 32233 (Physical Address) Parcel# 177602-0040 and that Bloom Behavioral Solutions will be (Name of Lessee) leasing space at this location. I hereby give my consent to the commencement of construction work to be performed in the above mentioned location built in accordance with Orange Park, FL. 4.31 ZA111-- — Geor etstone, Chief Engineer, Regency Centers, As Agent for Owner STATE OF FLORIDA Duval County The foregoing affidavit was sworn and subscribed before me this 7 day of (month), a\�/9 (year) by ( &� 's pe sonally known to me or has produced 1A— as identification. lAjf (Notary Signature) ip pt, WENDI HILL * ^,< Commission#GG 240468 gin".'c= Erb:re<.November 20,2022 eoF Ft p Bonded Lru Budget Notary Bole