370 GARDEN LN RERF21-0236 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
IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Ccl_rden
Job Address: 3 /c) tikn1). L ,• /3 & Permit Number: E(�F G( `U Z JJ(
Legal Description 27- 0.12V-4.5 0?) - Se_/vu"RI"'A 64vcv, t/1,.1? /6)A-4 RE# 2Ws'-
C
Valuation of Work(Replacement Cost)$ [7Uo 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? IfYesjmust submit separate Tree Removal Permit) ❑No
Describe in detail the type of work to be performed:
I'ZCIZ(3bF
?( Florida Product Approval# 2 ti A0 t#' /pj.us- 'A'. ,no /5-?/4 for multiple products use product approval form
Property Owner Information
Name Frt[WC s M (,ftnNO' Address 3 20 &14:02y
n _
City +1ct/) 1 ,L ?Lc: State t L Zip 3.2.23 3 Phone 90 y- ;;j iJ/- 7574'
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company c(,.,IJ(3&L( IAutrES (1N4) (lob(s.JG Qualifying Agent 1 4OMAS r3 S,'fl p
Address H Si) - IU(, S R I'S A/ 4cA City SA!,Wr( Jvi>,,,� State r( Zip 3 s y
Office Phone Job Site Contact Number
State Certification/Registration# C c c ( 3'11 SJ1 E-Mail SLN f3 IL1 .ANONo/,l=S Aoma.
Architect Name&Phone#
Engineer's Name&Phone ft
Workers Compensation Insurer OR Exempt<Expiration Date ' 3/Z5
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 AO YOUR NO1TICE OF COMMENCEMENT.
(Signature of Owner or Agent (Sign ure of Contractor)
Signed and sworn to(or affirmed)before me this 1.1" day of Si ned nd swo n (or affirme.) a •.'re m!this0[i •.y of
SCP; , '(ozl , by rn/wc4s NGnA,vay i
(Signature of No a (Signature of Notary)
THOMAS B.SMITH
/ it KATHERINE KARR-GARCIA
•''�.,,, .': MY COMMISSION#HH 029415 [/]
Personally Kno �+�3R,-i *c Personally Known OR
r..r�-..:o, EXPIRES:August 22,2024 M47-
� Commission�GG 160854
[ ]Produced(dent o` ,P: ThfuNp [ ] Produced IdentificationExpires October 3,2022
Bon� T e of Identification:Type of Identificati r YP 40,0agond•dPint Budge wr.ryswlw
NOTICE OF COMMENCEMENT
State of F l c,Ctt OA Tax Folio No. I 1 2 0 1.V 5'o 15'
County of LvA L
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: '3.) - 084 09 -1S - 2qC SELVA
1Art1IA GAROCA/ Pr LoIS °I , 10 r(Cf) okt (3 14,4 - 11-15-
Address
`il4 - I115-Address of property being improved: 3-)V GAR DIA/ LN /a-rtAN-rtC 13L/CL FL 3 2233
General description of improvements: (L ft 00(
Owner: Efl/.NCtS I-1 GR/alloy Address: 310 GPMW W /aT(AA/1:c a(h (L
Owner's interest in site of the improvement:
Fee Simple Titleholder(if other than owner):
Name:
Contractor: S(.-n) f3Ct-f loin tS f"l) Rbpr,.,,/C L.LC
Address: Li 50- I v(, 311.. 13 n/ 41,9 5/)w4 fp NNS (( 3 2 LO
Telephone No.: ' Oy- 3 i1- 0311O Fax No:
Surety(if any)
Address: Amount of Bond$
Telephone 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,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
Doc#2021259219,OR BK 19940 Page 1850, ted: 4(.."-',/ )ji Date: / A
Number Pages:1 are me this '11 L day of S�P'1 tot, in - . . • ' val,State
Recorded 10/04/2021 11:48 AM, 9orida,has personally a -- as— S7}�'��
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL P Y PP �, ,
ary Public at Large,State o' I •o,:*ntyAf,J)�gai1•�HH� 15
COUNTY ., MT yu^""
RECORDING $10.00 ' sion x fires: I`•:
J\•
tonally Known: trii ;�� I or
F' cation: