351 seminole rd demo21-0033 rte DEMO PERMIT PERMIT NUMBER
►, '' CITY OF ATLANTIC BEACH DEM021-0033
,v 800 SEMINOLE ROAD ISSUED: 10/8/2021 •
`.:v._) ATLANTIC BEACH, FL 32233 EXPIRES: 4/6/2022 I
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:
351 SEMINOLE RD DEMO INTERIOR ONLY INTERIOR DEMO $1500.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170434 0005 SALTAIR ACRES SEC 02
COMPANY: ADDRESS: CITY: STATE: ZIP:
Xtreme Renovations LLC 100 Glorieta Drive St. Augustine Fl 32095
OWNER: ADDRESS: CITY: STATE: ZIP:
CRIBLUX SOLUTIONS LLC 13364 BEACH BLVD UNIT 714 JACKSONVILLE FL 32224
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.
. LIST OF CONDITIONS
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 4S5-0000-322-1000 0 $100.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455 0000-208-0600 0 $2.00
TOTAL:$104.00
Issued Date: 10/8/2021 1 of 1
t'='''r) \ Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department **ALL INFORMATION
� 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Ent 9'' IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
.1V\.C)Z 1 -C3 3
Job Address: 3.91 S€►l''.vl e. izd Permit Number. .�I !,i -"✓,,) i c_
Legal Description r(7' 15 1 b - 15 - /. 6 6 RE'. 1 1 '09 39 —coo,.5'
•
Valuation of Work(Replacement Cost)$ Heated/Cooled SF ` V9 Z(tj Non-Heated/Cooled I (D t 6
Soo_/
• Class of Work: ❑New ❑Addition OAlteration l repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial aesidential /
• If an existing structure,is a fire sprinkler system installed?: [Wes qNo //
• Will tree(s)be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) Flo
Describe in detail the type of work to be performed: S M 4 II DPS d i
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name (,t.'LIL)l( �$(�1uN O1S I L Address `336'1 lgeKi) Old 0nit 7Iq �-�x' f
City V. Zip 3-L7Z Li Phone 909 e ciq JHI �ZZZr
State P'1�
E-Mail �Z. i d Lf ibl u y . LioM
Owner or Agent(If Agent, ower of Attorney or Agency Letter Required)
Contractor Information 1
Name of Company 4scnl f 1,460%141,0J' Qualifying Agent go ww J -rii0r+4 S
Address It(37 CG.i.avc vl -krz;( t-1.'4 (°4 City 7qy State FL Zip ,.j 2_Z16.
Office Phone 909 - 413 '-0 X73 Job Site Conta t N ember - Z3 - It 73
State Certification/Registration# , -I5 30L07 E-Mail ko Loot-0,44s fl C M Ail, (QM
Architect Name&Phone# ,
Engineer's Name&Phone# P
Workers Compensation Insurer Ell[M et OR Exempt s/Expiration Date Cj/l 7/ZO l 7
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 YOUR NOTICE OF COMMENCEMENT.
.�- S_., - /
(Signature of Owner or Agent) (Signature of Contractor)
Signed and sworn to(or affirmed)before me this Q f day of Signed and sworn to(or affirmed)before me this day of
0 c+' , 269,( ,by 'lp5k 00- , Lott by Uvoi ll i�►tt'+/aS
(Si:na ur- .f\. .• (Signature of Notary
Notary Public State of Florida �r� Notary Pudic State of Florida
Lawrence Gikrwn +► . Lawrerke UMW!
( ] rsonally Known OR •y • Aly Comm^tg 100925 [ ]Personally Known OR . My Commission HH 100925
Produced Identificatio alp - . O����S [•Produced Identification a�a/ Expires 03/04/2025
Type of Identification: Type of Identification: ••,/~... o ✓
ID
NOTICE OF COMMENCEMENT
State of F1.. Tax Folio No. 170 zi 3y -0005
County of Dv vC
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: 1 0 - 15 1 to —2_ S - Z (, E
,QE. --7._ cAA- Thzl- LOT 2 77
Address of property being improved: 3-G1 SeM;AC IC ►`U 44-1 u,44,c b'e4c.h
General description of improvements: Slv14I i D cti 0/ ?4,141-6 (A I'A e4/ F1 cD.,�,[,� 1)r x I/
Owner: Cx 1 [)0y 3-01ut,'04S 11 L. Address: Ilft 1336q Bt'€ich Sivi04" 7i j J0.Y
Owner's interest in site of the improvement: i.k1 r S FL ✓ 3 zt-ZY
Fee Simple Titleholder(if other than owner):
Name: Vl
Contractor: x�,tcnC vtntld�I1,0.1S 114, bfoil o�,,;s /f _
Address: , (97 GtrtV sp' kr-c,;( Uhi� ) Ott ,fax /f Lc.-4(
Telephone
z t
Telephone No.: q{01 -9 72 .3672 Fax No:
Surety(if any) Nki
Address: Amount of Bond$
Telephone No: Fax No:
Name and address of any person aking a loan for the construction of the improvements
Name: ✓P
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: Ali A
Address:
Telephone No: Fax No:
In addition to himself, owner designates the following person to rarai„o , - - Pa a egg tion
713.06(2)(b), Florida Statues. (Fill in at Owner's option) Doc#2021264271,OR BK 19948 9
Number Pages:1
Name: /J f Recorded 10/08/2021 11.06 AM, —
Address: PHILLIPS CLERK CIRCUIT COURT DUVAL
COUNTY -
Telephone No: Fa) RECORDINGJODY $10.00
Expiration date of Notice of Commencement(the expiration date _ ,_, ,,... ii UIII we aate of recording unless a different date is
specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER
Signed:ori, Date: Oct. OB. 2-01 I
Before me this day of in the County of Duval,State
Notes?ubNc Sfax of Florida Of Florida,has personally appeared 7EID 14 HO
Lawrence Gilmore Notary Public at Large,State of Florida,County of Duval.
• • My COnl nasion HH 100925 My commission expires: Marco _Ir 2 07
•
E> 03/04/025 Personally Known: _� _or
Produced Identification: yp