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298 PINE ST RES20-0203 NEW CONTRACTOR Building Permit Application Updated 10/9/18 City of Atlantic Beach Building Department **ALL INFORMATION ,, 800 Seminole Road, Atlantic Beach, FL 32233 I Oil 2) l HIGHLIGHTED IN GRAY IS REQUIRED. Phone: (904) 247-5826 Email: Building-Dept@coab.us Job Address: 2 !f �r (i 5 Permit Number: , \G 2.0 - 02-03 Legal Descriptions � ��� y �_5� 6E# /705W--40 o o p Valuation of Work(Replacement Cost) $ /6ioev Heated/Cooled SF /o/c Non-Heated/Cooled • Class of Work: ❑New ❑Addition DAlteration Nepair ❑Move ❑Demo ❑Pool DWindow/Door • Use of existing/proposed structure(s): DCommercial KResidential • If an existing structure, is a fire sprinkler system installed?: DYes ,No • Will tree(s) be removed in association with proposed project? DYes(must submit separate Tree Removal Permit) XNo Describe in detail the typeAerROYQ of work to be performed: Q �� •.r. � � {� C_ L'-/C//'y / t/ 1 elkc'ii ' i 7— Florida Product Approval#FL,. /3/92, / Ackl.'ZQda for multiple products use product approval form Property Owner Information Name /5e/fen gg h ��il Address Zq0 , - City /anTL, G ��{�, , State i - zip 32213 Phone 7FL, - j2_ X103 E-Mail K# -� -Ct )4)0Y151t1- �� et,a1 Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information Name of Chnpany L I/X06 Qualifying Agent /71407'y Address r o,i e,x 57/3 CityD—cax gG State GL Zip 322 yp Office Phone Job Site Contact Number —• / — p State Certification/Registration#tJ-/Z 5y5-2(=. F-Mail /7f/J/t/}'7-- je//fp4,47-A- Architect Name&Phone# Engineer's Name&Phone# Workers Compensation Insurer OR ExemptExpiration Date /741149 2,7 Application is hereby made to obtain a permit to do the work and installations as indicat d. 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 A 0.1 ' NEY BEFORE RECORDING OUR NOTICE OF COMMENCEMENT. '�1---� (Signature of Owner or Agent) (Signature of Contractor) Signed and sworn to(or affirmed}before me this 24 day of Signed and sworn to(or affirm )before me this i —day of Seple-�- , 1o)I , by /ta,e., �e res�-e:r QCf10 1 , -o ( , by 1l M o _ i .ti (Signat redpfarCOLE RENTERIA JANMAURICIO WALKER ROBERTSON ? Commission#GG 152020 g ` MY COMMISSION$HH 009325 Expires February 4,2022 u O Bonded Thru T F n� EXPIRES:June 11,2024 „, Troy air Insurance 800-3 [ ] Personally Known OR :,.....op, [ ]Personally Known OR �" ,%.°F F`;,•' Bonded Thru Notary Public Underwriters LA Produced Identificatio21 '' Produced Identification p Type of Identification: ►'Jr., - Z¢�,1� Type of Identification: ft..Pt_ M�(to 3— o I) NOTICE OF COMMENCEMENT State of Tax Folio No. County of To Whom It May Concern: The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713 of the Florida Statutes,the following information is stated in t is NOTICE OF COMMENCEMENT. / Legal Description of property being improved: �� �� ce _ 3 Le7T / 7/ • Address of property being improved: ,Q _ General description of improvementslerne� D ea �� APP14/, _79 Owner: 114ce,i ���'�j,l�'Z/y Address: 2- , %// ..' r ; / //1 flZ Owner's interest in site of the improvement: Fee Simple Titleholder(if other than owner): m o o`m c o ocog30 Oz< � cr Name: -i-13 co 2 n Contractor:1Z, V TnCi 0 F o F �eAl Address: © ��a o N N Telephone No.:9O �� Fax No: X N Surety(if any) -0 - c- coo V Address: Amount of Bond$ -71 C) Telephone No: Fax No: 0CD -� cn Name and address of any person making a loan for the construction of the improvements o 0 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 �j l�,[/ Signed: � /ii Date: Cl�Tl2-40�1 ''. JANMAURICIO WALKER ROBERTSON Before me this 2£4. day of r , bew- in the County of Duval,State MY COMMISSION#HH 009325 Of Florida,has personally appeared ka,p., • EXPIRES:June 11,2024 Notary Public at Large,State of Florida,County of Duval. rFQFF°P Bonded ThruNotary Public Undenwiters My commission expires: Ji-,e_ 1( L U�C/- """1"••••"".- Personally Known: or Produced Identification: