705 ATLANTIC BLVD UNIT 20 COMM21-0055 Building Permit Application Updated 10/9/18
11 .:,.. 'i City of Atlantic Beach Building Department **ALL INFORMATION
" 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTEDINGRAY
°t►f IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us y�
Job Address: 7O ATre44-1i IL.--L,1 (Ai r7" Permit Number: 0,3A4syN 2 ''— DOSS
Legal Description r-: 20-2.$-Z .GS• • 4.4Lo -)'s 1 -. RE# 4x10(PSS`- (:)(566SWtI1. lrCtote])ty 14 ;cit, o2D ,i-t.s-girls
Valuation of Work(Replacement Cost)$7r vrvV Heated/Cooled SF(cU Non-Heated/Cooled
• Class of Work: ❑New ❑Addition i iteration ❑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 Io
• Will tree(s)be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) o
Describe in detail the type of work to be performed: (t tP-t'z-, Ivy 0 y-T-R c,-1/. .. FP),S t 0e' yp;r ;4 ij,tL13-6‘1110
UVJ r" j2 t r - CT7 / 4t $6,2-V/ J 7-14-1i' 4€2-
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name LY firth , Se 4,4\ LLC Address 2,360 Pnargh, - 2ci J S\.tii{, 3b1
City 4A-t.kt.a... geZtekk, State PL.. Zip 322le Phone G'IOU-2S3-WV
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company t9P1)aint-' Qualifying Agent MIUM-CL PtvfP2
Address I1135 67--A•(7/5 (^zMO City,)AG/k7004r,µ4„ State -f.-4.-- Zip S'7- `f
Office Phone 904-f3v7.4;744I Job Site Contact Number '(off ,3t..,=,-'<4/14( -
State Certification/Registration# Crc-04 '4J7/ E-Mail MIC4M-t_t4u ni rl e I .G GI 6•Mik-/` r Cpm)
Architect Name& Phone# J1/`�.
Engineer's Name&Phone# 1(174
Workers Compensation Insurer ' vtJ,) * 1517-o144 OR Exempt❑ Expiration Date 12'3+,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 TWI • • IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINAi .•'i-, '1:1141111141"- WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING •UR ilt : *►MMENCEMENT.
( ----- (Signature o"li-r• :-nt) (Signature of Contractor)
4-ned and sworn to(or affirmed)before me this day of Sign d and sworn to(or affirmed) before me this 1 day of
AV
.4 / Mgr
1/4tV. ' n •' ,L ilia Wetzel -
f =_COMMISSION G(�233593 ..��, .'%tlrfl'4 ,, Wetzel
-" �`- I 2022 + COMMISSION GGA
----
[-I-Personally Known OR �� ♦-,',4: EXPIRES: July ), [ ]Personally Known OR
[ ]Produced Identification ' ti„�,,s�� EXPIRES: July 1, 2022
Bonded Thru Aaron Ids [ oduced Identification Ai-"4"-'s. •`��o ��� Notary
Type of Identification: Type of Identification: M ''t S
NOTICE OF COMMENCEMENT
State of (LAVE_(PA- Tax Folio No.
County of "-Otis;
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: 10-4 20-2S-24E .lot, Sczl -o sa.I,Lo4s 144,-1+45,'14L,`14,1 1141 -Iifilogo)
S w Vt. S-c C,Lo b By WR. eak , OQ-t toy-rt.- t 3 074
Address of property being improved: '7/5" A L71 (3yvn 'T 7-0 ,471 1L T3 LM r-L '?Z 3
r
General description of improvements: /.J7 !OR F---/IL/511Up'b-lT e / A ' � vp�z I
uiL- ?W4'
( '
//c-j�'Z 4 2 ✓IGcr 71,1-G✓ 4J4 —
Owner: 5 f jVl61 , SCs� LLC Address: Z3cb ANAishoi, 94 S 1 N �L
Owner's interest in site of the improvement: A 2 4.
Fee Simple Titleholder(if other than owner):
Name: ` /
Contractor: 414.1144.c... M
. (/,'L . LLam,.,,••
Address: ZS j4094-14kP(1'r QZc� )Q t'rZ4L 136RC,•4//t ??---c,
Telephone No.: 4�f-w...5";6,741 Fax No:
Surety(if any) >' r A-
Address: Amount of Bond$
Telephone No: Fax No:
Name and address of any perso aking a loan for the construction of the improvements
Name: ! i 4/
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: N!-
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), Florid Statues. (Fill in t Owner's option)
Name: (U/{l i �t/r f4
Address: .2.5!" ... 0 N 'Orr-kT 4 pi..‘ -- 'C•CGr Ft- 3"zzCo4
Telephone No: ' fi:24t '1:)SYo`-7/4r` Fax No:
Expiration date of Noce ofrCommencement(the expiration date is one (1)year from the date of recording unless a different date is
specified): Ia I ' -O:Z
THIS SPACE FOR RECORDER'S USE ONLY OWNER
,i
Doc#2021275708.OR BK 19967 Page 907, :ned: Date: IA • �-1
Number Pages: 1 efore me this 4 day of ,.v..a . the C a ty o Duva
Recorded 10/20/2021 09:13 AM, f Florida,has se ..- ...-.•e. .., .m J , /I/,/
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL otary Public at Large,State of Florida,County of Duval. 4 f f f. '.
COUNTY 1y commission expires: 1, . ' �'/, I. la Wetzel
RECORDING $10.00 ersonally Known: �— ••` AllitZW. . _ . !, 0'233893
roduced Identification: =4C. J'L ? .9
- ;,* • ' • , t ' , 2022
'°°„4.„,0''� Bonded'Nu Aaron Notary
,
it
SEMINOLE
SEMINOLE SOUTH.LOG
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PERMIT APPLICATION SUMMARY
2
3
BUILDING CODE SUMMARY
DESCRIPTION - interior remodel of existing retail space
FLORIDA BUILDING CODE COMMERCIAL 2017
FLORIDA ACCESSIBILITY CODE 2017
PROJECT ADDRESS:
NEC 2017 _1eaa,ztr,
DATE: I onvaM,
SHEET TTRE:cave exa.
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SHEET NUMBER:m,
SLYAINOLE
SEMBIOLF SOLIDI,LLC
2310 Ma.Point Read 19.301
al..Be.FL NAB
RA 05.18801
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