2 Composite - Building Permit ApplicationBuilding Permit Application`s ° B
City of Atlantic Beach Building Department
800 Seminole Road, Atlantic Beach, FL 3223
Phone (904) 247-5826 Email:
REVIEWED FOR
CODE
COMPLIANCE
9 1 2020
RECEIVED
(.By Toni Gindlesperger at 4:36 pm; Aug 18, 2020'
*ALL INFORMATION
HIGHLIGHTED IN GRAY
(� IS REQUIRED.
Job Address: 342 19th Street, Atlantic Beach, FL 32233 Permit Number: RES20-0226
Legal Description 36-64 09 -2S -29E SELVA MARINA UNIT 12-A LOT 5
11't -
RE# 17 72020
i2'/2
Valuation of Work (Replacement Cost) $ 1 JSi,C,'L7O Heated/Cooled SF Non- Heated/Cooled
• Class of Work' New ❑Addition @Alteration @Repair ❑Move @!Demo ❑Pool
• Use of existing/proposed structure(s)• ❑Commercial @Residential
• If an existing structure, is a fire sprinkler system installed?* ❑Yes IN No
@Window/Door
• Wilt tree(s) be removed in association with proposed project? ®Yes (must submit separate Tree Removal Permit) LI No
Descnbe in detail the type of work to be performed:
Updated Floors, Kitchen, Bathrooms, Roof, Windows, Landscaping, Painting,Wall Removal
Florida Product Approval # for multiple products use product approval form
Property Owner Information
Name Thomas Bourdon Address 342 19th Street
City Atlantic Beach
E Mail tombourdon7@gmail.com
State FL
Zip 32233 Phone 860874-1941.
Owner or Agent (If Agent, Power of Attorney or Agency Letter Required) Owner
Contractor Information
Name of Company pax Pro Censtuctien Ina: Qualifying Agent f (''s r 61..c 4L5 l'
Address 309 Odours MillStvd. City Ponte Vedra Beach State FL Zip 32082
Office Phone 904.5°9.5392 Job Site Contact Number Doll 3o3 r3k9 L.
State Certification/Registration #f te-C /Si -c(.-,61.7- E -Mail laxPrel@Platt-earn
Architect Name & Phone #
Engineer's Name & Phone #
Workers Compensation Insurer OR Exempt M Expiration Date TS /7//2022-
ncation 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: Inaddition to the requirements of -this
permit here may additional restrictions applicahleta this propertyrthat inaY be found .inthe pathic records of is county and
there may be additional permits, required from other gctvernmentatentitiessuch as water management ;distr cis, state agencies, or
federal agencies'
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that alt 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
RECORDO YQ�R I OF COMMENCEMENT.
r gnature of Owner or Agent)
Sig ed and sworn to (or affirm
,by
before
e th'
day of
(Sig at /ff Contractor)
Sig ed and sworn to (or affirmed) beforemge thisll? day of
��_.c,1 — ,'::m,by
[ l Personally Known OP
nature o
LAS DE OLIVEIRA
otary Public, Commonwealth of MassachuSetta
My Commission Expires Aug. i4, 2026
AWroduced Identification L t�
y7 pe of Identification: m i r.) Le -
[) Personally Known. OR
(t -}Produced Identification
Type of Identification: L e „7- i r' :
1/2 (Siggi ERJBif n ctiVionda
Chr stopher Motln
My Cornm3ss&on GG 927955
Expires 10/30/2023
NOTICE OF COMMENCEMENT
State of Florida
County of Duval
Tax Folio No. 1720204242
To Wham 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: 36-64 09 -2S -29E SELVA MARINA UNIT 12-A LOT 5
Address of property being improved: 34219th Street, Atlantic Beach, FL 32233
General description of improvements: Updated Floors, Kitchen, Bathrooms, Roof, Windows, Landscaping, Painting,
wall removal
Owner: Thomas and Kathleen Bourdon
Address
342 19th Street, Atlantic Beach, FL 32233
Owner's interest in site of the improvement:. Owner
Fee Simple Titleholder (if other than owner):
Name:
Contractor: Jax Pro Constriction lnc.
Address: 309 Odours Mill Blvd., Ponte Vedra Beach, FL 32082
Telephone No.: (904) 509-53922
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: PBC Mortgage, LLC
Address: 16604 Town Center, Parkway North Suite A, Westlake, FL 33470
Phone No:. P54) 9444035
Fax No:
Name of person within the State of Honda, other than himself, designated by owner upon whom notices or other documents may
be served: Name.
Address:
Telephone No: Fax Nt.
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 dateis
specified):
THIS SPACE FOR RECORDER'S USE ONLY
IRA
th al Markaachme
pares Aug. 14, 20
OWNER.
Si: ed. c/Yt Date:
Bel re me this day of %i forep in the oun State Sufi lJt
Of ., as personally appeared S — /Wety ,
ilitil tary Public at Large, Sta .a ). a, Cou uval. 1,7 "9Slav i S iCo (PIC expires: D$ [o
Personally Known: ,
Produced Identification:
or