1977 Beach Ave RES18-0415 New Permt, Bosco Transfer rs`��'`)-6•pr
Building Permit Application Updated 10/9/18
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800ity SeminoleofAlatic RoadBeach, AtlanticuilBeaching , FLepartment 32233 HIGHLIGHTED INRMATION GRAY
ort19 IS REQUIRED.
Phone: (9, 1404)) 247-5826 Em�a�iil:'/Building-Dept@coab.us , ;
Job Address: /977 gE4 / ,///,)ii.G L e.. / ,3,-V.33 Permit Number: /g O,/'S
Legal Description -25- e"49d;✓✓[ fi f.d4,akzt44 JJrri977oi 6 /AVF(E# /697;?3 -/c .
Valuation of Work(Replacement Cost)$ ,27d POO _Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ENew EAddition reAlteration ERepair ❑ ove [Memo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial CdResidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes 13No
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) IZINo
Describe in detail the type of work to be pe fo ed:
IM() (,),/ '� An 1fi,od i- D,rs)i/p e._ a. rte/ii 4i c 40Ar- r
Florida Product Approval# for multiple products use product approval form
Property,O��wner Inform
ation
Name /i/IA fL 4k._ Address 7 / Ze- Af A✓ . I6 33
City , o(fS/1/( State 11 Zip 0755 Phone (XId) a'o9- '393
E-Mail kh'hO r((.foA3e}/rMJZ•( wF)
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company 13osco 6160,r4k (c /eoki 43 Qualifying Agent /5/, 1)
Address ,27/5-g /1�/Wher / City ;r : State FG Zip ,3, ;•733
Office Phone 610'1 ?//-&&?O Job Site Contact Number CAV ;i137-552,c
State Certification/Registration# 4,& /00-0, ,g E-Mail adoe_ : •60,41
Architect Name& Phone#
Engineer's Name& Phone# I Sy96
{(.5
Workers Compensation Insurer TOAIE-. A/Afrad9L<.�d/ w•OR Exempt❑ Expiration Date % / ,ROv?a
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or nstallation 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 •.1 • • NEY BEFORE
L
RECORDING Y IICE OF COMMENCEMENT.
( ture of Ow r or Agent) (Signature of Contractor)
fli-yl/c,Fby -r/E' c°,,� "--6,v,.,c/F-�t� i 24
Signed and sworn to(or'affirmed) before me this Li day of Sign d and sworn o(ora firmed)before me this i/ day of
�'V , h'h1 , by ED ,.'47i4-7--/,"47i47-1 a/ /,/• , by9R )z> j, �e�sc o
(Signature of N6tary) /9/y54 C,gr,4 y (Signature of-Notary)
f.[ea r2,...-4 r- - -
:; WILLIAM L.POPE P •,
., MY COMMISSION#GG 348645 � �"t WILLIAM L.POPE
] Personally Known OR .% -, .: Personally Known OR �• '•• MYCOMMISSION#GG 348645
[ ]Produced Identificatio = '-7`-o: EXPIRES:October 19,2023 [ 1 Produced Identification =.,i :'�
�F oP; w=,--, EXPIRES:October 19,2023 ,
Type of Identification: ........• Bonded mruNotary Public Undenvriters Type of Identification: '•'•'F'• 'e`` ers
NOTICE OF COMMENCEMENT
State of / zU/6M Tax Folio No. /69 L?3 /OO
County of L(1,//1z_
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
O�F COMMENCEMENT.
Legal Description of property being improved: D9 /I✓&&1
-073 " e ,c �/� ( Lo.Jt9,1j},'K)/)
0u)ecca JAlyT /977 0/e -,22,177
// 6`�oY-v � /177 ��
Address of property being improved: /977 ,c:22>Ci dlr L /fUfj/'� 3aa33 _
General description of improvements: ,Adici L. , 1 Z7 ti //a)AW 'r/"i E0 �16 /vAl � T
Address: 74 1 € eal) a✓®
�a'Sy
Owner's interest in site of the improvement: ( d/1
Fee Simple Titleholder(if other than owner): _
Name: /�
Contractor: /% /6ar_ 1e-� Ga� Acfc3P_5;
Address: 6y/'(b/� i* '/or £,9i I1/9A)1 G (l X
,I 33
Telephone No.: 410 , /0 o?O Fax No: �;".d/' /-0
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: I
ff
N g
In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Ser
713.06(2)(b), Florida Statues. (Fill in at Owner's option) z o a
Name: o 8 r
rW �
Address: r 0 a
Telephone No: Fax No: 2 U
Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a different d.tg. s.1;: .:
ation date ii
ofityc/c 1 L iy e 5 L'-//
THIS SPACE FOR RECORDER'S USE ONLY OWNER ..•.•.•..moo
Doc#2021301663,OR BK 20011 Page 1890, Signed: Date: / 71//,?1 /
Number Pages: 1
Recorded 11/12/2021 08:17 AM, Before me this ti Ii day o ,. (M e in the County of Duval,State
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL Of Florida,has personally appeared
COUNTY Notary Public at Large,State of Florida,County of Duval. /�
RECORDING $10.00 '
My commission expires:
Personally Known: or
Pro•uce• Identi ic• •n: