1209 W PLAZA RES22-0004 lift Building Permit Application Updated 10/9/18
j,!, City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Jjr�r IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us f- //��
Job Address: / Co 9 vi 10 /q G q Permit Number: 1` L ZZ' 0004-
Legal /8-3if 17— 2 S— ?96--
• 3 9 '47M-nft $ec•,ch S, RE# l 7/ 0.24, -" 07190
t,al le sue Zld
Valuation of Work(Replacement Cost)$ .20 /C• Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): DCommercial Residential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes No
• 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: CA TE O E:v4 ht/4 GOte NEW L.IF
Gv l OQc614a,JC. t4 FLo0l2. Q Ll `VA'Tor2. be—.14 Lip T.
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name /;: e'i e Address /Z () 9 vJ lc%
City /\ T f c . I'I c_ (jty C[ cj-i State FL. Zip „ZZ s Phone 90 '/ —2Z.6 •- 9c
_
E-Mail i r' t ?.-i _ err, L'l A I'f's Ct a f -
Owner or Agent(If Agent, Power of Attorney DfAgency Letter Required)
Contractor Informatio _ t`(� n' '
Name of Company E 42 I, feiS��S ,-[ 1V0(414 QF
uali yi gAgent EDwl �' ej Tec—
Address ab o17? WEST PO S'7: City 4,f' Tl G Ei•}State FL Zip 322-33
Office Phone 904- Z7o -21$ Job Site Contact Number 9o'}— (D 1(s- SIo5/o
State Certification/Registration#CC/504/5-1? E-Mail ed W in ru+4-I)tc'ch @ J Q i _ I I. co rY1
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt Expiration Date 7-.2.7-23
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 Y•UR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAta' F CING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
R COR` tc NOTICE OF COMMENCEMENT.
(Signature of Owner or Agent) (Signature of Contractor)
ned and sworn to(or affirmed) before me this I/I`I11 day of Signed and sworn to(or affirzd)before m4is •ay of
C ,OW,l by C •• N \1CX\1n Pte.— , 2024 , by vw•mai ; •
(Signature of Notary) • :1- u +S ►.'
[ 1 Personally Known OR > Personally Known OR
N4Produced Identification / !!!!!! [[ 1��Produced Identification
Type of Identification: T.X.- P(s L UP-5 E Type of Identification:
o�^�•0 •, TONI GINDLESPERGER
c. MY COMMISSION#GO 353178
,p..••. c.
REBECCA SIMMONS • �; EXPIRES:October 6,2023
L : Commission#NH 131192 .. .. ` Bonded Thru Notary Pubiic Underwriters
nni
+: r`,• Expires May 19,2025
F•°r,ftp.• Bonded TTru Troy fain Insurance 8003851019
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s
N(JTICE OF CIMMENCEMENT
State of Flo flack- County of V Vo.- I Tax Folio No. 1 7 1 e22-(° "C 9 00
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: 113- 3 4 i,-2 S'-24 E . 39
/4' 14t4ZIG S EAGA-1 SEC. H. LOTS q�5 co gI-14 210
Address of property being improved: 1 .09 W o 4 ? a-Z Ga. 4+1644 i G
'Bch Fl. 32.2.33
General description of improvements: I A S j a4 L,L,., " LIFT"
Owner: B r'i a1A 4 E,!' '1 Edt.
Vo Address:n h 1 ZO q W QS-�' a-Lcc� G DSL•
Owner's interest in site of the improvement: fti ('fS i t e1'1 C ' F L. 3/2_33
Fee Simple Titleholder(if other than owner):• Q
Name: aatvJi h C. 7 tAi#bt�C k C6 C 1504 t S b
Contractor: L 41a LE. n1rief►Se.S o+ 41 1k-•�or-za� LLC.
Address: 2(O2 ' '8 wasT
Cod � . �ck.cCsonvi ll.e, FL. 32233
Telephone No.:°/0 yt" 270 - 212 5 Fax No:
Surety(if any) L'I a
Address:
Amount of Bond$
Telephone No: Fax No:
Name and address of any person making a loan for the construction of till Doc#2022006318,OR BK 20088 page 2480,
Number Pages:1
Name: (� Recorded 01/10/2022 10:07 AM,
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL
Address: COUNTY
Phone No: RECORDING $10.00
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: G
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: G
Address:
Telephone No: Fax No:
Expiration date of Notice of Commencement(the expiration date is one year from the date of recording unless a different date is
specified):
THIS SPACE FOR RECORDER'S USE ONLY , ; '
Signed: /
LEANNE oONOHUEDate: ///e2 /r Z
? ;; Before me this `� day r�,�1,,Mthe Couf Duval,State
Commission#GG 943250 o ' of-` DC‘(
'
_%;.. Expires April 28,2024 Of Florida,has personally appeared
'''?o►:�°"'
Personally Known:Thru Troy Fain Insurance 800.3857018
Produced Identifi 'o • \..\•1 ‘-)\.) 1\ �\ �aJ or
Notary Public:
My commission expires: ' tk
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