1057 LITTLE CYPRESS KEY RES22-0005 siding `i''`'" Building Permit Application Updated 10/9/18
c _..� 'r' City of Atlantic Beach Building Department **ALL INFORMATION
-cm sfr 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: 1057' Erol. Clef-4s 141, Aft 'c-Btette,,a 3Z233Permit Number: Razz -ocxJ 3
Legal Description 44-40 1G-2$-24E SelvO. LtaktS Vrict 3 Lot I1f RE# 1-72.027- 5,30
Valuation of Work(Replacement Cost)$ 13,195..° Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ENew ❑Addition ❑Alteration [B(Repair ❑Move ❑Demo EPool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial L}d'Residential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes ANo
• Will tree(s)be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) jefio
Describe in detail the type of work to be performed:
OWN)ve Arm net lace 2rd ;tor Wird•w t•-t.,,,� di - +l V 4. c1d'ing.
,
Florida Product Approval# F L 13 2Z 3.3 1-104,-.11e. Fb.net Sid',y�q for multiple products use product approval form
Property Owner Information `J
Name V i;ll ar.► Allen Aeon Address IOS? I_ 1tk cypress Vty
City A.1-41etic \ c� State FL Zip 3 22 33 Phone
E-mail l.-_,N.. O
\ ^.eJ _J �A--.'.; . c_c,,M
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company(.-oG{d rt Co reat nutti on r T20/41,,3 SerifilifyingAgent .Z L„ Le44 ar+
Address SRO Tirv4an.hne 'pr, CityZorkser►v',1I.t_ State Pg- zip 32Z 77
Office Phone QO4t- 4944` 3$45 Job Site Contact Number ctO'f- QQ'f-38 G5
State Certification/Registration#G1ZC.0023q'I E-Mail LFN Loce�2th connects+. nst
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exemptg Expiration Date
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS,
WELLS, POOLS, FURNACES,BOILERS, HEATERS,TANKS,and AIR CONDITIONERS,etc. NOTICE: In addition to the requirements of this
permit,there may be additional restrictions applicable to this property that may be found in the public records of this county,and
there may be additional permits required from other governmental entities such as water management districts, state agencies,or
federal agencies.
OWNER'S AFFIDAViT:I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT. .,�� �(/�� .,\�,.-�� t
(Signature of Owner or Agent) (Signature of Contractor)
i
Signed and sworn to(or affirmed)before me this , j _day of Signed • . sworn to(or affirmed)before me this I1 day of
.Jiani,eiy —, 2-n,7- ,by 1A11 (,4w, 71/1J-,v1 .1R),:ii,r j , 24/-2- , by J11rnsts L ae.kher4--
1
;aQ`^: Notary) �— tJ:: SigffdldEalttl 1 5
:.• CQ51A91l918R a i '�: :,; Commission#HH 026502
-;p� MPif4$AN � . Expires August 2,2024
F °i°'' 741)Y co 9Q . I 19 .fit ?'� Bonded Thru Troy Fain Insun^c�€00.385-7019
,[,�(Personally Kno n ffi�^••" f9)Y ss���'._e�,:���,tQ�c� 'Personally Known OR ���,��•
[ ] Produced Identification -�.�.„-,, [ ]Produced Identification
Type of Identification: Type of Identification:
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NOTICE OF COMMENCEMENT
Permit No. Tax Folio No. 177027-5830
State of Florida County of Duval
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: 44-60 16-2S-29E
Selva Lakes Unit 3
Lot 118
Address of property being improved: 1057 Little Cypress Key
Atlantic Beach,FL 32233
General description of improvements: siding repair
Owner William Allen Moon
Address 1057 Little Cypress Key,Atlantic Beach,FL 32233
Contractor Lockhart Construction and Roofing Services LLC
Address 5380 Timberline Drive.Jacksonville.FL 32277
Phone No. (904)994-3865 Fax No.
Surety(if any)
Address Amount of bond$
Phone 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 or herself,designated by owner upon whom notices or other
documents may be served:
Name
Address
Phone No. Fax No.
In addition to himself or herself,owner designates the following person to receive a copy of the Lienor's Notice as provided in
Section 713.06(2)(b),Florida Statutes. (Fill in at Owner's option.)
Name
Address
Phone 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
Signed: \ Date: Ito\ZatZ,
Before me this if lit' day of jAA
in the County of j / State of Florida, as personally appeared
Doc#''("")^n8485,OR BK')nno' Page 1632, (/J1((t M mtOJn herein by
Number Pages: 1 40140,, erself and affirms that all statements and declarations herein are
Recorded 01/12/2022 08:31 AM, true and accurate.
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL
COUNTY )� iv �J / ,
RECORDING $10.00
‘77-1 gra A7 L .(fJz —/`in/7,CI` i 4i /f s--
Notary Public at Large, !.`�
My commission expires ;•►'"! �, E N LEE WILLIS
Personally known ) 447 .:Commission#HH 026502 or
Produced identificatione'o�; Expires August 2,2024
dr h,,. Bonded Thni Troy Fain Insulnnee800<985.7018