1620 BEACH AVE DEMO22-0002 Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department "ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
;:; IS REQUIRED.
Phone: (904) 247-5826 Email: Bu.iding-Dfept@coab.us
Job Address: 1620 BEAL�� AVL _
Permit Number: LEEN\CMZ CA90 Z
Legal Description b9-25-2<ie OLEAN Ci. t%c UlJ\T t•i0 1 5i0 Pr La 7 Lcrr 6 31 Ka_ RE# f f0C1 5q 7- b5c3
Valuation of Work(Replacement Cost)$ /0/OCC Heated/Cooled SF Non-Heated/Cooled
• Class of Work: 7,New ❑Addition EAlteration .-;Repair Move XDemoifiPooi 'Window/Door
• Use of existing/proposed structure(s): ECommercial Residential
• If an existing structure,is a fire sprinkler system installed?: -:Yes VhNo
• Will tree(s)be removed in association with proposed project?Eyes(must submit separate Tree Removal Permit) YNo
Describe in detail the type of work to be performed:
Dem° , eR6fv oQcl .gyL.-,411 R)� "tIZCT fN��.NC��
ifJCC .,.CR— C) Ly
Florida Product Approval# __ for multiple products use product approval form
Property Owner Information
Name AH Living Trust Address 1188 Dance Dr
City Sonoma State CA Zip 95476 Phone 707-815-7!5a
E-Mail antnnsonoma( ma rpm
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) —_— —
Contractor Information
Name of Company �t 1k k. .5 Tax The 5 Qualifying Agent - --�g (ZA P�t 111c3
Address q' 2 0[¢Ar l -Bti D city A..--? . State r I Zip 322_33
Office Phone %LI-Z`1(o-/S Job Site Contact Number clog- 755--`lcf'/8
State Certification/Registration# E-Mail - ,t CI PS T A.11 I Dt;2c--,C CGfAnc"A.<7'• Ir\I E-r
Architect Name& Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt`s"Expiration Date 5/7/ 2-3
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-'ROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LEND A k Ai 14' NEY BEFORE
RECORDING Y TICE OF COMMENCEMENT.
(Signature of Owner or Agent) (Signatu of Contractor)
Signed and sworn to(or affirmed)before me this S A D day of Signed and sworn to(or affirmed)before me this -2 I day of
r1U s •tr y 1 t(tem„,-,‘,:-1 �:.1�1gc +� <f VCA 2 � ,by r ;
t'L'Ac., ril ' (-.krtc A��.�^ .2i
(Signature of Notary '^ �
x pi cue C_.c4 .- Li -- (...-,).3 ;Sit 'Y - AMELIA Gi,i.1 LEY
{,•` .:,,t. :?'':.•, ,,, ,r. :::+t l.i,• :76171
9p Personally Known OR t Personally Known 0• 1 •• • .irgismt .+,2026
'f G.f F\'?.�: -r Mdi,:l 11;: •:.-, y Put•...,:denh'INn .
( ]Produced Identification �Produced Identificat•� ,
T,,, of itiontifiratinn• Type of Identification: `C. `p'�- " ".;.i. - ._
NOTICE OF COMMENCEMENT
State of VI-- Tax Folio No.
County of Du\/A
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain reai 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: 01-25--2c1E (AF—k,1 spelt:; lJtviT 't0 1 Sf D ? 11 Tr 7
Orr (p BLK1 0/R 'BkS czs,- SS9N-/(O8
Address of property being improved: /(0 2.0 -SeAC r\ poi 32_Z3-3
General description of improvements: DEn"o / (--ar.E I .Q c JEftrp 3
Owner: AH Living Trust Address: 1188 Dance Dr, Sonoma, CA 95476
Owner's interest in site of the improvement: 100%
Fee Simple Titleholder(if other than owner):
Name: _
Contractor: -Rt.,I�i
Address: 99 Z (DC-CA Bl\lb\l(1 322_33
Telephone No.: 90--22/(0- /50a 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:
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: Jerry Lowe
Address: 7500 Powers Ave, Main Leasing Office, Jacksonville, FL 32217
Telephone No: (904) 737-552 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:
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 date is
specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER
Doc#2022020438.OR BK 20110 Page 2301, ;ned: Date: /'/zv� ��-
Number Pages: 1 ?fore me this .;.c" :� day of is >itii.r h in the County of f3trvs.Stjte
Y appeared ��i�
Recorded 01/25/2022 09:55 AM, f�Iti;1a nos personal) �" �t �`
1�+ roc x.
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL atary Public at Large,State offa,County of BasraI.bN\1r ' _
COUNTY �
RECORDING $10.00 y commission expires:C y _ t,k3 e•nnaa ,
arsonally Known: YR fLYL : ._.. rY.�rv� c — N°t''' or
oduced Identification: