425 MAKO DR RERF22-0028 Building Permit Application Updated 10/9/18
11,:lyCity of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
J'"'�- IS REQUIRED.
'Phone: (904) 247-5826 Email:,Building-Dept@coab.us
I
Job Address: "I 25 gaga Dr. A'�'�.1el iC I ilWi- fa.. 3ZZ3 Permit Number: RE RT Z Z - 00 z E,
Legal Description 31 -16 11-2 S-Z4 039 Of 12 dt 12oq*L (a4un S t.hJ f RE# II i y 6(p OW
2 or LOT Z5 13 LK_ )2, r�
Valuation of Work(Replacement Cost)$-715 80.t5.-p Heated/Cooled SF I I oy Non-Heated/Cooled 3 (p 1,0
• Class of Work: ❑New ❑Addition Xlteration Xriepair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial sidential
• If an existing structure, is a fire sprinkler system installed?: ..)nes ❑No
• Will tree(s)be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) .P_SINo
Describe in detail the type of work to be performed: )2 e 1z0,-c-' VJ,-Y1,.-N 0 U..,2tnS (Orf1 1rcs-
D U► 1.n'1 (V('di\t C alii t SV\if-)Op)S -
Florida Product Approval# rI_ I t-AD-1`i - K 1s J for multiple products use product approval form
Property Owner Information
Name 100 d, AR__( (lQ , Address L-2 Yr kJ QC,
City A \ 16 o ti C 3 c ccf 1-\_ State _ Zip 32? 3-3 Phone ' CV--},—3 2 3- ) 9 Z- 9_
E-Mail \ kir(00 Q.- 0 COMC 6-St-, 1r'1.i"
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information L\ p
Name of Company S�J1/4n� 5g. &l
OZ) (\5 C c% 'elk tJ ualifying Agent •1 t S 13t'Y iC-e_ y
Address I to 2 -1 �1 t . S , J tit'.., )( 'f Q(,,- State fl _ Zip 3 2.Z_�•J
Office Phone q'C7q - 3-2...3 - 1 GI 2 Job Site Contact Number 90-A -c-(4 S—� 'S
State Certification/Registration# CCC 13 V-VZ P) E-Mail 1e S1 P ®Su t' y\SF its) (&YV1
Architect Name&Phone# N 1A
Engineer's Name&Phone# N 1 er
Workers Compensation Insurer OR Exempt Expiration Date 0' [ ip f Z-0 2.3
Application is hereby made to obtain a permit to do the work and installations as indicate/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 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.
\v\ & r^ ,.-12..M c• — T --
(Signature of Owner or Agent) ^(Signature of Contractor)
Signed and sworn to(or affirmed)before me this U.t%--day of Signed and sworn to(or affirmed)before me this I I day of
,Tw-. 2--1- ,by - �......--- ,..st.- iAr-f1 , )o2 ,by a✓< <1.--/k--Q 4
<►ti'Y°.L;:i THERON GIBSON (Signature of Notary) ' '"4i ER JOHNSTON
'_�'�'`" Notary Public-State of Florida �,� MY COMMISSION#HH 051579
�/�c Q, Commission#GG 298676 ":
'?of r� ;m.���.. EXPIRES:October 27,2024
. t 1 p4ots,+igm,.�iSimhttoR15,2023 [ ]Personally Known OR 'TOFF°c public Underwriters
Bonded Ttw Notary_—( 14eJsc c�rlle„,fleel,e„— produced Identification G ”'
Type of Identification: !/ Type of Identification: f • __
NOTICE OF COMMENCEMENT
State of FLORIDA Tax Folio No. 171466-0000
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: 31-16 17-2S-29E R/P OF PT OF ROYAL PALMS UNIT 2 A LOT 23 BLK 12
Address of property being improved: 425 MAKO DR.,ATLANTIC BEACH,FL 32233
General description of improvements: RE-ROOF
Owner: LINDA TERRONE Address: 425 MAKO DR.,ATLANTIC BEACH,FL 32233
Owner's interest in site of the improvement: OWNER
Fee Simple Titleholder(if other than owner): N/A
Name:
Contractor: SUNRISE ROOFING COMPANY
Address: 762 7TH AVE.S.,JACKSONVILLE BEACH,FL 32250
Telephone No.: (904)495-1835 Fax No:
Surety(if any) N/A _
Address: Amount of Bond$ _
Telephone No: Fax No:
Name and address of any person making a loan for the construction of the improvements
Name: N/A
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: N/A
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: NSA
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
"gned: �� 1G\ .�C/�V c �� Date: 1 �\p
Doc#2022023526,OR BK 20116 Page 119, ?fore me this Lie "' day of in the County of Duval,State
Number Pages: 1 f Florida,has personally appeared ���a `��ce-s�gem _
Recorded 01/26/2022 04:28 PM,
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL )tary Public at Large,State of Florida,County Du
y commission expires: f I S � 2-5 I Vie;... THERON triteGIBSof
N
COUNTY 12 ' A' Notary Public-Stete of Florida
RECORDING $10.00 irsonally Known: .. o; °
;� off: Eeairaissiwit CC 298676
oduced Identification: O t— of
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