1937 W SEVILLA BLVD RERF22-0099 E-5‘...:-1,T?),, Building Permit Application
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j City of Atlantic Beach
J / 800 Seminole Road,Atlantic Beach, FL 32233
1.-1-,37:1,,)%
Phone: (904) 247-5826 Fax: (904) 247-5845 �y
Job Address: 1937 Sevilla Blvd West Permit Number: iF RE 2-Z v0c'i C1
Legal Description 45-7 08-2S-29E Sevilla Gardens Unit 2 Lot 15 RE#169462-0330
Valuation of Worli (Replacement Cost)$ 15,961.12 Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s) (Circle one): Commercial Residential
• If an existing structure, is a fire sprinkler system installed?(Circle one): Yes No N/A
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal
Describe in detail the type of work to be performed:
Re-roof
Florida Product Approval# Feltbuster FL-186-R1 Shingles FL-10124.1 for multiple products use product approval form
Property Owner Information
Name: Angela Strock Address: 1937 Sevilla Blvd West
City Atlantic BPa-h State ZipFL X283
E-Mail angelastrock@googlemail.com
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company: Patriot Roofing Services, Inc. Qualifying Agent: Joshua Pennington
Address 1695 Hereford Road City Middleburg State FL Zip 32068
Office Phone 904-413-7725 _ Job Site/Contact Number 904-982-4052
State Certification/Registration# CCC1330098 E-Mail joshp( ,patriotrsc.com
Architect Name& Phone# N/A
Engineer's Name&Phone# N/A
Workers Compensation _
Exempt/Insurer/Lease Employees/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 regulationg
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.
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
RECORDI G YOUR NOTICE OF COMMENCEMENT. ___.___
Vii‘..4„/ I . .
(Signat re of Owner or Agent including Contractor) (Signature of Contractor)
Si ed and sworn to(or affirmed) before me this) 7 day of Signe4 and sworn to(or affirmed) before me this. 7 day of
2. 2.-2-7, 1: / iz.) , iZ , by
,: . reAttklQ2aiilihardson (Sig ature of Notary)
rJ °° NOTARY PUBLIC 4V'RV48 Willie C.Richardson
`' : Q-` °�NOTARY PUBLIC
s STATE OF FLORIDA 9
=Comm#GG210238 = • 2 STATE OF FLORIDA
` 1% +•,• • Commit GG210238
Personally Known OR `NCE 19 Expires 8/12/2022 Personally Known OR :r� e
]Produced Identification [ ] Produced Identification N E 19� Expires 8/12/2022
Type of Identification: Type of Identification:
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No Tax Folio No. 169462-0330
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: 45-7 08-2S-29E Sevilla Gardens Unit 2 Lot 15
Address of property being improved: 1937 Sevilla Blvd West,Atlantic Beach, FL 32233
General description of improvements: Re-roof
Owner Angela Strock
Address 1937 Sevilla Blvd West, Atlantic Beach, FL 32233
Owner's inteCest in site of the improvement 100%
Fee Simple Titleholder(if other than owner)
Name N/A
Address
Contractor Patriot Roofing Services, Inc.
Address 1695 Hereford Road, Middleburg, FL 32068
Phone No. 9044134725 Fax No. 1-844-272-1819
Surety(if any) N/A
Address Amount of bond$
Phone 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 E
Address
Phone 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 Statutes.(Fill in at Owner's option).
Name N/A
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 ER
Signed: A DATE
Before me this day of in the
County of Duval,State of Florida.has personally appeared
herein by
Doc#2022107870,OR BK 20244 Page 2098, himself/herself and affirms that all statements and declarations herein
Number Pages: 1 are true and accurate ,gyp.r Willle C. Richardson
Recorded 04/27/2022 03:26 PM, <� �� NOTARY PUBLIC
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL / STATE OF FLORIDA
COUNTY ��ii��'''�� 210238
RECORDING $10.00 . ' �— •
• •lcatLar•..State of � n --4��17
:112/2022
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Produced In