785 SAILFISH DR RES22-0131 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
`�'iti:V' IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: -1c 1 V�,.. 'C \ �. \y_,,c�. &- )1.L.Ls Permit Number:/ RESZ-Z—CD t 5
Legal Description .10-40 1.7-a.-S- )-f) " Jd yu,/ gams.-S u 1 Ui 1 zot (/kURE# 1.-7 i Z 3ci -000C)
Valuation of Work(Replacement Cost)$ 15 9p D Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial VResidential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes ❑No
J
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit ❑No
Describe in detail the type of woj tg.,be performed: pia.,$tyY /2_ efoor ) /,(3-1, 2r-ofv ll`airy oily
Ca,+'t ct' ?1 t i,c 4 a o�`= -We-et) �0'
Florida Product Approval# for multiple products use product approval form
Propert Owner information `` , 2
Name ,,V...,(,;,.1\,_o :tet Address .. v... _ \. Q t k,. (.33City . L _ State ((� Zip , �r Phone 1�: ' r�A{'��
E-Mailrn i
Owner or Agent(If Agent, Pow of Attor Agency Le iter Required)
Contractor Information
Name of Company _ 6 ?I ' , . LA AS 'if Qualifying Agent X.657 4..--g1c4 "
Address let 0# Yin< Mil/ '/,/'. City Pv ' State 7-G Zip 3 ._01.1.-
Office
._08,tOffice Phone Job Site Contact Number 5O'--$1)0 C39)---
State Certification/Registration# C,6G /$ _oUG� E-mail `Ta---A Pro arr. Y.Go)' --
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt Li Expiration Date off.'/0 — •-(---(
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 A *RNEY BEF• •
RECO',! OU' NOTICE OF COMMENCEMENT.
' �'0nat ipg
of Owner or Agent
y
) (Signature of Contra tor)
Signed and sworn to(or affirmed)before me this ly day of �i ed and sworn to(or a :d)before me his day of
April , 202Z,by tv .1 ' � Q c , OZ z,b A, =_ _ A 1 S
Att o 'otar (S 7 atu . ?:_w_SINIF lip
,i;' JEAN M.KOHN ,
14-7r1 Notary Public-State of Florida
[ 1 Personally Known OR ',v.., Commission#GG 916819 [ ]Personally Known OR
''... ::e -- --
[ ]Produced Identification °F f`^ My Comm.Expires May 4,2024 [ ]Produced Identification
Type of Identification: Bonded through National Notary Assn. Type of Identification:
Doc#2022115698,OR BK 20257 Page 498,
NOTICE OF COMMENCEMENT Number Pages: 1
•
`"T' 'r State of Florida County of St.Johns Recorded 05/03/2022 02:25 PM,JODY PHILLIPS CLERK CIRCUIT COURT DUVAL
COUNTY
It - Permit No. RECORDING $10.00
I. Tax Folio No.
to-'f.
THE UNDERSIGNED HEREBY GIVES NOTICE THAT IMPROVEMENT WILL BE MADE TO CERTAIN
REAL PROPERTY,AND IN ACCORDANCE WITH CHAPTER 713,FLORIDA STATUTES,THE
FOLLOWING INFORMATION IS PROVIDED IN THIS NOTICE OF COMMENCEMENT.
Expiration Date of Notice of Commencement(the expiration date Is 1 year from the
Date of recording unless a different date is specified
Owner's name(print) (\ p(:` ``. C.3( (
�`�NX.,_NX.,_ �
Owner's address 1 5�/\ ,�
( 1 Ft\ ��I. f\ <& 3iiV
Owner's interest in property 60-1 T Q _J D- / l
Legal description of property 30-10 I ',?....9.- 5 Pftr`/a^ r J1,g (�C..ri't t `O t L/ (3/g O
Property address T7p s Sen t/ ,'� J, Ar: At 4 �Ls'Luzi�_ ea.-G-e 1 ')4.--Z/J ��Z�33
•General description of improvement /ha4b 4?Y /3a. 0/►7/4, re r, 'fit,)Y2 1h
Fee simple title holder,if other than owner(print)
Address Q� '' / p,, / q Q
Contractor's name(print)/�V"''6 /(t) /(d5, f4���/I/ pp Phone((/"'a) �l 0.9. , J�
Address 30 5 DO`O)Y)� m/// ehri/� /ve i 3. p)Pax(__)
Surety's name,if any(print) Amount of bond S
Address Phone( ) Fax( )
Lender's name(print) Phone( _)
Lender's address Fax(_)
PERSONS WITHIN THE STATE OF FLORIDA DESIGNATED BY OWNER UPON WHOM NOTICES OR OTHER DOCUMENTS MAY BE
SERVED AS PROVIDED BY SECTION 713.13(1)(A)7,FLORIDA STATUTES:
Name(print) Phone( )
Address Fax(_)
IN ADDmON TO HIMSELF OR HERSELF,OWNER DESIGNATES
OF TO RECEIVE A COPY OF THE LIENOR'S NOTICE AS PROVIDED IN SECTION 713.13(1)B),FLORIDA STATUTES.
PHONE NUMBER OF PERSON OR ENTITY DESIGNATED BY OWNER:
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE
NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713,
PART I, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED
AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK
OR RECORDING YOUR NOTICE OF COMMENCEMENT. UNDER PENALTIES OF PERJURY, I
DECLARE THA HAVE READ THE FOREGOING AND THAT THE FACTS ST TE I IT ARE TRUE
TO THE j ja. MY j WLEDGE AND BELIEF. 4 2Z
Signatur, , I` or .es. ,or(ss or Lessee's Authorized Officer/Director/Partner/Manager Date igned
��, Duval F L
Print Name of Pfrson SI g Above In County Named Of State
STATE OF FLORIDA COUNTY OF ST.JOHNS
The fur Ding instrument was acknon ledgell before me by means of l physical presence or O online notarization,this LI day
of Peplel V .2012by k\1,1 hon./ Lel>,r►e as "OW V V for
/III ili
itti011rill
r JEAN M.KOHN
,p Public.State of Florida .. Notary Public-State of Florida
Je 4's t 5, K 0 in n ( ® . Commission it GG 916819 1
'y Commission Expires: Imam 4,2014M1 My Comm.Expires May 4,2021
My Commission Number is: q 5.19485.19489 ( Bonded through National Notary Assn.
Personally Known ✓I OR Produced Identification Q
Type of Identification Produced
I-pdaied 02.06.20
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