1373 BEACH AVE ROOF22-0033 j
r`- Building Permit Application
�, Cityof Atlantic Beach BuildingDepartment
ent **
ALL INFORMATION NUpdated 10/9/18
,
:, 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
~vJ'tIle IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: I V72) 1�( c L �
\ Au1� �1� V-/... i
&k. 1v. ,V- �'3 Permit Number:�C)C;F Z2- v Q 3 3
Legal Description („ t Ido-a')-au- R9w,iv. ka„\e‘ Lcilc, 9, 10 {‘lc. 5t)._ RE# 17U3LU`0060
Valuation of Work(Replacement Cost)$ t5.)600 Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door (t:-AJUr
• Use of existing/proposed structure(s): ❑Commercial dResidential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes C 'Jo
• Will tree(s)be removed in association with proposed proiect? ❑Yes(must submit separate Tree Removal Permit) EcNo
Describe in detail the type of work to be performed:i-() 44 it {�_l'44f fe_rM„� ft(i � vQX „n sl.;.t�iz
ic-S l�1 j /A'41 '�t 11 '7 j 4-.tirk (tic f. aid?'(•:iw,Cjl1— t ce 1 S`NRkZ ?..) ;c6
Florida Product Approval# L. 1311q for multiple products use product approval form
Property Owner Information
Name LOW. 7-a,,r;1. \-(1dr1.us, 1,1-4- Address 1Yf x) ' ,1A (Nye_(NV .
City R��An�� �c,c\ State Zip 3,2.D.:3-1) Phone 901--J—cej3-- c75 ZS
E-Mail r✓1ac.ew)on 6 ty..LI covsA
Owner or Agent(If Agent;'Power of Attorney or Agency Letter Required)
Contractor Information c
Name of Company L�... \,,,14(.15 c Nlar.ck LLA QualifyingAgent YYe itskvoto
Address ,1pC,v. / s)C`(t. 91', City ,\,.. hrkv.Yle_ State Ti--- Zip 3.p'1
Office Phone 90q-3q6 Will Job Site Contact Number $5,2"2k1,- 1/(46'
State Certification/Registration# CcLI )21 1l E-Mail ),Je-C cSCQS.c:,Ow^
Architect Name& Phone#
Engineer's Name& Phone#
Workers Compensation Insurer_?„L,114c4s '0\SU .0/.,cr)c•T.i o ,, JR Exempt❑ Expiration Date 7/21/gal
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
RECO I r` R N TICE OF COMMENCEMENT. - <
(Signature of Owner or Agent) (Signature of Contractor)
Signed and sworn to or affirmed) before me this day of Sign:: : . worn to(or affirmed)before me this o day of
J V , 7,62Z- •, by I �G vh S�C)v� • i. 2012 , by t - A lid) i
/ /•
=mailPti'•.,, STANTON i oty) ;o:,'., L, .turdbfNQO CH HUDMON
Notary Public tate o F on a I .. e•': Notary Public State of Florida
•' I o; Commission N GG 933448
':� �r $` Commission�GG 933448
A-13,
. of r ` My Comm,Expires Mar 16, 2024 I `'�b'v r,. ` My Comm.Expires Mar 16.2024
/14-Persona*KrioWig,Red through National Notary Assn. 0 kPersonally Known OR 'Bonded through National Notary Assn.
[ ] ProduceeP,de,i ,v
lrr----——-- — [ ] Produced Identification
Type of Identification: Type of Identification:
Doc # 2022154620 , OR BK 20316 Page 1556, Number Pages: 1 ,
Recorded 06/09/2022 09:20 AM, JODY PHILLIPS CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10 . 00
NOTICE OF COMMENCEMENT
State of c(o(140. Tax Folio No. 170300--600c.)
County of vi-A
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property,and in accordance with Section 713
of the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMENT.
Legal Description of property being improved: G-1 169-as-aq f`\\ •c.. bead Lor 9)10 8►k 5Z
Address of property being improved: IV) gbh )`.lL- ("'4 +164_, I5e_ej" ' L 3
General description of improvements: Par�4, 1 (c- f1(o�... [c ie AAA te-f SL'z-.s 0+1 1oi^z�
(ouF L✓/ 1„q' I Cil k 5 k 0vt!1eflkyAt - &IAA c k( S\w fog '_z
Owner: WN1t ;1) l4el(,,Stc 7 L�( Address: 1372) ?c'c- Ptvc. (261 � �.ut f F'- W3
Owner's interest in site of the improvement: (6O 6
Fee Simple Titleholder(if other than owner): (� /
Name: A
Contractor: ,1$k) Q NNN�,\ckrS c I t"'OF‘d�II t,Cu —
Address: 9.656-a. RSSel1e_ s`)-. ttnl�Z, ) vi.....
Telephone No.: 90�'3`f IULIt Fax No:
Surety(if any) � —
Address: J n Amount of Bond$
Telephone No: f'S Fax No:
Name and address of any erson making a loan for the construction of the improvements
Name: (Lp‘Address:I
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: V. 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: f J
Address: 1
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 �j A
Signed: / ( �— Date: /�.i•7•••22.7 `2
Befor a this 7 day of A u vae , Z in the County of Duval,State
Of Florid- -s•er o -II a.•e- -• - c4 a'i, .
Notary P..ip�••:tge,5���(�¢►14t4DAtON
of luval. f.S
My corn .i.••=c,�tAc.;. estotary Public-State of Florida t '
Personal =•`�j:',i i .�Eothmisslon p GG 933448 or
¢yd��� My Comm.Expires Mar i6,2024
PraIuCe.I II''tl3�t'-Tf-oti2ed thtuugh Natfu,,,I NuUry Ass+h-44