271 BELVEDERE ST RES22-0226 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
--0;119%- IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Z 91 Se Iv Z-2-- CDD-Z
Job Address: ��re Si',�'�•', �'�c.vt�L I�Ic,h FL Permit Number:
N,(Z 1. 4 4s6
Legal Description 10-`S n-- 2.S -- Z 9 rJ 5 Fth,f S(.4.. 1 Zv# �5 1 RE# I '} Os 0 3 0 0 o O
Valuation of Work(Replacement Cost)$ I I GOO Heated/Cooled SF +/' Non-Heated/Cooled
• Class of Work: ❑New ❑Addition *Iteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial XResidential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes 51,,No
• Will tree(s)be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) kNo
Describe in detail the type of work to be performed: 1.10e, 6,1 -Fe - 4.4 1-11 z. 64,r4k 3�.�C. 0-r- tit- 1i $`S
s;3,"1 w. II bi rc el-ced frJ i1, h..Ctli-c Ckp sic) vii t cin tx5
Florida Product Approval# i 31�2, 2 for multiple products use product approval form
Property Owner Information
Name 'SeAddress Z1-i R.614e...4 Lre 5f'
City 130x State FL Zip 3Z2-3'-z, Phone cWe/ - ( 12
E-Mail •-fri1,(ilS c( a01
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information fl<-{z-l. 13✓. I Butt-r 6,1 Ft e-+c k
Name of Company 'P1 L 3-i/1ti�r �,�,1 0( �rS Qualifying Agent (�r w1.+ iI e1-0-ver
Address CI 3 fU V t cam(,- +3l ,i�( �� City (�� N_„44ftate rL Zip 3. Z 2 33
Office Phone 40 �$- W5 "3't Z Job Site Contact Number s z 3
State Certification/Registration#1 L 12L1,733(T E-Mail 9ret✓t t 0 �/��{L- 1etQ r i
Architect Name&Phone#
Engineer's Name&Phone#_
Workers Compensation Insure' . . __ •••• -3 OR Exempt,3Expiration Date. s
Application is hereby made to obtain a permit to do the work and installations as indicated.I certify that no work or installation nas
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 LENDER0 AN ATTORNEY BEFORE
RECORDI G YjPFICE OF COMMENCEMENT.
nature of Owner or Agent) (Signature of Contractor)
Signed and sworn to(or affirmed)before me this pi day of Signed and sworn to(or affirmed)before me th•is �f' day of
o?o).2Z ,by J ecc t4 i alt 20,42,by Ft c:'
(Signature of Notary) (Sig ature of Notary)
Notary Public State of Florida
[Personally Known OR Jenifer A Motes NI4rsonally Known OR
Notary Public State of Florida
My Commission Produced Identification ® Jenifer A Motes
[ ]Produced Identificati. fill HH i83o51 [ ]
Type of Identification: Ex•.10/20/2025 My Commission
Type of Identification: 11111
Exp.10/20/2025
NOTICE OF COMMENCEMENT
State of 'FL Tax Folio No. —
County of pWG,
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: I D- 1 ' LS -- 2_49.1 Sot 1+r\ t / s
LrT 45 , N i / Z Lrsr 45® c 11.. r
Address of property being improved: 2.41 Bj�G
e1Ve 5+( t7T tti P LL �22Sj
General description of improvements: '�nb )1;,.,g int' .J h`.fzi 4'c I cy S‘ d.4 0"
4(00 4% P4- port do /lath Sc jC- of �o�•sc J —
Owner: Teff t f Address:
Owner's interest in site of the improvement: I OQ
Fee Simple Titleholder(if other than owner): ,NA
Name:
Contractor: &r,n f
Address: si3 N + $ RI..J /U A 6 32233
Telephone No.: got-I- L/65-3123 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:
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:
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#" " 06775,OR PK 2(1801 Page 787 • o2�
Signed: Date: '
Number Pages:1 Before me thi 811 day of Au a34-,10,22, in the County of Duval,State
Recorded 08/09/2022 09:16 AM,
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL Of Florida,has personally appeared 3c.P V}i4-G
COUNTY Notary Public at Large,State of Florida,County of Duval.
RECORDING $10.00 My commission expire5: o . 2 O. ? O
Personally Known: Notary Public State of FI fde
Produced Identification: Jenner A Motes
1111"1" HH 183051
EiXp.10/20i2025