631 SELVA LAKES CIR RFNC22-0092 ` `
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" Cityof Atlantic BeachBui Building Department ..All
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: IS REQUIRED.
lob Address: / --‘14114p 41/6/' S �,• i`u i At)&.,- . - Pe mit Number: _,__ N3`-'-7—'_C- '' l Z
Legal Description r�3 ' i/ +a5 rf REtt .17.9 t :�r) - 56�U
Valuation of Work(Replacement Cost)S, g--j 7• s-o Heated/Cooled SF Non-Heated/Cooled
4-(°
• Class of Work: ; -`_- '.:Addition .:Alteration liRepair Move ['Demo [Pool ti Window/DoorN- k
• Use of existing/proposed structure(s). r_iCommercial .tet`Residential 0th I\� .-c-0 (�`L `
_p• If an existing structure,is a fire sprinkler system installed?: Lilies i$No ��� QS--
• Will trees)be removed in association with lir osed Protect? . Yeslmust_s rnIt separate T
0 ree Remv2vai Perntitl i NQ
Describe in detail the type of work to be performed. f e//f}-(„� h't,44- Lf •,G-f- 7Ct�, 'U /-4-re.../.'
fIf S.S 41/1) )_.:� i`,' f9r 'Ce .66 A'h.-yn76/
Florida Product Approval tt — for for multiple products use product approval form
Progerty_Owner Information
Name �f1/j'Wit!Jif 'v x"12 "'in/ € _ Address f '�/ .5 41 Jt LST'/ £/' '4'
City_ Lr/ % ' h c 114 _ _State FL _Zip 330 ?- Phone 7t .owe' - M
E-Mail /?nly' eS/`/L44( �U / LA'"-i _
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) _
- Contractor Information _
Name of Company . )`1Vi:l'i, CYNi_.T 4fslt Qualifying Agent t..-.4tx, kC_< `isa .;'s.s,,i°I
Address t•tt,GC ` (\:.. L-( -i- City It .C`-r -i:u iii-' State_F L_ Zip i -L I_
Office Phone <t,C.--li-t F_ C r & Z lob Site Contact Number N3 4
State Certification/Registration#iI?CS `S 04 E-Mail i irc G 6-'%' t Vc', r'v c•C\ c c f\r we ' -C._ ( ;fl.
Architect Name& Phone q Iv4.1
Engineer's Name&Phone u _ r i.....
Workers Compensation Insurer.j'tci vf1f�C k 1_1 ,OR Exempt ,1 Expiration Date I b f 2 ____
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 ati the laws regulating
construction in this jurisdiction I understand that a separate permit must be secured for FI ECTRICAI. WORK Pt UMBING SIGNS
WFS POOLS,FURNACES, BOILERS. HEAT-FRS, TANKS,anti AIR CONDITIONERS,r-t, 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.
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OWNER'S AFFIDAVIT: I certify that all the foregoing information 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 9 JR NOTI, OF COMMENCEMENT. .....
-_
I5w, r.< . ..r .,w r Agent) (Signature of Contractor)
ned and sworn to(or of timed)bet me this --)_day of Signed and sworn to(or affirmed)before me this_-L day of
x� C / ` y)k C .ci s E. I 1 �' �:i •
kit . �. r -L�t � ,bv � � _;.._.. t Vii�'l
'' . • . , - fSienature of Notary)
i
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•,, DEANA GARCIA•
( )Personally Known OR {$erso (!y Known OR �!' . 4 �,�1
38111111
I I Produced Identification L� a r i'rud“. d identification `j, .,�`,;' EXPIRES:seram er»2.2.
Type of Identification: '"`'"'" '��� �+-�--...roof.- -ntification_-__. ‘144..i.somaguitaastrotime
Fence Addendum Updated 1/14/2021
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City of Atlantic Beach Building Department
800 Seminole Road, Atlantic Beach, FL 32233
PERMIT #
Phone: (904) 247-5826 Emaii: Building-Dept@coab.us
Job Address: i� Date:
.g/ Sa/v/i- P c rc%/ F
Property Type: /j`/go ��g a-a-g? Lot Type/ Features:
Residential $ One Street frontage(interior lot)
El Commercial E More than one street frontage(corner lot,through lot,
etc.)
0 Swimming Pool
1.Fence Material: Fence Height (select al! that apply):
Pap
ood lt,Four Foot(4ft)
O Chain Link Six Foot(6ft)
O Vinyl 0 Other
U Block/Stone (Plan details required for tootings and/or
retaining walls)
O Other
Fence Location:
Please submit an accurate and current boundary survey showing all existing improvements(including building footprint,
driveway, swimming pool,etc.)and location of fence/wall and any gates. Plan details required for block wall footings and/or
retaining walls and any portion or fencing above 6ft in height.
Will the fence be built in an easement?
❑ Yes (must submit separate Revocable Encroachment Agreement)
No
ill tree(s) be removed in association with proposed project?
O Yes(must submit separate Tree Removal Permit)
rNo
onditions of Approval:
• Roll off container company must be on City approved list. Roll off container cannot be placed on City right-of-way.
• All old fencing and debris must be removed from job site by contractor or homeowner.
I I
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.
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THE PROPERTY 5110I$N HEREON APPEARS TO LIE W1TT-IIN FLOOD HAZARD ZONE )( AS SCALED FROM FLOOD
INSURANCE RATE MAP 4001 FOR THE CITY OF 4yi . .I.-I./FLORIDA, DATED
IS SHOW AS A COURTESY ONLY AND DOES NOT CONSTITUTE A CERT7FCAT10N OF SAME.
TRI-STATE LAND SURVEYORS, INC.) 3r-�23s
8411 BA YMEADOWS WAY SUITE #2, JACKSONVILLE, FLORIDA
LEGEND BEARINGS BASED ON X/N/ LINE AS SHOWN.
• Mal
• nvorr an THIS SURREY DOES NOT REFLECT OR DETEWMINE OWNERS,-UP.
(W.;Mnr C'i Ls 4144) NUT VALIC) WI±KOUT 17-fE SIGMATurir. AND 77-IE CR GINAL r'.AISEC SCAL
• -mac' OF A FLORIDA LICENSED SURVEYOR AND MAPPER.
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NOTICE OF COMMENCEMENT
State of Rad/r/ // / Tax Folio No. I./ o q 556
County of Q() VA-6"
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713
of the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMENT.
Legal Description of property being improved:
/3-// /7 -aS - 2q1 E s€/vnf� Gf/ce/sUNr-/- Lot- g/
/
Address of property being improved: c 3/ SLX✓/9' C 1r�s e/r?/ e 6/ q�
General description of improvements: 1p,'/4-(z -et�� _SO u-71S/�Q
67/4-i- ,f-frCh ffAft2 //>>
Owner: /� / (� L W
/ive )77 7 ess:
Owner's interest in site of the improvement: A9(0O-- /(h/1i V Me.A1 7t 0J/ 7 )/N/Ce Z 2 1///`/f al"/ v
Fee Simple Titleholder(if other than owner): _
Name: fi/M
Contractor: S//1/11/J1/}(4
Fi/V i
Address: 9 6-t `,�/Vyl 303y
Telephone No.: W`! -72 -AV) Fax No: 9�%" , —J7D
Surety(if any) /'V//9 _
Address: Amount of Bond$
Telephone No: Fax No:
Name and address of any person making a loan for the construction of the improvements
Name: /V/4
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
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: 1` 'J
Address: j
Telephone No: Fax No:
Expiration date of Notice of Commencement(the expiration date is one(1)year f rp, 4ate ofTegMfitliEVP6MERdiff nt date is
specified): •'• ah • MY COMMISSION#GG 353178 _
• • 416.•a EXPIRES:October 6,2023
Doc#2022776529,OR BK 20418 Page 1245, OWNER
"?OF(.(:°" Bonded Thru Notary Public Underwriters
Number Pages:1 , g a J / a-d
Recorded 08/31/2022 02:43 PM, Signed: _ Date:
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL Before me this r N1/430L
day of � G in the County of D val,State
CROCORDING $10.00 UNTY Of Florida,has personally appeared _ l C' ,. L , , 11V c+ e
Notary Public at Large,State of Florida,&. y of uval._y
My commission expires: i` ' Z
Personally Known: or
Produced Identification: