1757 W PARK TER RERF23-0059 .�:.,', Building Permit Application Updated 10/9/18
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-.►- City •of Atlantic •Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQU`R�ED.
Job Address: 1-757 IPn r Terrcc e (,Lie„ I-- Permit Number: RE_IPS-
ZS- /Iv O S
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,gal Description Lel Zo, & tct t,1 idioiiiN�1 WIT No. �j RE# i-M O 0 031E
Valuation of Work (ReplacementCost)$ /S,GG,.. Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition DAlteration ItRepair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial 1 1.F<dentia)
• If an existing structure,is a fire sprinkler system installed?: al,fes ❑No
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) .(0
Describe in detail the type of work to be performed:
Cc`MPIe1-L rete. F" U _'n 6-Ar --r7,..b,z l,,,.t._ h(,1 /ar I L. /UCo 2 C, •-,e //�
Florida Product Approval# r? /01 2t-r(= y for multiple products use product approval form
Property Owner Information
Name Bloom-4., PP {crso•1 Address I -7S ) Par lc-_--re r r0%c e W Q-,
City A.f tc k, r B'e4.c r. State Ft,. Zip_ Phone C, c c - /SS 1
E-Mail b1alJGls?JS . 2 0 1e_l y4po . L.0"1
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information _
Name of Company fl onctinc . Roo ri,N) Cc,ti -
trac f-or./QualifyingAgent 0I A ' ' ' ' 410.--,
Address Zv SO .-1.1.1 C. - k ,5cr--4 City IJ*,(fun-e_ Bch State lis Zip yj Z'Z(.c..
Office Phone 2 2tt <-)US`l Job Site Contact Number ' 10rrm SSC-1"Z"
State Certification/Registration# R-c Owl_..?4/ 5 E-Mail -re.- n,vna./.R.. GI, c x.,,.,.,cc,,i..._ . n o L
Architect Name& Phone# X
Engineer's Name&Phone# >e
Workers Compensation Insurer OR Exempt Expiration Date Li ' 9 j 2 S
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
RECORDI OU TICE OF COMMENCEMENT. v`
( a-- G „�
( (Signature of Owner or Agent) ignature of ontractor)
441
Signed and sworn to(or affirmed)before m this 07 day of Si ned apd sworn to(or affirmed)before me this ( day of
Apr/ , .2_02_7 ,by e ;hr. PC4er-sor, _ 'i-L , ,ZoL,� ,by il'l,�fYv19.5 L. o V16.-•he,vN.
G7N u , 1 G 1�DStX-C�C`�tc
. . . t�Ql,9�,TL�.1 /1� ;'a atiRB(41[/Q ASHI
,�Y PU'�JANMAURICIO WALKER ROBERTSON U *' Commission HH 270865
'••'.',.41,,,:„.;,.,.,'•:s Expires June 4,2026
______
.• ,a� MY COMMISSION#HH 009325
[ ]Personally Known OR ;?,rte,,,i EXPIRES:June 11,2024 [ ]Personally Known OR
„[hProduced Identificatio Bonded ThruNotary PubficUnderwriters VProduced Identification /
Type of Identification:_ • • , ,. c____c - Type of Identification: II 1 6i_ enc? 4l 2 S•
Permit Number Tax Folio Number
NOTICE OF COMMENCEMENT Doc#2023075275,OR BK 20646 Page 2386,
Number Pages: 1
Recorded 04/17/2023 03:08 PM,
STATE OF FLORIDA JODY PHILLIPS CLERK CIRCUIT COURT DUVAL
COUNTY
COUNTY OF DUVAL RECORDING $10.00
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.
1x Description of property(Street address): 17 5 7 PG.- k Te r (,ti es L.--
Legal Description: Lot 2 o l3 Jock / Z .f-e_/,a Piot s','1 Ivc', 3
eau k '3 1.en c i c
2. General description of improvement: ge rc, ' P,,. ,,'t haul c
3. Owner information:
a. Name and Address: $Icu r lerJo -, 1 —IS' 7 ec.-k Te r r c c t (AJ f -
a. Interest in property: GLA,„/- Ai-I.... 1_4 , Ct c_L, P
b. Name and address of fee simple titleholder(other than owner):
1.a. Contactor's name and address: (nor‘.q. S Co.. 'tec,.c_,6-o C•-) t!e p F lc- 3
b. Phone number: 2 21 -vac c Fax number:
5. Surety Information:
a. Name and address:
b. Phone Number: 13 /__ Fax Number:
c. Amount of Bond:
5. a. Lender's name and address: N n
a. Phone Number: F+
'. Person within the State of Florida designated by Owner upon whom notices or other documents may be served
as provided by 713.12(1)(a)7.Florida Statutes.
a. Name and address: ^
b. Phone numbers of designated persons: N +�-
. a.In addition to himself or hersee,Owner designates of
Al / to receive a copy of the Lienor's Notice as provided in Section
713.13(1)(b),FloridiStatutes.
b. Phone number of person or entity designated by owner:
I. Expiration date of notice of commencement(the expiration date is one(1)year from the date of recording unless a
different date is specified) J C A
YARNING TO OWNER:ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE
IOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713,
'ART I, SECTION 713.13,FLORIDA STATUTES,AND CAN RESULT IN YOUR PAYING TWICE FOR
MPROVEMENTS TO YOUR PROPERTY.A NOTICE OF COMMENCEMENT MUST BE RECORDED
►ND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION.IF YOU INTEND TO OBTAIN
'INANCING,CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK
RECORDIN YO NOTICE OF COMMENCEMENT.
ignature of Ow ( wner's Authorized Officer/Director/Partner/Manager):
Signatory's Title/Office)
he foregoing instrument was acknowledged before me this 20 1 3
g g g �7 day of �r, :�9'•....•,,
.
nn
y Il� •rrn Pe-a-e-rxo.1 as 0,-'0.2-/- for Prop r-.iy C z
8 m n c
om
lotary: a cn
�Gn/044/r,'Cy-a aclb[!f->c Z m
ersonally Known or Produced Identification , Type of identification Produced: Pr-A,e,-- 6ti
ly commission expires: OC//i, 01-,{
W �
� A
„2_02-,1
a
nder penalties of perjury,I declare that I have read the foregoing and that the facts stated in it are true to the
est of my knowledge and belief.