1917 Seminole Rd FOUN23-0011 COAB Permit Form with ConditionsOWNER:ADDRESS:CITY:STATE:ZIP:
BROBST CARL W JR 1917 Seminole Rd Atlantic Beach FL 32233
COMPANY:ADDRESS:CITY:STATE:ZIP:
HOME SERVICES BY
MCCUE OF NORTH
FLORIDA
981 11TH AVE S Jacksonville S JACKSONVILLE
BEACH FL 32250
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
169542 0532 BEACHSIDE
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
1917 SEMINOLE RD
FOUNDATION ONLY SINGLE OR
TWO FAMILY FOUNDATION
ONLY
Remove and replace existing
concrete footer $4504.00
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $75.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $37.50
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
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.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY 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 RECORDING YOUR NOTICE OF COMMENCEMENT.
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
1 of 2Issued Date: 9/11/2023
PERMIT NUMBER
FOUN23-0011
ISSUED: 9/11/2023
EXPIRES: 3/9/2024
FOUNDATION ONLY PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $116.50
2 of 2Issued Date: 9/11/2023
PERMIT NUMBER
FOUN23-0011
ISSUED: 9/11/2023
EXPIRES: 3/9/2024
FOUNDATION ONLY PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
i---,-,-*.,, BUILDING PERMIT APPLICATION FOR INTERNAL OFFICE USE ONLY
City of Atlantic Beach BuildingDepartmentIA 'n P PERMIT# LUNL3 - (
800 Seminole Road,Atlantic Beach, FL 32233
Ainformatlon required to process
21--.1Phone: (904) 247-5826 Email: Building-DeptPcoab.us
Job Address s L•-m/,,,ai.e. Ro-9 0 /1 jL}NTie ! L RE# r r
Legal Description K\11 iy)11)01 C ( oark 141(0-i( 13l,?C Cf•'l,PL 3?.7
Valuation of Work(Replacement Cost) 4,C-5-0 LI Heated/Cooled SF 2 ) Non-Heated/Cooled SF 45S3.C-,
Class of Work: New Addition Alterationepa ['Move EDemo Pool Window/Door
Use of existing/proposed structure(s): Commercialesidential
If an existing structure, is a fire sprinkler system installed?: [Nes 1 o
Will tree(s)be removed in association with proposed project? Yes(Must submit separate Tree Removal Permit) [21No
Describe in detail the type of work to be performed:
02.01W(2_(Z oX Sti r4 r'j (Ai -1-ely ra 3 ,00ortt c'rt -hen pour'
lctu 2_-r\x 21-t ccrei-e -F00-k-ertocci( cc 1t nh c_dlerc it n ce AS to Ii
T Lu',-11-, 4-r 02-bar.
Florida Product Approval# For multiple products use Product Approval Information Sheet)
Property Owner Information Name
1'
t.L._ 6 6 S i 0;2 Phone ''a y 5 )6 _/Ays
Address /"`T t 7 6,-n9i „vdyc-z,v A-i0 City /}- I )-#9-,v:iG /3‘--4-Cii State f:L zip 3,;z
L; 33
Email evil 82 t t?S j , d2--..1-'4wner or Agent(If Agent,Power of Attorney or Agency Letter Required) Q li/ti&/€
Contractor Information Name of Company iki 1_ L 1. Cc • I(CLjQ PhonE(cy '2((1 -?151
Address '!.'\ 1 li."- [
j 5('C 'fl City, lrlr `
1, ,
f,.
Y 11 l 'r YL1 State FL Zip 7-2-
Qualifying Agent 1'I4d'' l O (c o e State Certification/Registration# C CC( )'1' '
Email ee 1 C hrlYVC Ql1 ii(
CV(«10-c,Job Site Contact Number C(101)L —COL!Z
Worker's Compensation insurer n t n5t-cif C e. CC,OR Exempt Expiration Date
Architect's Name j Email
Ir, ( ,/
Phone
Engineer's Name !° 'Email j +f I Phone
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 maybe 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 YOU PAYING TWICE
FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING,CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RDI UR11OTICE OF COMMENCEMENT.
Signature of Owner:or A entg ) Signature of Contractor)
Sign d and sworn to(or affirmed) befo e me this 7
rL
day of Signed and sworn to(or affirmed)before me this 25th day of2., by ' / . 4,4a _ /: August 3 by = CC -
Signature of Notary Signature of Notary ///_L, •
Personally Known OR [ Produced .entification Personally Know OR [ ] Produ -. Identification
Tyle )r{antifira#inc•I . 04 Type of Identification:
1; :*., MARIA 0 MCMINN
f-m-. :,: MY COMMISSION#GG 932234
EXPIRES:March 1,2024
44'..:—:f.`,
O'' Bonded Thru Notary Public Underwriters v`
MARIA D MCMINN
s4 MY COMMISSION#GG 962234ISN
7417,
F^ EXPIRES:March 1,2024o`:„?
Bonded Thru Notary Public Underwriters
Doc # 2023184956, OR BK 20801 Page 559, Number Pages: 1 ,
Recorded 09/07/2023 01 :35 PM, JODY PHILLIPS CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10.00
I
NOTICE OF COMMENCEMENT
i State of 110Lcf 1
CF) )/Jt
Tax Folio No. .7-q7_-
County of L- _QE\
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
i of the Florida Statutes,the following information is stated in this NOTICE OF CONI IENCEM1QENT.legal Description of property being improved:
e
it •I (2_ [CIS(r
n i•IhC cigich 32
Address of property being improved: 1 `Al toga' 6e0ch _L 32233
l General description of improvements:L1)
t • j !t``1 I e""i fa °P e
t
i
1 l 'X k- t i -- - • . 1
J Owner: e//}a R o R ST V
Address: / / /7 Samir /''11 I 1 I?tfCH f l
3aJ)3j IIOwner's interest in site of the improvement:0LY
Fee Simple Titleholder(if other than owner):i
Name: 1ifiContractor:. ) 1\C "• A ll( )
Address:A e1
1Q _, Ci0ti. 'lUlil0 t QO c'hr -L J _250
I
Telephone No.:(`q('l, )?I Fax–7I r5I Fax No:1
1 Surety(if any) I
j Address: Amount of Bond S f
i
i
i Telephone No: Fax No:
I
i Name and address of any person making a loan for the construction of the improvements
Name:
Address:
Phone No:Fax No:
I Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other documents may l
a
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:
a
i Telephone No: Fax No:
of Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a different date is
a specified): •
1
THIS SPACE FOR RECORDER'S USE ONLY OWNER /J
Signed:
v" -* Before me this , 5 day of
CA r
in t e County of Duval.State
U R1 DNCUMW N pQe,red lOtFlorida,has personal a
W COMMISSION
Wirth
Notary Public at I arge,State of lorida,Cu4 y o uwl.i.:4' EKPIRE3:Wirth1,2024
IiiZ
d. Bonded tlwMoWYAbfc11n0entlln
MyLommissionexpires:
r Personally Knower_ /_ or
i/ Produced Identification P1 UIr-
CT
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