1800 SEVILLA BLVD UNIT 303 COMM23-0064 =;,1=Lir;,, BUILDING PERMIT APPLICATION FOR INTEINAL OFFICE USE ONLY
City of Atlantic Beach Building Department r,4
PERMIT# LO/Y1/A7 6
Y\ 800 Seminole Road, Atlantic Beach, FL 32233 **ALL information required to process
"or;»' V Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address 1800 leuY ((cA. fbrcS (lrti1 3c-3 / BO 1 . ` RE# fel 301c1 - oyoo
Legal Description Q$ .. 2.5 - 2'L 2• j. id PT G�� !OT O (? CI a/ft 3776 -YI'.� ~sem
ReCle..11 Otis. 1
Valuation of Work(Replacement Cost).)g 5'0-6 Heated/Cooled SF 1.$1) al P-1- Non-Heated/Cooled SF pti,r.C....
•Class of Work: ❑ New ❑Addition XAlteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial Kiesidential • If existing structure, is a fire sprinkler system installed?:❑Yes❑No
•Will tree(s) be removed in association with proposed project? ❑Yes (Must submit separate Tree Removal Permit) X No
Describe in detail the type of work to be performed:
K i+ON eAn RerecrSe( new,/c kJ/0 unit (exS c)FT, n w 9 Fd-) I view pe'ici. .d- 1.iq& >.
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no 4t,(1 n- Fie or,°.-j .„ jc; Cb.e-1 , 5C.*ie ti�.ca-pn 4- acee/.,f i
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"I/I? Supply Jry, 4- pi.", _c.. -ea-1,-c r 51'\..1,e_ aP ‘,4,11 .
Florida Product Approval#f ;L �, _ (For multiple products use Product Approval Information Sheet)
Property Owner Information Name �j} ,� Q f Phone q'OL( -32.4_.qa 7.5--
Address 1$GU Sev1(c., Blvt City Afloyvf-)` ate[,, State FL Zip 37233
Email s h$r,,s1(S(Ie Qom.I.rOwner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information!Name of Company ' IFk� r (3vi Id—s Phone Clog- qc S% 3(2 3'
Address 3-(3 /U�•,,}�'1-G• I Blu ,/V, City A,, ,„,.n i,,,, e.,,,,6 k State FL Zip 32133
Qualifying Agent State Certification/Registration# C R(_ 13 33 it 3
Email in,,,,_,_ f1 - 6u:I. or-s . ce)vv.1 Job Site Contact Number C!UC.1 - qcs_ 30_3
Worker'eCompensation Insurer OR Exempt F Expiration Date l 57 to /2[.4
Architect's Name Email Phone
Engineer's Name Email 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 city/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 YOU PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT
MUST BE RECORDED AND POSTED ON THE SITE OF THE IMPROVEMENT BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
(Signature of Owner or Agent) (Signature of o A .ctor)
Signed and sworn to(or affirmed)before me this ,j' day of Signed and sworn to(or affirmed) before me this 1- day of
1 �Q 1b�/ , ' / �.�,r.rn1 '1 3 by Gr,1� fp p c
RIPSignature of Notar _ � Signature of Notar _ __ !
[ ] Personally Knownn OR [)(Produce�tification [ ] Personally Known OR iI 'roduced Identification
Type of Identification: i L Qt Type of Identification: '✓ _ _
►o14,.; CARMALLITTA ROWELL
(: ) Notary Public-State of Honda I " MARIE �IN� Flog•
; t,Te? Commission#HH 428170 "1Ian m ssiCn' HH.42
I 2c
' " M Comm.Expires Aug 18,2027 �» - f9m +j$,
d fires.Ser
NOTICE OF COMMENCEMENT
State of F'lof 1'Uu.. Tax Folio No.
County of el VrA,
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: 08 - 2.5 - 2c1 E 2. 2Lk , PT Gtr-f"' 0 �
4
P -( D °Ac 3T-1-6 (3 Ph.,66 1. R iff r ee f( v."( Arco, _
Address of property being improved: !too 5e..1 ( !n II Luc t %A+nt * 363 613 12 r Ate»faz
General description of improvements: 14:4-ti, Gv. re. 14-1. FIN/4-1,(iv 4- e.-G e p*
w `~y W/Q out o� k�`h.� G„ e$1-ents:n sTely p( — 3 1 4tw ()tido..-I-5
Owner: fjkc .njNitt4uG. ( 5 Address: t$GU SLV 4`(1 t„ BIUCS un 3c 3 b(S 12
Owner's interest in site of the improvement: AOC) AH�.N h' f3e�cL�
Fee Simple Titleholder(if other than owner): _
Name:
Contractor: Gm el +-LL•eri ( I (t 4 tt. Lr 1-6%-4 13 CS S•��
Address: [3 /Uc_v f Zc. I ��I vc1 4J /4 HG-v1 h Z iJ es-c 322 3 3
Telephone No.: Cio u-1(6 317 3 Fax No:
Surety(if any) _
Address: Amount of Bond$ _
Doc#2023252019,OR BK 20892 Page 159,
Telephone No: Fax No:_ Number Pages: 1
Name and address of any person making a loan for the construction of Recorded 12/11/2023 1051 AM,
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL
COUNTY
Name: RECORDING $10.00
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
The foregoing instrument was acknowledged before me n �,Ai . / /617/r °'4 --
���G
Signed: //�� Date: 3
'� physical presene o� Befor me this •. o . ,. . �i t15eCounty of Duval,State
online notarization. Of Florida,has personally appeared ' Uj2. s _
����� �� 2p2 Notary Public at Large,Stanof Florida,Count of Duval.
this day oiC� y�a3year) My commission expires: L4.A .A S T I iI Z6� .
Personally Known: , 'w`''' la.: '*W Lpr
by Produced Identification: , L a Notary Public•State of Florida I
: Commission#HH 428170
My Comm.Expires Aug 18,2027