425 STEWART ST RES24-0038 -- -- BUILDING PERMIT APPLICATION FOR INTERNAL OFFICE USE ONLY
_ City of Atlantic Beach Building Department _ //,,_ O
PERMIT# <��z4t O 35
800 Seminole Road, Atlantic Beach, FL 32233
°ALL information required to process
"'r Phone: (904) 247-5826 Email: Building-Dept(Wcoab.us
Job Address WS- Si-et-Jet-v-1 5/ . JRE# /7Z,�y-0506,
Legal Description y3-s� f7 tS- zu- —j,1- 2.,�C�"� 5",,6,,./,(4/,.5-,„ ,, /Ay/474 LD JL/Z
Valuation of Work(Replacement Cost) 17 ()OC Heated/Cooled SF Non-Heated/Cooled SF
•Class of Work: ❑ New ii Addition 0Alteration ❑Repair ❑Move ['Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial OResidential •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) ❑ No
Describe in detail the type of work to be performed:
I`Cftlav6 d Id c /art n 7, /4 fr 1 ttei. w,,,, , /aim
Florida Product Approval# /3/9Z. Z (For multiple products use Product Approval Information Sheet)
Property Owner InformationrmName (/ J``//(. /,"le Ilfi .7 Phone ?l/, /, s'ygz
Address // 37 3 /'/C)i," ,R'GX 7 A /.), City '�jity State // Zip rZZ FS—
Email
^ n�,�'�`es e bO •6Wnr or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information Name of Company 6-/,i.pTO[�eS, ” 5 Phone 9a7_yZV-ff?S--
Address 77a) cJA. 140,,(,,,"-- vt - T City -jay ` State Pi Zi
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VC
qualifying Agent j?/, rvieS State Certification/Registration# 455'_ 7 y
Email t/r g.,Sp r CfY.Idl e41 54r•irf . C0.1-t Job Site Contact Number p
Worker's Com nsation Insurer 5k0 OR Exempt ❑ Expiration Date VI-$6
Architect's Name Email Pho e
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.
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 RECOR' ' ' : .ICE OF COMMENCEMENT MAY RESULT
IN YOU PAYING TWICE FOR IMPROVEMENTS TO YOUR PRO RTY. A NOTICE OF COMMENCEMENT
MUST BE RECORDED AND POSTED ON TH SITE OF THE I , PROVEMENT BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN INANCING, COj1 SULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDI G YOUR NOTI r: OF COMMENCEMENT.
p / C:IXL-7- 1 -c---- .
(Signature of Owner or Agent) (Signature of Contractor) •
Signed and sworn to(or affirmed) before me this r2- day of Si• ed sworn to(or - ed)before • ., this, Z day of
re- —t , 2c2)-'k by (ML)c- I A\1 d 110 •, It•y I 0-/ 31i%1e
Signature of Notary 5 \ Signature of Notary - --401 ,14.1.
[ j Personally Know OR [ Produced Identification
[ j P sonally Known OR [ I Produce. Identi ication
� William Henry Atkins,Ill
Type of Identification: C�\"``6,C,P0B' Notary pubic Type of Identifi io.{...,
State of Florida w ' • �'= TONI GINDLESPERGER
'-' o�.'"My Commission Expires 02/28/2026 MY COMMISSION#HH 407122
O``, Commission No, HH 234101 .;sem o_
.:: �` EXPIRES:October 6,2027
NTS f Hz7 NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No. ,/�
State of F it"it 4 t County of /d..t Jq. L_
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 bein improved: 93' CO 7-45
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Address of property being improved: j 't . --5-7/1W4-8"4-,s4•
a`t. (' a G .?2,033
General description of improvements: rte Ll.) 5 .. ./,r 7 / /04 .,L./--
Owner Cile{,elr t ' /1;ef tio�i p• i...9vi'
Address // 773 Vo' antij/14
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Owners interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor Silty-- S;tiers exa y`T-rt _ i�1,�,
ti
Address I27 0 p.,,,, m}.,t,.,- j)... , j'A4 , F- 72.4z5—
Phone No. Fax No.
Surety(if any)
Address Amount of bond$
Phone 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 or herself,designated by owner upon whom
notices or other documents may be served:
Name
Address
Phone No. Fax No.
In addition to himself or herself,owner designates the following person to receive a copy of the Lienor's Notice as
provided in Section 713.06(2)(b), Florida Statutes.(Fill in at Owner's option).
Name
Address
Phone 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 11111111h V NEERR/ �//
Signed: / �» ' ' — DATE / a/°2� fl'....•
Before me this Z day of 'LPL -_._ in the
County of Dykal,.St too Flo' a has pGrss ppeared
Doc#2024034977,OR BK 20956 Page 1583, �[ M�}tJ herein by
Number Pages:1
himself'herself and affirms that all statements and declarations herein
Recorded 02/21/2024 09:19 AM, are true and accurate
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL I I ► illiam Henry Atkins,III
COUNTY ' :�► li Notary Public
RECORDING $10.00 imiA � `7 State of Florida
Notary is at Large.-The of • (1,4- .' plres 02/28/2026
My commission expires: 0 • a u.HH 234101
Personally Known J _or
Produced kMnfiarnfinn --
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