548 PELICAN KEY RES24-0039 SIDING Sri%-Lir BUILDING PERMIT APPLICATION FOR INTERNAL OFFICE USE ONLY
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Cty of Atlantic Beach Building Department '', E3
s PERMIT# Zi"�39
5 800 Seminole Road, Atlantic Beach, FL 32233
r "ALL information required to process
u,Ssvr Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address jL/3 pp 1I''64 cL )LCA RE# /7ZcZ7- � y
Legal Description 1/5 -// / 7- ZS Z'i ' Sf%'tet <<< /1s' 1-n , '/—z /c) 7"---
Valuation
of Work(Replacement Cost) / 9a v Heated/Cooled SF Non-Heated/Cooled SF
• Class of Work: ❑ New ❑Addition Alteration Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial Residential • 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:
r•e Pic)Or L,)Uv,) s• -'c1 i Li , i 0 S X 11 /i'-( :-1 "e' L e; p Aa . (ot /—
Florida Product Approval# r*.?' qz, Z (For multipleproducts use Product Approval Information Sheet)
Property Owner Information Name /A)�' ' ,� he tip I-0 Phone 90 / f 3 Q97 j'
Address L(2 fir 1.ca ,n /L ' 14-1
. J City] A f" . &e / . State I`L Zip 32 Z ? .13
Email I."i ,l 6, 1Own r gent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information// Name of Company L ` : Pi C.: A .� Phone i/11 `/2 '3'Ss'S—
Address 7 7UU p6,:J.0 A1, H f-- /.— City T7)( State Fc_.. Zip 3?7 Z s.--
Qualifying
Qualifying Agent ''tor . ..._14,1 0,4S k IA es State� Certification/Registration# •1 $S Z cr d
Email 't r P ILS g S"/d pee-s,‘,,,, Pir-S and `, t,i ll , Job Site Contact Number D 3 c
Worker's Compen ation Insuter 54,A OR Exempt ❑ Expiration Dater 7 S
Architect's Name Email P ne
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.
YOUR FAILURE TO RECORD A ' 'TICE 6 F COMMENCEMENT MAY RESULT
IN YOU PAYING TWICE FOR IMPROVEMENTS TO YOU : PR 1 P * . A NOTICE OF COMMENCEMENT
MUST BE RECORDED AND POSTED ON THE SITE y F T E vPROVEMENT BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, Co SULT WITH YOUR LENDER OR AN
47ATTORNEY BEFORE RECORDING YOUR N• I 'E • ` COMMENCEMENT.
f 0
(Signatur f Owne, .r Age (Signature of Contractor)
Signed and sworn to(or affirmed)before me this 3 l„4-day of Signa,, and sworn to(ora ed)bef.m: his 2 ( day of
J�blpc� , a0aT by W.f.4, itino `1 Z by �1A st- 44,'vL�G
Signatur f Notary f I ! �" Signature of Notary v
Personally ,,
Known Produced Identification Personall Known ORProduced Iden :tion
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ms
Type of Identification: MARY KAYE LEVRIETT Type of Identifica r,�e,.,: ;• —
Notary Public,State of Florida :: LESPERGER
My Comm.Expires 07/23/2025 0; MY COMMISSION#HH 407122
Commission No.HH142493 :;7;..F:.. EXPIRES:October 6,2027
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No. .n
State of to-tld ti u
County of 64.Jgt. I
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. t
Legal description of property being improved: L/ `/ +/ 7 Z5 l
5?/i,6_ G,/fit'S G/,4. .- E.
Lv Y- ?1
cam- I
Address of property being improved: J�� �e// ed/r--i '-_ e."/41lctiiI':tc A'' e'A "L.., Z.z�3
General description of improvements: 11-) Ste f'F 1 / pet r I vi 4--
Owner '
)°f/%6 1
/i / '(r t l�1 f1%'l C. 1 1) `1"e 1.-- 44.' ` 6 it e
Pe
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Address /A J 4'/J ' i /. / ,411/. l�Pa.e/7 l�
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Owners interest in site of the improvement
Fee Simple Titleholder(if other than owner) —
Name
Address
Contractor Skip e0-- S:c.fer-5 c4M,) Trr`Wv
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Address 2700 Pccr✓w po hi-4— 4r . ZT4-.1c , a 7Z2.2-5---
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
It 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 o Nen
different date is specified): •C..- - Q,
I N
THIS SPACE FOR RECORDER'S USE ONLY / °C• NER
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Signed: _'_ DATE //a 112-y • 0 0
Before me this ay of zdn,"4 .?paN in the w rn •a Z
County of Duval.State of Florida.t appeared Q •E5Wco(X%9[ (n►G herein by ]C
Doc#2024034980,OR BK 20956 Page 1586, himse f herself and rms that a/statements and declarations herein r E g.
9 are true and accurate Q 3E
Number Pages:1
Recorded 02/21/2024 09:19 AM, i i
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL
COUNTY
RECORDING $10.00 I Notary Pubis at Lar .S eof ......County of ___
My commission expires. 3 eZCQS
soly wn or
i PPerroducenald IdnntKnoiru�at,,,r,y♦b —